March 20, 2019

States Propose Expanding Coverage for Breast Cancer Screening

Several states have introduced, adopted or made progress in legislation relating to expanded digital mammography coverage, required breast density notification or mandated insurance coverage for digital breast tomosynthesis (DBT).

Arkansas

In Arkansas, Gov. Asa Hutchinson signed into law SB 380. The new law provides health insurance coverage for mammograms, including DBT. It covers mammograms for women ages 35 to 40 and annual mammograms for women 40 and over. It also covers breast ultrasounds for evaluating dense breast tissue and diagnosing breast diseases, such as cancer.

Connecticut

Connecticut’s Insurance and Real Estate Committee sponsored HB 7124 and SB 838, which were recently filed with the legislative commissioner’s office. Both bills would provide coverage for mammograms for women ages 30 or older, which may include DBT. The bills would cover annual mammograms when recommended by a physician, if the patient has a family or personal history with breast cancer or if the patient has a prior history of breast disease. The bills would also provide coverage for ultrasound screenings if a mammogram demonstrates heterogeneous or dense breast tissue or if the patient is deemed to be at high risk for breast cancer.

Hawaii

In Hawaii, HB 481 and its companion bill SB 1034, which were introduced in January, would expand health insurance coverage for breast tomosynthesis. The House version has passed its chamber and recently passed the Senate’s Commerce, Consumer Protection and Health Committee. The Senate bill passed its chamber and will be discussed in a hearing by the House Committee on Consumer Protection and Commerce on March 21.

Illinois

In Illinois, SB 162, introduced in late January, has gained seven co-sponsors. It would expand coverage to diagnostic mammograms when deemed medically necessary and would cover breast ultrasounds for evaluating dense breast tissue.

Minnesota

In Minnesota, HB 440, introduced in January, has added eight co-sponsors and has been referred to the House’s Health and Human Services Finance Division Committee. The bill provides coverage for DBT for women who are at risk for breast cancer. Those “at risk for breast cancer” would be defined as having a family history, testing positive for BRCA1 or BRCA2 mutations, having a previous diagnosis of breast cancer or having heterogeneously or extremely dense breasts.

Maine

In Maine, Sen. Catherine Breen introduced LD 1264/SP 384. It would amend the definition of screening mammography to include DBT screening and would require insurance coverage for the procedure.

Rhode Island

Rhode Island’s Sen. Cynthia A. Coyne introduced SB 579. The bill would mandate insurance coverage for DBT screenings. It would require insurers to pay for two mammography screenings per year when recommended by a physician for women who have been treated for breast cancer within the previous five years or have a genetic predisposition to breast cancer.

If adopted, the bill also would mandate all health care facilities that perform mammography or DBT screenings to inform patients about breast density findings from their procedures. The summary of the mammography report would include the following notice:

“Your mammogram indicates that you have dense breast tissue. Dense breast tissue is relatively common and is found in about forty percent (40%) of women. The presence of dense tissue can make it more difficult to detect cancers in the breast by mammography because it can hide small abnormalities and may be associated with an increased risk. Hence, you may benefit from supplementary screening tests, which may include a breast ultrasound screening, or a breast MRI examination, or both, depending on your individual risk factors.

We are providing this information to raise your awareness of this important factor and to encourage you to discuss your dense breast tissue, as well as other breast cancer risk factors, with your health care provider. Together, you can decide which screening options are right for you.

A report of your results was sent to your physician. You should contact your physician if you have any questions or concerns about this report.”