I 118th CONGRESS 1st Session H. R. 4286 IN THE HOUSE OF REPRESENTATIVES June 22, 2023 Mr. Higgins of New York (for himself, Mr. Fitzpatrick , and Ms. Castor of Florida ) introduced the following bill; which was referred to the Committee on Energy and Commerce , and in addition to the Committee on Ways and Means , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL 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.

1. Short title This Act may be cited as the Increasing Access to Lung Cancer Screening Act . 2. Medicaid coverage of annual lung cancer screening with no cost sharing for certain individuals (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 such screening is recommended under guidelines published by the United States Preventive Services Task Force, 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, 2024. (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. 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, 2024. (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. 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, 2024. (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, 2024. 5. Lung cancer screening education and outreach (a) In general The Secretary of Health and Human Services (in this section referred to as the Secretary ), in consultation with patient and lung cancer advocacy groups, shall conduct an education and outreach campaign for purposes of informing individuals and health care providers of— (1) the importance of lung cancer screenings; and (2) the categories of individuals who should receive such screenings. (b) Manner of outreach The Secretary may carry out the campaign described in subsection (a) directly, by contract, through the issuance of grants, or otherwise. In carrying out such campaign, the Secretary shall ensure that the campaign is targeted to reach individuals at high risk of lung cancer. (c) Funding There are authorized to be appropriated $10,000,000 for each of fiscal years 2023 through 2027 for purposes of carrying out this section. 6. Report Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a study and submit to Congress a report on the demographics of individuals diagnosed with lung cancer and individuals screened for such cancer. Such report shall identify— (1) any segments of the population diagnosed with lung cancer but not captured in current screening eligibility guidelines (such as firefighters, veterans, and women under 50 years of age); and (2) actions the Federal Government could take to improve screening for such cancer among such segments.