Bill Text: FL S0670 | 2024 | Regular Session | Introduced


Bill Title: Coverage for Mammograms and Supplemental Breast Cancer Screenings

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2024-03-08 - Died in Banking and Insurance [S0670 Detail]

Download: Florida-2024-S0670-Introduced.html
       Florida Senate - 2024                                     SB 670
       
       
        
       By Senator Davis
       
       
       
       
       
       5-00610A-24                                            2024670__
    1                        A bill to be entitled                      
    2         An act relating to coverage for mammograms and
    3         supplemental breast cancer screenings; creating s.
    4         409.9064, F.S.; defining the terms “mammogram” and
    5         “supplemental breast cancer screening”; requiring the
    6         Agency for Health Care Administration to provide
    7         Medicaid coverage for annual mammograms and
    8         supplemental breast cancer screenings for certain
    9         women under certain circumstances; requiring the
   10         agency to seek federal approval, if needed, to
   11         implement specified provisions; amending ss. 627.6418,
   12         627.6613, and 641.31095, F.S.; defining the term
   13         “supplemental breast cancer screening”; revising
   14         coverage for mammograms under certain individual
   15         accident and health insurance policies, group,
   16         blanket, and franchise accident and health insurance
   17         policies, and health maintenance contracts,
   18         respectively; requiring coverage for supplemental
   19         breast cancer screenings under such policies and
   20         contracts under certain circumstances; revising
   21         applicability; providing an effective date.
   22          
   23  Be It Enacted by the Legislature of the State of Florida:
   24  
   25         Section 1. Section 409.9064, Florida Statutes, is created
   26  to read:
   27         409.9064Coverage for mammograms and supplemental breast
   28  cancer screenings.—
   29         (1)As used in this section, the term:
   30         (a)“Mammogram” means an image of a radiologic examination
   31  used to detect unsuspected breast cancer at an early stage in an
   32  asymptomatic woman and includes the X-ray picture of the breast
   33  captured using equipment that is dedicated specifically for
   34  mammography, including, but not limited to, the X-ray tube,
   35  filter, compression device, screens, film, and cassettes. The
   36  radiologic examination must include two views of each breast.
   37  The term also includes images from digital breast tomosynthesis
   38  and the professional interpretation of images from any
   39  mammography equipment, but does not include any diagnostic
   40  mammography image.
   41         (b)“Supplemental breast cancer screening” means a
   42  clinically appropriate examination, in addition to a mammogram,
   43  deemed medically necessary by a treating health care provider
   44  for breast cancer screening in accordance with applicable
   45  American College of Radiology guidelines, which examination
   46  includes, but is not limited to, magnetic resonance imaging,
   47  ultrasound, and molecular breast imaging.
   48         (2)Subject to the availability of funds and subject to any
   49  limitations or directions provided in the General Appropriations
   50  Act, the agency must provide coverage for the following every
   51  year for a Medicaid recipient who is a woman 25 years of age or
   52  older:
   53         (a)One mammogram to detect the presence of breast cancer.
   54         (b)One supplemental breast cancer screening to detect the
   55  presence of breast cancer if:
   56         1.Based on the breast imaging reporting and data system
   57  established by the American College of Radiology, the woman’s
   58  mammogram demonstrates that the woman has dense breast tissue;
   59  or
   60         2.The woman is at an increased risk of breast cancer due
   61  to:
   62         a.A personal or family history of breast cancer;
   63         b.A personal history of biopsy-proven benign breast
   64  disease;
   65         c.Ancestry;
   66         d.Genetic predisposition;
   67         e.Not having given birth before the age of 30; or
   68         f.Other reasons as determined by the woman’s health care
   69  provider.
   70         (3)The agency shall seek federal approval, if needed, for
   71  the implementation of this section.
   72         Section 2. Section 627.6418, Florida Statutes, is amended
   73  to read:
   74         627.6418 Coverage for mammograms and supplemental breast
   75  cancer screenings.—
   76         (1) As used in this section, the term “supplemental breast
   77  cancer screening” means a clinically appropriate examination, in
   78  addition to a mammogram, deemed medically necessary by a
   79  treating health care provider for breast cancer screening in
   80  accordance with applicable American College of Radiology
   81  guidelines, which examination includes, but is not limited to,
   82  magnetic resonance imaging, ultrasound, and molecular breast
   83  imaging.
   84         (2) An accident or health insurance policy issued, amended,
   85  delivered, or renewed in this state on or after July 1, 2024,
   86  must provide coverage for at least the following for any woman
   87  who is 25 years of age or older:
   88         (a) One A baseline mammogram a year, including a digital
   89  breast tomosynthesis mammogram for any woman who is 35 years of
   90  age or older, but younger than 40 years of age.
   91         (b) A mammogram every 2 years for any woman who is 40 years
   92  of age or older, but younger than 50 years of age, or more
   93  frequently based on the patient’s physician’s recommendation.
   94         (c)A mammogram every year for any woman who is 50 years of
   95  age or older.
   96         (d) One supplemental breast cancer screening or more
   97  mammograms a year, based upon a physician’s recommendation, if
   98  the for any woman who is at risk for breast cancer because of
   99  dense breast tissue, as demonstrated by the woman’s mammogram
  100  and based on the breast imaging reporting and data system
  101  established by the American College of Radiology; because of a
  102  personal or family history of breast cancer;, because of having
  103  a personal history of biopsy-proven benign breast disease;
  104  because of ancestry; because of genetic predisposition;, because
  105  of having a mother, sister, or daughter who has or has had
  106  breast cancer, or because the a woman has not given birth before
  107  the age of 30; or because of other reasons as determined by the
  108  woman’s physician.
  109         (3)(2)Except as provided in paragraph (1)(b), for
  110  mammograms done more frequently than every 2 years for women 40
  111  years of age or older but younger than 50 years of age, The
  112  coverage required by subsection (2) (1) applies, with or without
  113  a physician prescription, if the insured obtains a mammogram
  114  and, if applicable, a supplemental breast cancer screening in an
  115  office, facility, or health testing service that uses
  116  radiological equipment registered with the Department of Health
  117  for breast cancer screening. The coverage is subject to the
  118  deductible and coinsurance provisions applicable to outpatient
  119  visits, and is also subject to all other terms and conditions
  120  applicable to other benefits. This section does not affect any
  121  requirements or prohibitions relating to who may perform,
  122  analyze, or interpret a mammogram or the persons to whom the
  123  results of a mammogram may be furnished or released.
  124         (4)(3) This section does not apply to disability income,
  125  specified disease, or hospital indemnity policies.
  126         (5)(4) Every insurer subject to the requirements of this
  127  section shall make available to the policyholder as part of the
  128  application, for an appropriate additional premium, the coverage
  129  required in this section without such coverage being subject to
  130  the deductible or coinsurance provisions of the policy.
  131         Section 3. Section 627.6613, Florida Statutes, is amended
  132  to read:
  133         627.6613 Coverage for mammograms and supplemental breast
  134  cancer screenings.—
  135         (1) As used in this section, the term “supplemental breast
  136  cancer screening” means a clinically appropriate examination, in
  137  addition to a mammogram, deemed medically necessary by a
  138  treating physician for breast cancer screening in accordance
  139  with applicable American College of Radiology guidelines, which
  140  examination includes, but is not limited to, magnetic resonance
  141  imaging, ultrasound, and molecular breast imaging.
  142         (2) A group, blanket, or franchise accident or health
  143  insurance policy issued, amended, delivered, or renewed in this
  144  state on or after July 1, 2024, must provide coverage for at
  145  least the following for any woman who is 25 years of age or
  146  older:
  147         (a) One A baseline mammogram a year, including a digital
  148  breast tomosynthesis mammogram for any woman who is 35 years of
  149  age or older, but younger than 40 years of age.
  150         (b) A mammogram every 2 years for any woman who is 40 years
  151  of age or older, but younger than 50 years of age, or more
  152  frequently based on the patient’s physician’s recommendation.
  153         (c)A mammogram every year for any woman who is 50 years of
  154  age or older.
  155         (d) One supplemental breast cancer screening or more
  156  mammograms a year, based upon a physician’s recommendation, if
  157  the for any woman who is at risk for breast cancer because of
  158  dense breast tissue as demonstrated by the woman’s mammogram and
  159  based on the breast imaging reporting and data system
  160  established by the American College of Radiology; because of a
  161  personal or family history of breast cancer;, because of having
  162  a personal history of biopsy-proven benign breast disease;
  163  because of ancestry; because of genetic predisposition;, because
  164  of having a mother, sister, or daughter who has or has had
  165  breast cancer, or because the a woman has not given birth before
  166  the age of 30; or because of other reasons as determined by the
  167  woman’s physician.
  168         (3)(2)Except as provided in paragraph (1)(b), for
  169  mammograms done more frequently than every 2 years for women 40
  170  years of age or older but younger than 50 years of age, The
  171  coverage required by subsection (2) (1) applies, with or without
  172  a physician prescription, if the insured obtains a mammogram
  173  and, if applicable, a supplemental breast cancer screening in an
  174  office, facility, or health testing service that uses
  175  radiological equipment registered with the Department of Health
  176  for breast cancer screening. The coverage is subject to the
  177  deductible and coinsurance provisions applicable to outpatient
  178  visits, and is also subject to all other terms and conditions
  179  applicable to other benefits. This section does not affect any
  180  requirements or prohibitions relating to who may perform,
  181  analyze, or interpret a mammogram or the persons to whom the
  182  results of a mammogram may be furnished or released.
  183         (4)(3) Every insurer referred to in subsection (2) (1)
  184  shall make available to the policyholder as part of the
  185  application, for an appropriate additional premium, the coverage
  186  required in this section without such coverage being subject to
  187  the deductible or coinsurance provisions of the policy.
  188         Section 4. Section 641.31095, Florida Statutes, is amended
  189  to read:
  190         641.31095 Coverage for mammograms and supplemental breast
  191  cancer screenings.—
  192         (1) As used in this section, the term “supplemental breast
  193  cancer screening” means a clinically appropriate examination, in
  194  addition to a mammogram, deemed medically necessary by a
  195  treating physician for breast cancer screening in accordance
  196  with applicable American College of Radiology guidelines, which
  197  examination includes, but is not limited to, magnetic resonance
  198  imaging, ultrasound, and molecular breast imaging.
  199         (2) Every health maintenance contract issued or renewed on
  200  or after July 1, 2024, must January 1, 1996, shall provide
  201  coverage for at least the following for any woman who is 25
  202  years of age or older:
  203         (a) One A baseline mammogram a year, including a digital
  204  breast tomosynthesis mammogram for any woman who is 35 years of
  205  age or older, but younger than 40 years of age.
  206         (b) A mammogram every 2 years for any woman who is 40 years
  207  of age or older, but younger than 50 years of age, or more
  208  frequently based on the patient’s physician’s recommendations.
  209         (c)A mammogram every year for any woman who is 50 years of
  210  age or older.
  211         (d) One supplemental breast cancer screening or more
  212  mammograms a year, based upon a physician’s recommendation, if
  213  the for any woman who is at risk for breast cancer because of
  214  dense breast tissue as demonstrated by the woman’s mammogram and
  215  based on the breast imaging reporting and data system
  216  established by the American College of Radiology; because of a
  217  personal or family history of breast cancer;, because of having
  218  a personal history of biopsy-proven benign breast disease;
  219  because of ancestry; because of genetic predisposition;, because
  220  of having a mother, sister, or daughter who has had breast
  221  cancer, or because the a woman has not given birth before the
  222  age of 30; or because of other reasons as determined by the
  223  woman’s physician.
  224         (3)(2) The coverage required by this section is subject to
  225  the deductible and copayment provisions applicable to outpatient
  226  visits, and is also subject to all other terms and conditions
  227  applicable to other benefits. A health maintenance organization
  228  shall make available to the subscriber as part of the
  229  application, for an appropriate additional premium, the coverage
  230  required in this section without such coverage being subject to
  231  any deductible or copayment provisions in the contract.
  232         Section 5. This act shall take effect July 1, 2024.

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