Lawmakers in various states are considering legislation that either expands mandated insurance coverage to recognize the positive clinical efficacy of digital breast tomosynthesis or requires physicians and health care facilities to inform women about density breast findings from their breast imaging exams.
Digital Breast Tomosynthesis (DBT) Coverage
Arkansas HB 2022 became Public Act 708 on March 29. The law defines breast ultrasound and modifies definition of screening mammography to include digital breast tomosynthesis. The law specifies that “insurance coverage for screening mammograms, including digital breast tomosynthesis and breast ultrasounds, shall not prejudice coverage for diagnostic mammograms or breast ultrasounds as recommended by the woman's physician.” Screening mammography and breast ultrasound, based upon physician’s recommendation, are deemed an ‘essential health benefit.’ A breast ultrasound may be subject to any applicable copayment as required under a health benefit plan but shall not be subject to a deductible.
Ohio SB 121 was introduced on March 30, 2017. The bill adds tomosynthesis to the current definition of “screening mammography.”
Breast Density Reporting
Colorado SB 17-142 on breast density reporting is now a final act that was transmitted to the governor on April 3. When signed, the act will go into effect on Oct. 1, 2017. The bill calls for a specific notice to be included in the mammography report if the patient has been determined to have dense breast tissue.
Kentucky HB 78, an act relating to patient notification of mammogram results showing dense tissue, was delivered to the governor on March 30. It creates a new section of KRS 214.550 to 214.556 to require the provider of mammography services to provide information to a patient on breast density when appropriate and would permit the Department for Public Health to provide updates to the definition of "dense breast tissue" if appropriate.
Maryland HB 190 passed in its chamber of origin and was returned by the opposite chamber without amendments. The bill would modify codified notice related to breast density to state that “together, a patient and the patient’s physician can decide whether additional screening options might be right for the patient.” If signed into law, the effective date of the act will be Oct. 1, 2017.
Mississippi SB 2006, an act to authorize the department of health to adopt regulations to specify the information to be provided in the written mammography report to patients was approved by the governor on March 27. The department shall adopt regulations that specify the information to be provided to patients receiving mammogram services in the written report of mammography results that is furnished directly to patients by the entity performing the mammography services under the federal Mammography Quality Standards Act, 42 USC Section 263b. Any information that the department requires to be provided in the report shall be evidence-based, consistent with accepted medical standards and not inconsistent with the federal Mammography Quality Standards Act or regulations promulgated under that act.
Nebraska LB 195, a bill relating to breast density reporting, moved forward to enrollment and review for engrossment on April 3. If signed into law, all health care facilities performing mammography shall be required to include the patient's individual breast tissue classification in the summary of the mammography report, based on the Breast Imaging Reporting and Data System as established by the American College of Radiology. Facilities also shall be required to include a specific notice in the mammography report sent to patients, and the language of the notice may be updated in the future to “reflect advances in science and technology, as long as it continues to notify patients about the frequency of dense breast tissue and its effect on the accuracy of mammograms and to encourage patients to discuss the issue with their health care provider.”
West Virginia HB 2471 has been approved by the state’s House of Delegates and is advancing through the Senate committee process. The bill would secure coverage for comprehensive ultrasound screening of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue or if a woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by a woman's physician or advanced practice nurse. Additionally, the bill seeks to provide education to cancer patients concerning the prevention and treatment of cancer and directs the state health officer to develop standard informational language to be included in mammogram results for patients with high breast density. The bill calls for the state health director to work with radiologists and mammography facilities to include a statement of the patient’s breast density with mammogram results given to the patient, and on the dissemination of standard information regarding breast density.