State legislatures are actively engaged in introducing and considering measures that would improve their breast cancer screening laws. The American College of Radiology® (ACR®) provides an update on breast health legislation being tracked this session. Specific topics include measures to eliminate patient cost sharing and repeal or revision of existing breast density notification.
Arkansas
House Bill (HB) 1309 (Act 268), a bill to update Arkansas law to ensure health plans cannot apply copayments or deductibles to screening mammograms or breast ultrasounds, was signed into law by Gov. Sarah Huckabee Sanders. The law also stipulates that diagnostic breast exams cannot have higher cost-sharing than screening exams.
Senate Bill (SB) 123 adds “supplemental breast examination” as a defined service under Arkansas law, clarifying that such exams may include contrast-enhanced mammography, breast MRI, ultrasound or molecular breast imaging.
Arizona
HB 2561 seeks to prohibit Arizona health plans from imposing cost-sharing requirements for diagnostic and supplemental breast examinations. “Diagnostic breast examination” and “supplemental breast examination” are defined in accordance with National Comprehensive Cancer Network (NCCN) guidelines, detailing that these include contrast-enhanced mammography, MRI, ultrasound or diagnostic mammography. The bill ensures that any abnormality detected during a breast screening, or risk factors such as personal or family medical history, triggers coverage of appropriate imaging without additional copayments, coinsurance or deductibles.
Connecticut
SB 450 seeks to define breast ultrasound as a screening procedure for insureds, thereby ensuring coverage for the service.
SB 757 would require self-funded municipalities to provide coverage for mammograms, tomosynthesis, MRIs and ultrasounds. Many municipalities (cities and towns) in Connecticut operate as self-funded entities and are able to join the Connecticut Partnership Plan 2.0 managed by the Office of the Controller. A membership in the Connecticut Partnership 2.0 allows them to participate in the state employee health plan.
Florida
SB 158 would prohibit any cost-sharing requirements for diagnostic or supplemental breast examinations under the state group insurance program. Florida’s state group insurance programs, administered by the Florida Department of Management Services, cover eligible state employees, retirees, and their dependents with a range of benefits including health plans. While these programs may involve some level of self-funding for healthcare costs, they often partner with insurance carriers for administration, networks, and claims processing.
HB 131 would allow patients with dense breast tissue to receive ultrasound or other additional screening tests without first undergoing a conventional mammogram.
HB 141 seeks to prohibit cost-sharing for diagnostic and supplemental breast examinations under the state group insurance program.
HB 187 would revise coverage for mammograms and mandates coverage for supplemental breast cancer screenings under certain circumstances.
Hawaii
SB 189 would expand mandatory health insurance coverage for low-dose mammography for occult breast cancer to include any supplemental imaging deemed medically necessary for a patient of any age having an above-average risk for breast cancer as determined by the use of a risk-factor modeling tool. It also would expand mandatory health insurance coverage to include additional supplemental imaging for any patient, regardless of age, as deemed medically necessary by the patient's primary care provider. The bill passed a second reading in the Senate.
HB 598 would prohibit cost-sharing for certain diagnostic and supplemental breast exams.
Indiana
HB 1061 would have required health plans to cover diagnostic and supplemental breast examinations without any cost-sharing for patients. The bill failed.
Kansas
HB 2296 would require certain health insurance plans to impose a no-cost-sharing requirement for a diagnostic or supplemental breast cancer examination on an insured.
SB 219 contains similar requirements as HB 2296.
Missouri
SB 232 would repeal state-mandated provision of law relating to breast density notifications following screening mammograms.
HB 398 seeks to amend existing state mandated breast density notification language.
New York
Assembly Bill (AB) 1158 would extend eligibility for covered breast cancer screenings to individuals with a second-degree (in addition to first-degree) relative who has a prior history of breast cancer.
AB 580 would treat a notice of dense breast tissue as a determination of medical necessity, thereby guaranteeing coverage of breast ultrasounds if recommended.
SB 768 would require incarcerated individuals to receive breast cancer screening and diagnostic testing in accordance with nationally recognized clinical guidelines.
SB 310 would require insurance coverage for ultrasound and other diagnostic procedures for individuals with a prior history of breast cancer or a first-degree relative with such a history.
North Dakota
HB 1283 would mandate that no cost-sharing be imposed for diagnostic or supplemental breast exams as defined in the measure and directs a report to the legislative assembly regarding implementation. HB 1283 passed the House and awaits action in the Senate Appropriations Committee.
Oklahoma
HB 1974 would set parameters for preventative diagnostic services, including breast cancer screening.
HB 1389 seeks to ensure that Oklahoma health benefit plans provide no-cost coverage for screening, diagnostic and supplemental breast cancer examinations. It defines breast imaging procedures, including low-dose mammography, breast tomosynthesis, MRI, ultrasound and molecular breast imaging, and clarifies eligibility for women based on age, risk factors and clinical guidelines.
Women ages 35 to 39 are entitled to one low-dose mammography screening every five years, while women 40 and older receive annual screenings. If the health plan is a high-deductible plan tied to a health savings account, the bill’s provisions still apply after meeting the minimum deductible, consistent with federal law. If enacted, the law would go into effect on Nov. 1. The bill passed the House and was sent to the Senate.
Rhode Island
HB 5430 would prohibit cost-sharing requirements for diagnostic or supplemental breast examinations. The House Health and Human Services Committee recommended the measure be held for further study.
SB 197 mirrors HB 5430 to prohibit cost-sharing for diagnostic and supplemental breast examinations. The Senate Health and Human Services Committee recommended the measure be held for further study.
South Carolina
HB 3202 would require health insurance policies to provide coverage for diagnostic and supplemental breast examinations without cost-sharing requirements, including mammography, MRI, ultrasound or molecular breast imaging. The bill follows National Comprehensive Cancer Network guidelines and clarifies certain exceptions for high-deductible health plans under federal law. It is in the House Committee on Labor, Commerce and Industry.
South Dakota
HB 1070, a bill that would have prohibited cost-sharing in certain health insurance policies for diagnostic and supplemental breast imaging, failed.
Texas
HB 2659 would align mammography reports with U.S. Food and Drug Administration breast density notice requirements. It is in the House Disease Prevention & Women and Children Health Subcommittee.
SB 1084, similar to HB 2659, would require mammography report alignment with federal notice guidelines. The Senate passed the bill April 2 and it is now ready for consideration by the House for further legislative action.
Utah
HB 146 repeals the breast density notification requirement mandated by the state to align with federal language. The bill was into law by Gov. Spencer Cox and enacted March 24.
HB 314 would have prohibited cost sharing for diagnostic breast exams in line with National Comprehensive Cancer Network guidelines. The bill failed when the Utah Legislature adjourned sine die.
Virginia
HB 1828/
VA SB 1238, legislation to eliminate cost sharing for diagnostic and supplemental breast exams, was signed into law by Gov. Glenn Youngkin March 24, and goes into effect July 1.
West Virginia
SB 262 seeks guarantees that insurance policies in West Virginia include coverage for annual mammograms for women aged 40 and older without requiring a prior physician order. It also specifies coverage for younger women with a family history of breast cancer or other risk factors, allowing mammograms at intervals deemed medically necessary by their provider. In addition, if a mammogram reveals dense breast tissue or an increased risk of breast cancer, insurers would have to cover ultrasound screening.
The ACR Government Relations Committee of the Breast Imaging Commission will continue to assist states as these bills move through the legislative process.
For more information or if you have questions, contact
Eugenia Brandt, ACR Senior Government Relations Director.
