Increasing Access to Lung Cancer Screening Act
Bill: H.R.9336 | Sponsor: Rep. Higgins, Brian (D-NY)
Policy area: Health

Summary:
Increasing Access to Lung Cancer Screening Act
This bill provides for coverage without prior authorization requirements of annual lung cancer screenings under Medicaid, Medicare, and private health insurance for individuals for whom screenings are recommended under U.S. Preventive Services Task Force guidelines. It also expands Medicaid coverage of counseling and pharmacotherapy for cessation of tobacco use to all individuals, rather than only pregnant women.

To amend title XIX of the Social Security Act to require coverage under 
State plans under the Medicaid program for annual lung cancer screening 
with no cost sharing for individuals for whom screening is recommended 
 by U.S. Preventive Services Task Force guidelines, to expand coverage 
   under Medicaid of counseling and pharmacotherapy for cessation of 
                  tobacco use, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Increasing Access to Lung Cancer 
Screening Act''.

SEC. 2. MEDICAID COVERAGE OF ANNUAL LUNG CANCER SCREENING WITH NO COST 
              SHARING FOR INDIVIDUALS FOR WHOM SCREENING IS RECOMMENDED 
              BY U.S. PREVENTIVE SERVICES TASK FORCE GUIDELINES.

    (a) In General.--Section 1905(a)(4) of the Social Security Act (42 
U.S.C. 1396d(a)(4)) is amended--
            (1) by striking ``and'' before ``(F)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``; and (G) an annual lung cancer screening for 
        individuals who are eligible under the plan and for whom 
        screening is recommended by the U.S. Preventive Services Task 
        Force guidelines, without regard to prior authorization''.
    (b) No Cost Sharing.--
            (1) In general.--Subsections (a)(2) and (b)(2) of section 
        1916 of the Social Security Act (42 U.S.C. 1396o) are each 
        amended--
                    (A) in subparagraph (G), by adding at the end ``, 
                or''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(H) lung cancer screening for which payment may 
                be made under the State plan pursuant section to 
                1905(a)(4)(G);''.
            (2) Application to alternative cost sharing.--Section 
        1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o-
        1(b)(3)(B)) is amended by adding at the end the following new 
        clause:
                            ``(xiv) Lung cancer screening for which 
                        payment may be made under the State plan 
                        pursuant to section 1905(a)(4)(G).''.
    (c) Application to Medicaid Managed Care Organizations.--Section 
1932(b) of the Social Security Act (42 U.S.C. 1396u-2(b)) is amended by 
adding at the end the following new paragraph:
            ``(9) Lung cancer screening.--Each contract with a medicaid 
        managed care organization under section 1903(m) shall require 
        the organization to provide coverage for lung cancer screening 
        for which payment may be made under the State plan pursuant to 
        section 1905(a)(4)(G) without regard to prior authorization.''.
    (d) Effective Date.--
            (1) In general.--Subject to paragraph (2), the amendments 
        made by this section shall apply with respect to items and 
        services furnished on or after January 1, 2023.
            (2) Exception if state legislation required.--In the case 
        of a State plan for medical assistance under title XIX of the 
        Social Security Act which the Secretary of Health and Human 
        Services determines requires State legislation (other than 
        legislation appropriating funds) in order for the plan to meet 
        the additional requirements imposed by the amendments made by 
        this section, the State plan shall not be regarded as failing 
        to comply with the requirements of such title solely on the 
        basis of its failure to meet such additional requirements 
        before the first day of the first calendar quarter beginning 
        after the close of the first regular session of the State 
        legislature that begins after the date of the enactment of this 
        Act. For purposes of the previous sentence, in the case of a 
        State that has a 2-year legislative session, each year of such 
        session shall be deemed to be a separate regular session of the 
        State legislature.

SEC. 3. EXPANDING COVERAGE UNDER MEDICAID OF COUNSELING AND 
              PHARMACOTHERAPY FOR CESSATION OF TOBACCO USE TO ALL 
              MEDICAID INDIVIDUALS.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--
            (1) in subsection (a)(4)(D)--
                    (A) by striking ``by pregnant women''; and
                    (B) by inserting ``without regard to prior 
                authorization'' after ``(as defined in subsection 
                (bb))''; and
            (2) in subsection (bb)--
                    (A) in paragraph (1)--
                            (i) by striking the first place it appears 
                        ``by pregnant women''; and
                            (ii) by striking ``by pregnant women who'' 
                        and inserting ``by individuals who'';
                    (B) in paragraph (2)(A), by striking ``with respect 
                to pregnant women''; and
                    (C) in paragraph (2)(B), by striking ``by pregnant 
                women''.
    (b) Conforming Amendments.--
            (1) Section 1927(d)(2)(F) of the Social Security Act (42 
        U.S.C. 1396r-8(d)(2)(F)) is amended by striking ``, in the case 
        of pregnant women''.
            (2) Section 1916 of the Social Security Act (42 U.S.C. 
        1396o), as amended by section 1, is further amended--
                    (A) in each of subsections (a)(2) and (b)(2)--
                            (i) in subparagraph (B), by striking ``, 
                        and counseling and pharmacotherapy for 
                        cessation of tobacco use by pregnant women (as 
                        defined in section 1905(bb)) and covered 
                        outpatient drugs (as defined in subsection 
                        (k)(2) of section 1927 and including 
                        nonprescription drugs described in subsection 
                        (d)(2) of such section) that are prescribed for 
                        purposes of promoting, and when used to 
                        promote, tobacco cessation by pregnant women in 
                        accordance with the Guideline referred to in 
                        section 1905(bb)(2)(A)'';
                            (ii) in subparagraph (H), at the end by 
                        adding ``or''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(I) counseling and pharmacotherapy for cessation 
                of tobacco use (as defined in section 1905(bb)) and 
                covered outpatient drugs (as defined in subsection 
                (k)(2) of section 1927 and including nonprescription 
                drugs described in subsection (d)(2) of such section) 
                that are prescribed for purposes of promoting, and when 
                used to promote, tobacco cessation in accordance with 
                the Guideline referred to in section 1905(bb)(2)(A); 
                and''.
            (3) Section 1916A(b)(3)(B) of such Act (42 U.S.C. 1396o-
        1(b)(3)(B)), as amended by section 1, is further amended--
                    (A) in clause (iii), by striking ``, and counseling 
                and pharmacotherapy for cessation of tobacco use by 
                pregnant women (as defined in section 1905(bb))''; and
                    (B) by adding at the end the following new clause:
                            ``(xv) Counseling and pharmacotherapy for 
                        cessation of tobacco use (as defined in section 
                        1905(bb)).''.
    (c) Application to Medicaid Managed Care Organizations.--Section 
1932(b) of the Social Security Act (42 U.S.C. 1396u-2(b)), as amended 
by section 1, is further amended by adding at the end the following new 
paragraph:
            ``(10) Cessation of tobacco use.--Each contract with a 
        medicaid managed care organization under section 1903(m) shall 
        require the organization to provide coverage for counseling and 
        pharmacotherapy for cessation of tobacco use without regard to 
        prior authorization.''.
    (d) Effective Date.--
            (1) In general.--Subject to paragraph (2), the amendments 
        made by this section shall apply with respect to items and 
        services furnished on or after January 1, 2023.
            (2) Exception if state legislation required.--In the case 
        of a State plan for medical assistance under title XIX of the 
        Social Security Act which the Secretary of Health and Human 
        Services determines requires State legislation (other than 
        legislation appropriating funds) in order for the plan to meet 
        the additional requirements imposed by the amendments made by 
        this section, the State plan shall not be regarded as failing 
        to comply with the requirements of such title solely on the 
        basis of its failure to meet such additional requirements 
        before the first day of the first calendar quarter beginning 
        after the close of the first regular session of the State 
        legislature that begins after the date of the enactment of this 
        Act. For purposes of the previous sentence, in the case of a 
        State that has a 2-year legislative session, each year of such 
        session shall be deemed to be a separate regular session of the 
        State legislature.

SEC. 4. COVERAGE UNDER MEDICARE AND PRIVATE HEALTH INSURANCE OF ANNUAL 
              LUNG CANCER SCREENING WITHOUT UTILIZATION MANAGEMENT 
              REQUIREMENTS.

    (a) Medicare.--
            (1) In general.--Section 1834 of the Social Security Act 
        (42 U.S.C. 1395m) is amended by adding at the end the following 
        new subsection:
    ``(z) Special Rule for Annual Lung Cancer Screening.--
Notwithstanding any other provision of this title, in the case of an 
annual lung cancer screening for which benefits are provided under this 
part for any individual for whom such screening is recommended in 
accordance with guidelines issued by the Secretary, such benefits shall 
be provided without application of any prior authorization.''.
            (2) Application under medicare advantage.--Section 
        1852(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w-
        22(a)(1)(B)) is amended by adding at the end the following new 
        clause:
                            ``(vii) Prohibition of application of 
                        certain requirements for annual lung cancer 
                        screening.--In the case of an annual lung 
                        cancer screening for which benefits are 
                        provided under part B for any individual for 
                        whom such screening is recommended in 
                        accordance with guidelines issued by the 
                        Secretary for purposes of section 1834(z), an 
                        MA plan may not impose any prior authorization 
                        with respect to the coverage of such screening 
                        under such plan.''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply with respect to services furnished on or after 
        January 1, 2023.
    (b) Individual and Group Health Insurance Markets.--
            (1) In general.--Section 2713 of the Public Health Service 
        Act (42 U.S.C. 300gg-(3)) is amended by adding at the end the 
        following new subsection:
    ``(d) Prohibition of Application of Certain Requirements for Annual 
Lung Cancer Screening.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage may not 
impose any prior authorization with respect to the benefits under such 
plan or coverage for an annual lung cancer screening for any individual 
for whom such screening is recommended by the United States Preventive 
Services Task Force.''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply with respect to plan years beginning on or after 
        January 1, 2023.
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