119-hr3037

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3037 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3037

To amend title XXVII of the Public Health Service Act to prohibit group 
health plans and health insurance issuers offering group or individual 
health insurance coverage from imposing cost-sharing requirements with 
 respect to diagnostic and supplemental breast examinations.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 April 28, 2025

Mrs. Dingell (for herself, Mr. Fitzpatrick, and Ms. Wasserman Schultz) 
 introduced the following bill; which was referred to the Committee on 
 Energy and Commerce, and in addition to the Committee on Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
 each case for consideration of such provisions as fall within the 
 jurisdiction of the committee concerned

_______________________________________________________________________

 A BILL

To amend title XXVII of the Public Health Service Act to prohibit group 
health plans and health insurance issuers offering group or individual 
health insurance coverage from imposing cost-sharing requirements with 
 respect to diagnostic and supplemental breast examinations.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Access to Breast Cancer Diagnosis 
Act of 2025''.

SEC. 2. REQUIRING DIAGNOSTIC AND SUPPLEMENTAL BREAST EXAMINATIONS TO BE 
 COVERED WITH NO COST-SHARING REQUIREMENTS.

    (a) In General.--Subpart II of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-11 et seq.) is amended by adding at 
the end the following new section:

``

SEC. 2730. DIAGNOSTIC AND SUPPLEMENTAL BREAST EXAMINATIONS.

 ``

    (a) In General.--In the case of a group health plan, or a health 
insurance issuer offering group or individual health insurance 
coverage, that provides benefits with respect to diagnostic and 
supplemental breast examinations furnished to an individual enrolled 
under such plan or such coverage, such plan or coverage shall not 
impose any cost-sharing requirements for these benefits.
 ``

    (b) Construction.--Nothing in this section shall be construed--
 ``

    (1) to prohibit a group health plan or health insurance 
 issuer from requiring timely prior authorization or imposing 
 other appropriate utilization controls in approving coverage 
 for any diagnostic and supplemental breast examination; or
 ``

    (2) to supersede a State law that provides greater 
 protections with respect to the coverage of diagnostic and 
 supplemental breast examinations than is provided under this 
 section.
 ``
            (c) === Definitions. ===
-In this section:
 ``

    (1) Cost-sharing requirements.--The term `cost-sharing 
 requirements' means a deductible, coinsurance, copayment, and 
 any maximum limitation on the application of such a deductible, 
 coinsurance, copayment or similar out-of-pocket expense.
 ``

    (2) Diagnostic breast examination.--The term `diagnostic 
 breast examination' means a medically necessary and appropriate 
 (in accordance with National Comprehensive Cancer Network 
 Guidelines) examination of the breast (including, but not 
 limited to such an examination using diagnostic mammography, 
 breast magnetic resonance imaging, or breast ultrasound) that 
 is--
 ``
        (A) used to evaluate an abnormality seen or 
 suspected from a screening examination for breast 
 cancer; or
 ``
        (B) used to evaluate an abnormality detected by 
 another means of examination.
 ``

    (3) Supplemental breast examinations.--The term 
 `supplemental breast examination' means a medically necessary 
 and appropriate (in accordance with National Comprehensive 
 Cancer Network Guidelines) examination of the breast 
 (including, but not limited to such an examination using breast 
 magnetic resonance imaging or breast ultrasound) that is--
 ``
        (A) used to screen for breast cancer when there 
 is no abnormality seen or suspected; and
 ``
        (B) furnished based on personal or family medical 
 history or additional factors that may increase the 
 individual's risk of breast cancer.''.

    (b) Application to Grandfathered Health Plans.--

Section 1251

    (a)

    (4)
        (A) of the Patient Protection and Affordable Care Act (42 
U.S.C. 18011

    (a)

    (4)
        (A) ) is amended--

    (1) by striking ``title'' and inserting ``title, or as 
 added after the date of the enactment of this Act''; and

    (2) by adding at the end the following new clause:
 ``
            (v) Section 2730 (relating to coverage 
 for diagnostic and supplemental breast 
 examinations).''.
            (c) Application to High Deductible Health Plans With Health Savings 
Account Eligibility.--

Section 223
            (c) (2) of the Internal Revenue Code of 
1986 is amended by adding at the end the following:
 ``
        (H) Safe harbor for absence of deductible for 
 diagnostic and supplemental breast examinations.--In 
 the case of plan years beginning on or after January 1, 
 2026, a plan shall not fail to be treated as a high 
 deductible health plan by reason of failing to have a 
 deductible for diagnostic and supplemental breast 
 examinations.''.
            (d) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2026.
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