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SECTION 1. SHORT TITLE.

This Act may be cited as the ''Annual Mammogram and Prostate Cancer
Screening Coverage Act of 1998''.

SEC. 2. COVERAGE OF ANNUAL MAMMOGRAMS AND ANNUAL PROSTATE CANCER
SCREENING TESTS

(a) Group Health Plans.--
(1) Public health service act amendments.--(A) Subpart 2 of
part A of title XXVII of the Public Health Service Act is
amended by adding at the end the following new section:

''SEC. 2706. STANDARDS RELATING TO BENEFITS FOR ANNUAL MAMMOGRAMS AND
ANNUAL PROSTATE CANCER SCREENING TESTS.

''(a) Requirement.--
''(1) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage,
shall provide coverage for--
''(A) annual screening mammograms for female
participants and beneficiaries who are 40 years of age
or older; and
''(B) annual prostate cancer screening testing for
male participants and beneficiaries who are 50 years of
age or older.
''(2) Regulations.--The Secretary shall promulgate
regulations to carry out this section. In promulgating such
regulations, the Secretary shall provide that the coverage
required under paragraph (1) shall be comparable to the
coverage of similar benefits under the medicare program under
part B of title XVIII of the Social Security Act.
''(b) Prohibitions.--A group health plan, and a health insurance
issuer offering group health insurance coverage in connection with a
group health plan, may not--
''(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan, solely for the purpose of avoiding the requirements
of this section;
''(2) provide monetary payments or rebates to individuals
to encourage such individuals to accept less than the minimum
protections available under this section;
''(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided care
to an individual participant or beneficiary in accordance with
this section; or
''(4) provide incentives (monetary or otherwise) to a
provider to induce such provider to provide care to an
individual participant or beneficiary in a manner inconsistent
with this section.
''(c) Rules of Construction.--
''(1) Nothing in this section shall be construed to require
an individual who is a participant or beneficiary to undergo a
screening mammogram or prostate cancer screening test.
''(2) Nothing in this section shall be construed as
preventing a group health plan or issuer from imposing
deductibles, coinsurance, or other cost-sharing in relation to
benefits described in subsection (a) consistent with such
subsection, except that such coinsurance or other cost-sharing
shall not discriminate on any basis related to the coverage
required under this section.
''(d) Notice.--A group health plan under this part shall comply
with the notice requirement under section 713(d) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements
of this section as if such section applied to such plan.
''(e) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan or a health insurance
issuer offering group health insurance coverage from negotiating the
level and type of reimbursement with a provider for care provided in
accordance with this section.''.
(B) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)) is
amended by striking ''section 2704'' and inserting ''sections
2704 and 2706''.
(2) ERISA amendments.--(A) Subpart B of part 7 of subtitle
B of title I of the Employee Retirement Income Security Act of
1974 is amended by adding at the end the following new section:

''SEC. 713. STANDARDS RELATING TO BENEFITS FOR ANNUAL MAMMOGRAMS AND
ANNUAL PROSTATE CANCER SCREENING TESTS.

''(a) Requirement.--
''(1) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage,
shall provide coverage for--
''(A) annual screening mammograms for participants
and beneficiaries who are 40 years of age or older; and
''(B) annual prostate cancer screening testing for
male participants and beneficiaries who are 50 years of
age or older.
''(2) Regulations.--The Secretary shall promulgate
regulations to carry out this section. In promulgating such
regulations, the Secretary shall provide that the coverage
required under paragraph (1) shall be comparable to the
coverage of similar benefits under the medicare program under
part B of title XVIII of the Social Security Act.
''(b) Prohibitions.--A group health plan, and a health insurance
issuer offering group health insurance coverage in connection with a
group health plan, may not--
''(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan, solely for the purpose of avoiding the requirements
of this section;
''(2) provide monetary payments or rebates to individuals
to encourage such individuals to accept less than the minimum
protections available under this section;
''(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided care
to an individual participant or beneficiary in accordance with
this section; or
''(4) provide incentives (monetary or otherwise) to a
provider to induce such provider to provide care to an
individual participant or beneficiary in a manner inconsistent
with this section.
''(c) Rules of Construction.--
''(1) Nothing in this section shall be construed to require
an individual who is a participant or beneficiary to undergo a
screening mammogram or prostate cancer screening test.
''(2) Nothing in this section shall be construed as
preventing a group health plan or issuer from imposing
deductibles, coinsurance, or other cost-sharing in relation to
benefits described in subsection (a) consistent with such
subsection, except that such coinsurance or other cost-sharing
shall not discriminate on any basis related to the coverage
required under this section.
''(d) Notice Under Group Health Plan.--The imposition of the
requirement of this section shall be treated as a material modification
in the terms of the plan described in section 102(a)(1), for purposes
of assuring notice of such requirements under the plan; except that the
summary description required to be provided under the last sentence of
section 104(b)(1) with respect to such modification shall be provided
by not later than 60 days after the first day of the first plan year in
which such requirement apply.
''(e) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan or a health insurance
issuer offering group health insurance coverage from negotiating the
level and type of reimbursement with a provider for care provided in
accordance with this section.''.
(B) Section 731(c) of such Act (29 U.S.C. 1191(c)) is
amended by striking ''section 711'' and inserting ''sections
711 and 713''.
(C) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is
amended by striking ''section 711'' and inserting ''sections
711 and 713''.
(D) The table of contents in section 1 of such Act is
amended by inserting after the item relating to section 712 the
following new item:

''Sec. 713. Standards relating to benefits for annual mammograms and
annual prostate cancer screening tests.''.
(3) Internal revenue code amendments.--Subchapter B of
chapter 100 of the Internal Revenue Code of 1986 (as amended by
section 1531(a) of the Taxpayer Relief Act of 1997) is
amended--
(A) in the table of sections, by inserting after the item
relating to section 9812 the following new item:

''Sec. 9813. Standards relating to
benefits for annual mammograms
and annual prostate cancer
screening tests.''; and
(B) by inserting after section 9812 the following:

''SEC. 9813. STANDARDS RELATING TO BENEFITS FOR ANNUAL MAMMOGRAMS AND
ANNUAL PROSTATE CANCER SCREENING TESTS.

''A group health plan shall comply with the requirements of section
713(a) of the Employee Retirement Income Security Act of 1974.''
(b) Individual Health Insurance.--(1) Part B of title XXVII of the
Public Health Service Act is amended by inserting after section 2751
the following new section:

''SEC. 2752. STANDARDS RELATING TO BENEFITS FOR ANNUAL MAMMOGRAMS AND
ANNUAL PROSTATE CANCER SCREENING TESTS.

''(a) In General.--The provisions of section 2706 (other than
subsection (d)) shall apply to health insurance coverage offered by a
health insurance issuer in the individual market in the same manner as
it applies to health insurance coverage offered by a health insurance
issuer in connection with a group health plan in the small or large
group market.
''(b) Notice.--A health insurance issuer under this part shall
comply with the notice requirement under section 713(d) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements
referred to in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.''.
(c) Effective Dates.--(1) Subject to paragraph (3), the amendments
made by subsection (a) shall apply with respect to group health plans
for plan years beginning on or after January 1, 1999.
(2) The amendment made by subsection (b) shall apply with respect
to health insurance coverage offered, sold, issued, renewed, in effect,
or operated in the individual market on or after such date.
(3) In the case of a group health plan maintained pursuant to 1 or
more collective bargaining agreements between employee representatives
and 1 or more employers ratified before the date of enactment of this
Act, the amendments made subsection (a) shall not apply to plan years
beginning before the later of--
(A) the date on which the last collective bargaining
agreements relating to the plan terminates (determined without
regard to any extension thereof agreed to after the date of
enactment of this Act), or
(B) January 1, 1999.
For purposes of subparagraph (A), any plan amendment made pursuant to a
collective bargaining agreement relating to the plan which amends the
plan solely to conform to any requirement added by subsection (a) shall
not be treated as a termination of such collective bargaining
agreement.
(d) Coordinated Regulations.--Section 104(1) of Health Insurance
Portability and Accountability Act of 1996 is amended by striking
''this subtitle (and the amendments made by this subtitle and section
401)'' and inserting ''the provisions of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974, the
provisions of parts A and C of title XXVII of the Public Health Service
Act, and chapter 100 of the Internal Revenue Code of 1986''.
Annual Mammogram and Prostate Cancer Screening Coverage Act of 1998 - Amends the Public Health Service Act and the Employee Retirement Income Security Act of 1974 to require a group health plan, and a health insurance issuer offering group coverage, to provide coverage for annual screening mammograms for participants and beneficiaries 40 years old and older and annual prostate cancer screening testing for male participants and beneficiaries 50 years old and older. Prohibits related eligibility discrimination, monetary incentives to individuals, and penalties or incentives to providers.
Amends the Internal Revenue Code to require a group health plan to provide coverage for annual screening mammograms for participants and beneficiaries 40 years old and older and annual prostate cancer screening testing for male participants and beneficiaries 50 years old and older.
Amends the Public Health Service Act to apply the requirements of this Act to coverage offered in the individual market.
Amends the Health Insurance Portability and Accountability Act of 1996 to mandate coordination of regulations, rulings, and interpretations between the Secretaries of the Treasury, Health and Human Services, and Labor relating to matters over which two or more of the Secretaries have responsibility.