January 25, 2018

More States Consider Breast Tomosynthesis Mandates

Despite recently published studies demonstrating the cost effectiveness of digital breast tomosynthesis (DBT), some private health insurers are still reluctant to reimburse providers for these also clinically effective screening and diagnostic procedures.

In response, legislators in some states are hearing health care consumer and physician demands to require insurer acceptance. By the end of 2017, DBT coverage mandates were enacted in Arkansas, Connecticut, Illinois, Maryland, New Jersey, Pennsylvania and Texas.

The momentum for more state-by-state growth of DBT coverage mandates will likely continue in 2018. Legislation is under consideration in Massachusetts, New Hampshire, New York, Oklahoma and Ohio. A bill on tomosynthesis coverage is expected to be filed in Missouri.

With HB 639, Vermont is seeking a mandate for all insurers to provide coverage for screening by mammography and for “other breast imaging services” upon recommendation of a health care provider, as needed, to detect the presence of occult breast cancer and other abnormalities of the breast or breast tissue. Other definitions of “other breast imaging services” in the bill include “diagnostic mammography, ultrasound, magnetic resonance imaging, and other imaging services and technologies that enable health care providers to detect the presence or absence of breast cancer and other abnormalities affecting the breast or breast tissue.”

Washington’s Senate Bill 5912 directs the Washington State Office of the Insurance Commissioner to clarify that the existing mandates for mammography include coverage for tomosynthesis under the same terms and conditions currently allowed for mammography and that the application of a deductible and cost sharing is prohibited. The legislature also directs the health care authority to clarify that the existing mandate for mammography in RCW 41.05.180 includes coverage for tomosynthesis under the same terms and conditions currently allowed for mammography.