2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 38B - Women’s Rights Regarding Certain Health Insurance › § 31–3834.02. Coverage of preventive health services

§ 31–3834.02. Coverage of preventive health services.
(a) An individual health plan or group health plan and health insurance coverage through Medicaid or the D.C. Healthcare Alliance program shall provide coverage for, and shall not impose any cost-sharing requirements on, women for the following preventive health services and products:
(1)(A) Breast cancer screening;
(A-i) Adjuvant breast cancer screening, including magnetic resonance imaging, ultrasound screening, or molecular breast imaging of the breast, if:
(i) A mammogram demonstrates a Class C or Class D breast density classification; or
(ii) A woman is believed to be at an increased risk for cancer due to family history or prior personal history of breast cancer, positive genetic testing, or other indications of an increased risk for cancer as determined by a woman's physician or advanced practice registered nurse;
(B) Breast feeding support, services, and supplies;
(C) Screening for cervical cancer, including HPV testing;
(D) Screening for gestational diabetes;
(E) Screening and counseling for HIV;
(F) Screening and counseling for interpersonal and domestic violence;
(G) Screening and counseling for sexually-transmitted diseases;
(H) Screening and counseling for Hepatitis B and C;
(I) Well-woman preventive visits, including visits to obtain necessary preventive care, preconception care, and prenatal care;
(J) Folic acid supplementation;
(K) Breast cancer chemoprevention counseling and preventive medications;
(L) Risk assessment and genetic counseling and testing using the Breast Cancer Risk Assessment tool approved by the National Cancer Institute; and
(M) Rh incompatibility screening;
(2) Those evidence-based items or services that have in effect a rating of "A" or "B" in the recommendations of the United States Preventive Services Task Force as of September 19, 2017; and
(3) Any additional health services or products identified by rules issued pursuant to subsection (c) of this section.
(b) A health insurer and health insurance coverage through Medicaid or the D.C. Healthcare Alliance program offering health insurance coverage exclusively for prescription drugs shall provide coverage for, and shall not impose any cost-sharing requirements for women for contraceptive drugs, devices, products, and services, including those obtained over-the-counter and those prescribed and dispensed by a pharmacist pursuant to § 3-1202.08(g-1), and the following:
(1) Those evidence-based prescription-drug items or related services that have in effect a rating of "A" or "B" in the recommendations of the United States Preventive Services Task Force as of September 19, 2017; and
(2) Any additional contraceptive drugs, devices, products and services identified by rules issued pursuant to subsection (c) of this section.
(c)(1) Within 30 days after March 28, 2018, the Mayor, pursuant to subchapter I of Chapter 5 of Title 2, shall issue rules listing the items and services defined in subsections (a) and (b) of this section to be covered without imposing any cost-sharing requirements.
(2) The Mayor shall amend the rules required by this subsection as necessary to:
(A) Include additional preventive services or products for women or expansions of covered preventive services or products for women identified by the United States Preventive Services Task Force or the Health Resources and Services Administration of the United States Department of Health and Human Services after September 19, 2017; and
(B) Remove items or services defined in subsections (a) and (b) of this section that a federal agency determines to pose a significant safety concern, consistent with the requirements of 45 C.F.R. § 147.130(b).
(d) For the purposes of this section, the term "breast density classification" means the 4 levels of breast density identified in the Breast Imaging Reporting and Data System established by the American College of Radiology, which are:
(A) Class A, indicating fatty breast tissue;
(B) Class B, indicating scattered fibroglandular breast tissue;
(C) Class C, indicating heterogeneously dense breast tissue with fibrous and glandular tissue that are evenly distributed throughout the breast; and
(D) Class D, indicating extremely dense breast tissue.
(Apr. 3, 2001, D.C. Law 13-254, § 5b ; as added Mar. 28, 2018, D.C. Law 22-75, § 3(b), 65 DCR 1374; Oct. 30, 2018, D.C. Law 22-164, § 303(a), 65 DCR 9324; Mar. 22, 2019, D.C. Law 22-261, § 202, 66 DCR 1373.)
Emergency Legislation
For temporary (90 days) creation of this section, see § 3(b) of Defending Access to Women's Health Care Services Congressional Review Emergency Amendment Act of 2018 (D.C. Act 22-266, Feb. 21, 2018, 65 DCR 2119).