Access to Breast Cancer Diagnosis Act of 2021
Bill: H.R.5769 | Sponsor: Rep. Dingell, Debbie (D-MI)
Policy area: Health

Summary:
Access to Breast Cancer Diagnosis Act of 2021
This bill prohibits private health insurance plans from imposing higher cost-sharing requirements on breast cancer diagnostic examinations than initial breast cancer screening examinations. Diagnostic examinations are generally required after an initial screening detects an abnormality and typically require additional mammogram images (e.g., x-rays).

To amend title XXVII of the Public Health Service Act to prohibit group 
health plans and health insurance issuers offering group or individual 
 health insurance coverage from imposing cost-sharing requirements or 
   treatment limitations with respect to diagnostic examinations for 
   breast cancer that are less favorable than such requirements with 
          respect to screening examinations for breast cancer.

    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 ``Access to Breast Cancer Diagnosis 
Act of 2021''.

SEC. 2. REQUIRING PARITY IN COST-SHARING AND TREATMENT LIMITATIONS WITH 
              RESPECT TO DIAGNOSTIC AND SCREENING EXAMINATIONS FOR 
              BREAST CANCER.

    (a) In General.--Subpart II of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-11 et seq.) is amended by adding at 
the end the following new section:

``SEC. 2730. DIAGNOSTIC AND SCREENING EXAMINATIONS FOR BREAST CANCER 
              PARITY.

    ``(a) In General.--In the case of a group health plan, or a health 
insurance issuer offering group or individual health insurance 
coverage, that provides benefits with respect to a diagnostic 
examination for breast cancer furnished to an individual enrolled under 
such plan or such coverage, such plan or such coverage shall ensure 
that--
            ``(1) the cost-sharing requirements applicable to such 
        examination for such individual are no less favorable than such 
        requirements applicable to a screening examination for breast 
        cancer for such individual; and
            ``(2) the treatment limitations applicable to such 
        diagnostic examination for breast cancer for such individual 
        are no less favorable than such limitations applicable to a 
        screening examinations for breast cancer for such individual.
    ``(b) Restriction on Certain Changes.--A group health plan or 
health insurance issuer may not, for the sole purpose of complying with 
subsection (a), increase cost-sharing requirements with respect to 
screening examinations for breast cancer.
    ``(c) Construction.--Nothing in this section shall be construed--
            ``(1) to require the use of diagnostic examinations for 
        breast cancer as a replacement for screening examinations for 
        breast cancer;
            ``(2) to prohibit a group health plan or health insurance 
        issuers from requiring prior authorization or imposing other 
        appropriate utilization controls in approving coverage for any 
        screening or diagnostic imaging; or
            ``(3) to supersede a State law that provides greater 
        protections with respect to the coverage of diagnostic 
        examinations for breast cancer than is provided under this 
        subsection.
    ``(d) Definitions.--In this section:
            ``(1) Cost-sharing requirement.--The term `cost-sharing 
        requirement' includes a deductible, coinsurance, copayment, and 
        any maximum limitation on the application of such a deductible, 
        coinsurance, copayment, or similar out-of-pocket expense.
            ``(2) Diagnostic examination for breast cancer.--The term 
        `diagnostic examination for breast cancer' means a medically 
        necessary and appropriate (as determined by the health care 
        professional treating the individual) examination for breast 
        cancer to evaluate an abnormality in the breast that is--
                    ``(A) seen or suspected from a screening 
                examination for breast cancer;
                    ``(B) detected by another means of examination; or
                    ``(C) suspected based on the medical history or 
                family medical history of the individual.
            ``(3) Examination for breast cancer.--The term `examination 
        for breast cancer' includes such an examination using breast 
        ultrasound, breast magnetic resonance imaging, or mammography.
            ``(4) Treatment limitation.--The term `treatment 
        limitation' includes limits on the frequency of treatment, 
        number of visits, days of coverage, or other similar limits on 
        the scope or duration of treatment.''.
    (b) Application to Grandfathered Health Plans.--Section 
1251(a)(4)(A) of the Patient Protection and Affordable Care Act (42 
U.S.C. 18011(a)(4)(A)) is amended--
            (1) by striking ``title'' and inserting ``title, or as 
        added after the date of the enactment of this Act)''; and
            (2) by adding at the end the following new clause:
                            ``(v) Section 2730 (relating to parity for 
                        diagnostic and screening examinations for 
                        breast cancer).''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2022.
                                 <all>