Rhode Island and Illinois advance telehealth legislation mandating coverage of healthcare services. Oregon bill sponsors introduce a measure incorporating digital breast tomosynthesis (DBT) in supplemental breast cancer screening.
Rhode Island Gov. Dan McKee signed House Bill (HB) 6032 into law. The law, which took effect immediately, prohibits carriers from excluding a healthcare service for coverage solely because it is provided through telemedicine and is not provided through in-person consultation or contact if medically necessary and clinically appropriate. Carriers are prohibited from charging a deductible, copayment, or coinsurance requirement for a telehealth service higher than what would normally be charged for the same healthcare service performed in person. Prior authorization requirements for medically necessary and clinically appropriate telemedicine services are prohibited from being more stringent than for in-person care. The Rhode Island chapter supported the bill.
In Illinois, HB 3308 passed both legislative chambers and awaits the governor’s action. The bill would amend the Illinois Insurance Code to mandate coverage of healthcare services when delivered via telehealth as clinically appropriate. Patient cost sharing would be no more than if the healthcare service was delivered in person. The Illinois chapter monitored the bill.
Breast Cancer Screening
In Oregon, Reps. Schmidt (R) and Denson (D) introduced HB 371. The bill includes DBT as part of screening mammography. The measure defines supplemental breast cancer screening as “any additional screening method deemed medically necessary by a treating health care provider for proper breast cancer screening in accordance with applicable American College of Radiology guidelines, including magnetic resonance imaging, ultrasound, or molecular breast imaging.” Issuers would be mandated to cover supplemental breast cancer screening for an adult woman who meets either of the following conditions:
- The woman's screening mammography demonstrates, based on the breast imaging reporting and data system established by the American College of Radiology®, that the woman has dense breast tissue.
- The woman is at an increased risk of breast cancer due to family history, prior personal history of breast cancer, ancestry, genetic predisposition, or other reasons as determined by the woman's healthcare provider.
Coverage for supplemental breast cancer screening would cap at 130% of the Medicare reimbursement rate.
If a mammogram demonstrates that the patient has dense breast tissue, the summary of the written report containing the results would include a statement mandated in the bill intended to raise the patient’s awareness and stress the importance of routine screening mammograms:
“Your mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. However, dense breast tissue can make it harder to find cancer on a mammogram and also may increase your risk of developing breast cancer. Because you have dense breast tissue, you could benefit from additional imaging tests such as a screening breast ultrasound or breast magnetic resonance imaging. This information about your breast density is being provided to you to raise your awareness. It is important to continue routine screening mammograms and use this information to speak with your health care provider about your own risk for breast cancer. At that time, ask your health care provider if more screening tests might be useful based on your risk. A report of your mammogram results was sent to your health care provider.”