An Act Regarding Insurance Coverage for Diagnostic and Supplemental Breast Examinations
Maine Legislature, Session 131, LD 1836
Committee: Health Coverage, Insurance and Financial Services
Sponsors: MATHIESON, GRAMLICH, MOORE, BRENNER, JAVNER, MASTRACCIO, MATLACK, MEYER, PERRY, PRINGLE, SUPICA
Amends: 24-A MRSA §2745-A, 24-A MRSA §2837-A, 24-A MRSA §4237-A

Legislative Document
No. 1836
H.P. 1168
House of Representatives, April 27, 2023
An Act Regarding Insurance Coverage for Diagnostic and 
Supplemental Breast Examinations
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative MATHIESON of Kittery.
Cosponsored by Representative GRAMLICH of Old Orchard Beach, Senator MOORE of 
Washington, Senator BRENNER of Cumberland and
Representatives: JAVNER of Chester, MASTRACCIO of Sanford, MATLACK of St. George, 
MEYER of Eliot, PERRY of Calais, PRINGLE of Windham, SUPICA of Bangor.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §2745-A, as amended by PL 2007, c. 153, §1 and affected by 
§5, is further amended by amending the section headnote to read:
§2745-A.  Screening Coverage for screening mammograms and diagnostic and 
supplemental breast examinations
Sec. 2.  24-A MRSA §2745-A, sub-§1, as amended by PL 2007, c. 153, §1 and 
affected by §5, is repealed.
Sec. 3.  24-A MRSA §2745-A, sub-§1-A is enacted to read:
1-A.  Definitions.  For the purposes of this section, unless the context otherwise 
indicates, the following terms have the following meanings. 
A. "Cost-sharing requirements" means a deductible, coinsurance, copayment or out-of-
pocket expense and any maximum limitation on the deductible, coinsurance, 
copayment or other out-of-pocket expense. 
B. "Diagnostic breast examination" means a medically necessary examination of the 
breast, including an examination using diagnostic mammography, magnetic resonance 
imaging or ultrasound, that is: 
(1) Used to evaluate an abnormality seen on or suspected from a screening 
mammogram; or 
(2) Used to evaluate an abnormality detected by another means of examination. 
C. "Screening mammogram" means a radiologic procedure that is provided to an 
asymptomatic individual for the purpose of early detection of breast cancer and that 
consists of 2 radiographic views per breast. A screening mammogram also includes an 
additional radiologic procedure recommended by a provider when the results of an 
initial radiologic procedure are not definitive.
D. "Supplemental breast examination" means a medical examination of the breast, 
including an examination using diagnostic mammography, magnetic resonance 
imaging or ultrasound, to screen for breast cancer when there is no abnormality seen 
or suspected, but, based on personal or family medical history or other additional 
factors, the individual has an increased risk of breast cancer.
Sec. 4.  24-A MRSA §2745-A, sub-§2-A is enacted to read:
2-A.  No cost-sharing requirements.  An individual insurance policy may not impose 
any cost-sharing requirements on a screening mammogram, diagnostic breast examination 
or supplemental breast examination performed by a provider in accordance with this 
section.
Sec. 5.  24-A MRSA §2837-A, as amended by PL 2007, c. 153, §2 and affected by 
§5, is further amended by amending the section headnote to read:
§2837-A.  Screening Coverage for screening mammograms and diagnostic and 
supplemental breast examinations
Sec. 6.  24-A MRSA §2837-A, sub-§1, as amended by PL 2007, c. 153, §2 and 
affected by §5, is repealed.
Sec. 7.  24-A MRSA §2837-A, sub-§1-A is enacted to read:
1-A.  Definitions.  For the purposes of this section, unless the context otherwise 
indicates, the following terms have the following meanings. 
A. "Cost-sharing requirements" means a deductible, coinsurance, copayment or out-of-
pocket expense and any maximum limitation on the deductible, coinsurance, 
copayment or other out-of-pocket expense. 
B. "Diagnostic breast examination" means a medically necessary examination of the 
breast, including an examination using diagnostic mammography, magnetic resonance 
imaging or ultrasound, that is: 
(1) Used to evaluate an abnormality seen on or suspected from a screening 
mammogram; or 
(2) Used to evaluate an abnormality detected by another means of examination. 
C. "Screening mammogram" means a radiologic procedure that is provided to an 
asymptomatic individual for the purpose of early detection of breast cancer and that 
consists of 2 radiographic views per breast. A screening mammogram also includes an 
additional radiologic procedure recommended by a provider when the results of an 
initial radiologic procedure are not definitive.
D. "Supplemental breast examination" means a medical examination of the breast, 
including an examination using diagnostic mammography, magnetic resonance 
imaging or ultrasound, to screen for breast cancer when there is no abnormality seen 
or suspected, but, based on personal or family medical history or other additional 
factors, the individual has an increased risk of breast cancer.
Sec. 8.  24-A MRSA §2837-A, sub-§2-A is enacted to read:
2-A.  No cost-sharing requirements.  A group insurance policy may not impose any 
cost-sharing requirements on a screening mammogram, diagnostic breast examination or 
supplemental breast examination performed by a provider in accordance with this section.
Sec. 9.  24-A MRSA §4237-A, as amended by PL 2007, c. 153, §3 and affected by 
§5, is further amended by amending the section headnote to read:
§4237-A.  Screening Coverage for screening mammograms and diagnostic and 
supplemental breast examinations
Sec. 10.  24-A MRSA §4237-A, sub-§1, as amended by PL 2007, c. 153, §3 and 
affected by §5, is repealed.
Sec. 11.  24-A MRSA §4237-A, sub-§1-A is enacted to read:
1-A.  Definitions.  For the purposes of this section, unless the context otherwise 
indicates, the following terms have the following meanings. 
A. "Cost-sharing requirements" means a deductible, coinsurance, copayment or out-of-
pocket expense and any maximum limitation on the deductible, coinsurance, 
copayment or other out-of-pocket expense. 
B. "Diagnostic breast examination" means a medically necessary examination of the 
breast, including an examination using diagnostic mammography, magnetic resonance 
imaging or ultrasound, that is: 
(1) Used to evaluate an abnormality seen on or suspected from a screening 
mammogram; or 
(2) Used to evaluate an abnormality detected by another means of examination. 
C. "Screening mammogram" means a radiologic procedure that is provided to an 
asymptomatic individual for the purpose of early detection of breast cancer and that 
consists of 2 radiographic views per breast. A screening mammogram also includes an 
additional radiologic procedure recommended by a provider when the results of an 
initial radiologic procedure are not definitive.
D. "Supplemental breast examination" means a medical examination of the breast, 
including an examination using diagnostic mammography, magnetic resonance 
imaging or ultrasound, to screen for breast cancer when there is no abnormality seen 
or suspected, but, based on personal or family medical history or other additional 
factors, the individual has an increased risk of breast cancer.
Sec. 12.  24-A MRSA §4237-A, sub-§2-A is enacted to read:
2-A.  No cost-sharing requirements.  All individual and group coverage subject to 
this chapter may not impose any cost-sharing requirements on a screening mammogram, 
diagnostic breast examination or supplemental breast examination performed by a provider 
in accordance with this section.
Sec. 13.  Application. The requirements of this Act apply to all policies, contracts 
and certificates executed, delivered, issued for delivery, continued or renewed in this State 
on or after January 1, 2024.  For purposes of this Act, all policies, contracts and certificates 
are deemed to be renewed no later than the next yearly anniversary of the contract date.
SUMMARY
This bill provides that individual and group health insurance policies may not impose 
any cost-sharing requirements on a medically necessary diagnostic breast examination or 
supplemental breast examination performed by a health care provider. The requirements 
apply to insurance policies beginning on January 1, 2024.