February 28, 2019

States Introduce Bills on AUC and Expanded Cancer Screening

In January and February, state legislatures introduced bills covering use of selected appropriate use criteria (AUC), insurance coverage for younger women and special populations for breast cancer screening, and mandatory insurance coverage of MRI once every two years to assure patient access to the modality for early cancer detection.

Washington State

 In Washington State, Rep. Vandana Slatter introduced HB 1933, a bill that would replace prior authorization standards for noninvasive cardiac diagnostic imaging procedures in its current public employee health plan with selected AUC.

The bill would require participating health care providers, who seek to order a noninvasive cardiac diagnostic imaging procedure for a covered patient, to use the AUC selected by the authority to determine if a noninvasive cardiac diagnostic imaging procedure is appropriate. It would also prohibit participating health carriers from denying noninvasive cardiac diagnostic imaging procedures for purposes of prior authorization, if the health care provider used AUC selected by the authority and the procedure was determined to be appropriate for the covered patient.

Massachusetts

 In Massachusetts, Sen. Dean Tran, ranking member of the Health Care Financing Committee, introduced SD 559, a bill that would provide accident and sickness insurance coverage covering the cost of MRIs once every 48 months for the purpose of the early cancer detection.

West Virginia

In West Virginia, Delegate Sean Hornbuckle introduced HB 2224, a bill that would amend the state’s Public Employees Insurance Act to include coverage for the following:

  • One baseline mammogram examination for women 30- to 40-years old; a mammogram examination every year for women 40 and over; and, in the case of women who are younger than 40 and have a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age and intervals as deemed medically necessary by their health care providers
  • A comprehensive ultrasound screening of an entire breast or both breasts if a mammogram demonstrates heterogeneous or dense breast tissue, based on the American College of Radiology’s (ACR’s) Breast Imaging Reporting and Data System, 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
  • A radiologist or mammography facility that is certified by the Food and Drug Administration (FDA) or by a certification agency approved by the FDA shall include in the mammography summary information that identifies a patient's breast density. This information shall be based upon the ACR’s Breast Imaging Reporting and Data System