Access to Breast Cancer Diagnosis Act of 2021
Bill: S.1067 | Sponsor: Sen. Blunt, Roy (R-MO)
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.--Section 2719A of the Public Health Service Act (42 
U.S.C. 300gg-19a) is amended by adding at the end the following new 
subsection:
    ``(e) Diagnostic and Screening Examinations for Breast Cancer 
Parity.--
            ``(1) 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--
                    ``(A) 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
                    ``(B) 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.
            ``(2) Restriction on certain changes.--A group health plan 
        or health insurance issuer may not, for the sole purpose of 
        complying with paragraph (1), increase cost-sharing 
        requirements with respect to screening examinations for breast 
        cancer.
            ``(3) Construction.--Nothing in this subsection shall be 
        construed--
                    ``(A) to require the use of diagnostic examinations 
                for breast cancer as a replacement for screening 
                examinations for breast cancer;
                    ``(B) 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
                    ``(C) 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.
            ``(4) Definitions.--In this subsection:
                    ``(A) 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.
                    ``(B) 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--
                            ``(i) seen or suspected from a screening 
                        examination for breast cancer;
                            ``(ii) detected by another means of 
                        examination; or
                            ``(iii) suspected based on the medical 
                        history or family medical history of the 
                        individual.
                    ``(C) Examination for breast cancer.--The term 
                `examination for breast cancer' includes such an 
                examination using breast ultrasound, breast magnetic 
                resonance imaging, or mammography.
                    ``(D) 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 2719A(e) (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.
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