July 22, 2021

Bipartisan Sponsors Introduce PALS Screening Access Act in House and Senate

On July 21, U.S. Sens. Dianne Feinstein (D-Calif.) and Marsha Blackburn (R-Tenn.) and Reps. Debbie Wasserman Schultz (D-Fla.) and Fred Upton (R-Mich.) introduced the Protecting Access to Lifesaving Screenings (PALS) Act of 2021 (S.2412 /H.R.4612). The legislation would postpone recognition of controversial recommendations from the U.S. Preventive Services Task Force (USPSTF) that could limit access to breast cancer screening for women in their forties.

The legislation proposes to continue a moratorium on the USPSTF recommendations, which Congress has extended several times but is set to expire Jan. 1, 2023.

Lawmakers seek to make changes from the current PALS Act statute, including:
• Extension of the PALS Act moratorium through Jan. 1, 2028.
• Clarification that service women should benefit from this same screening mammography protection starting at age 40.
• Addition of clarifying statutory language that specifies “all modalities” is intended to include breast tomosynthesis; some insurers have failed to cover 3D mammography claiming the statutory language is unclear.

The Patient Protection and Affordable Care Act (PPACA) included provisions to eliminate patient cost sharing requirements as a barrier to accessing lifesaving cancer screens. PPACA requires individual and group (employer) insurance plans to provide certain preventive screening tests to beneficiaries free of out-of-pocket costs, as determined by agencies and advisory bodies including the USPSTF, the Centers for Disease Control, and Prevention and the Health Resources and Services Administration.

In 2009 and as part of a scheduled re-review in 2016, the USPSTF released breast cancer screening guidelines with a “C” grade for screening mammography for women ages 40–49 years, and a “B” for biennial screening mammography beginning at age 50. This was a significant departure from breast cancer screening guidelines of leading clinical organizations for women’s health — including the American College of Radiology® (ACR®)/Society for Breast Imaging, National Comprehensive Cancer Network and the American Medical Association. These groups recommend breast cancer screening beginning annually at age 40 for women of average risk.

If the current USPSTF recommendations were recognized for purposes of PPACA coverage mandates, individual and group (employer) insurance plans would no longer be required to cover annual mammography with no cost sharing for millions of women ages 40 to 49.

The ACR supports the PALS act and bill sponsors and will advocate for both House and Senate bills.

If you have questions or would like more information, contact Gloria Romanelli, ACR Senior Director, Legislative and Regulatory Relations.