Arizona 2024 Regular Session

Arizona House Bill HB2411 Compare Versions

Only one version of the bill is available at this time.

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1	1	REFERENCE TITLE: insurance; cost sharing; breast examinations State of Arizona House of Representatives Fifty-sixth Legislature Second Regular Session 2024 HB 2411 Introduced by Representatives Cook: Bliss, Carbone, Hernandez A, Willoughby An Act amending title 20, chapter 4, article 3, Arizona Revised Statutes, by adding section 20-841.14; amending title 20, chapter 4, article 9, Arizona Revised Statutes, by adding section 20-1057.20; amending title 20, chapter 6, article 4, Arizona Revised Statutes, by adding section 20-1376.11; amending title 20, chapter 6, article 5, Arizona Revised Statutes, by adding section 20-1406.11; relating to health insurance. (TEXT OF BILL BEGINS ON NEXT PAGE)
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9	9	REFERENCE TITLE: insurance; cost sharing; breast examinations
10	10	State of Arizona House of Representatives Fifty-sixth Legislature Second Regular Session 2024
11	11	HB 2411
12	12	Introduced by Representatives Cook: Bliss, Carbone, Hernandez A, Willoughby
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14	14	REFERENCE TITLE: insurance; cost sharing; breast examinations
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40	40	HB 2411
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44	44	Introduced by
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46	46	Representatives Cook: Bliss, Carbone, Hernandez A, Willoughby
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64	64	An Act
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68	68	amending title 20, chapter 4, article 3, Arizona Revised Statutes, by adding section 20-841.14; amending title 20, chapter 4, article 9, Arizona Revised Statutes, by adding section 20-1057.20; amending title 20, chapter 6, article 4, Arizona Revised Statutes, by adding section 20-1376.11; amending title 20, chapter 6, article 5, Arizona Revised Statutes, by adding section 20-1406.11; relating to health insurance.
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78	78	Be it enacted by the Legislature of the State of Arizona: Section 1. Title 20, chapter 4, article 3, Arizona Revised Statutes, is amended by adding section 20-841.14, to read: START_STATUTE20-841.14. Breast examinations; cost sharing; high deductible health plan; exception; definitions A. a hospital service corporation or medical service corporation that issues, amends, delivers or renews a subscription contract On or after January 1, 2025 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations. b. A hospital service corporation or medical service corporation that provides a subscription contract to a subscriber that is intended to qualify as a high deductible health plan as defined in 26 United States Code section 223(c)(2) may impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations and for items or services that are classified as preventive care until the minimum deductible is met. c. For the purposes of this section: 1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense. 2. "Diagnostic Breast Examination": (a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either: (i) Seen or suspected from a screening examination for breast cancer. (ii) Detected by another means of examination. 3. "Supplemental breast examination": (a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following: (i) Used to screen for breast cancer when there is no abnormality seen or suspected. (ii) Based on a personal or family medical history. (iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE Sec. 2. Title 20, chapter 4, article 9, Arizona Revised Statutes, is amended by adding section 20-1057.20, to read: START_STATUTE20-1057.20. Breast examinations; cost sharing; high deductible health plan; exception; definitions A. a health care services organization that issues, amends, delivers or renews an evidence of coverage On or after January 1, 2025 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations. b. A health care services organization that provides an evidence of coverage to an enrollee that is intended to qualify as a high deductible health plan as defined in 26 United States Code section 223(c)(2) may impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations and for items or services that are classified as preventive care until the minimum deductible is met. c. For the purposes of this section: 1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense. 2. "Diagnostic Breast Examination": (a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either: (i) Seen or suspected from a screening examination for breast cancer. (ii) Detected by another means of examination. 3. "Supplemental breast examination": (a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following: (i) Used to screen for breast cancer when there is no abnormality seen or suspected. (ii) Based on a personal or family medical history. (iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE Sec. 3. Title 20, chapter 6, article 4, Arizona Revised Statutes, is amended by adding section 20-1376.11, to read: START_STATUTE20-1376.11. Breast examinations; cost sharing; high deductible health plan; exception; definitions A. a disability insurer that issues, amends, delivers or renews a policy On or after January 1, 2025 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations. b. A disability insurer that provides a policy to an insured that is intended to qualify as a high deductible health plan as defined in 26 United States Code section 223(c)(2) may impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations and for items or services that are classified as preventive care until the minimum deductible is met. c. For the purposes of this section: 1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense. 2. "Diagnostic Breast Examination": (a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either: (i) Seen or suspected from a screening examination for breast cancer. (ii) Detected by another means of examination. 3. "Supplemental breast examination": (a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following: (i) Used to screen for breast cancer when there is no abnormality seen or suspected. (ii) Based on a personal or family medical history. (iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE Sec. 4. Title 20, chapter 6, article 5, Arizona Revised Statutes, is amended by adding section 20-1406.11, to read: START_STATUTE20-1406.11. Breast examinations; cost sharing; high deductible health plan; exception; definitions A. a group or blanket disability insurer that issues, amends, delivers or renews a policy On or after January 1, 2025 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations. b. A group or blanket disability insurer that provides a policy to an insured that is intended to qualify as a high deductible health plan as defined in 26 United States Code section 223(c)(2) may impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations and for items or services that are classified as preventive care until the minimum deductible is met. c. For the purposes of this section: 1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense. 2. "Diagnostic Breast Examination": (a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either: (i) Seen or suspected from a screening examination for breast cancer. (ii) Detected by another means of examination. 3. "Supplemental breast examination": (a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines. (b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following: (i) Used to screen for breast cancer when there is no abnormality seen or suspected. (ii) Based on a personal or family medical history. (iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE
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80	80	Be it enacted by the Legislature of the State of Arizona:
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82	82	Section 1. Title 20, chapter 4, article 3, Arizona Revised Statutes, is amended by adding section 20-841.14, to read:
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84	84	START_STATUTE20-841.14. Breast examinations; cost sharing; high deductible health plan; exception; definitions
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86	86	A. a hospital service corporation or medical service corporation that issues, amends, delivers or renews a subscription contract On or after January 1, 2025 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations.
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88	88	b. A hospital service corporation or medical service corporation that provides a subscription contract to a subscriber that is intended to qualify as a high deductible health plan as defined in 26 United States Code section 223(c)(2) may impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations and for items or services that are classified as preventive care until the minimum deductible is met.
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90	90	c. For the purposes of this section:
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92	92	1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense.
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94	94	2. "Diagnostic Breast Examination":
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96	96	(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
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98	98	(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either:
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100	100	(i) Seen or suspected from a screening examination for breast cancer.
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102	102	(ii) Detected by another means of examination.
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104	104	3. "Supplemental breast examination":
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106	106	(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
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108	108	(b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following:
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110	110	(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
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112	112	(ii) Based on a personal or family medical history.
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114	114	(iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE
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116	116	Sec. 2. Title 20, chapter 4, article 9, Arizona Revised Statutes, is amended by adding section 20-1057.20, to read:
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118	118	START_STATUTE20-1057.20. Breast examinations; cost sharing; high deductible health plan; exception; definitions
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120	120	A. a health care services organization that issues, amends, delivers or renews an evidence of coverage On or after January 1, 2025 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations.
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122	122	b. A health care services organization that provides an evidence of coverage to an enrollee that is intended to qualify as a high deductible health plan as defined in 26 United States Code section 223(c)(2) may impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations and for items or services that are classified as preventive care until the minimum deductible is met.
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124	124	c. For the purposes of this section:
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126	126	1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense.
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128	128	2. "Diagnostic Breast Examination":
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130	130	(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
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132	132	(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either:
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134	134	(i) Seen or suspected from a screening examination for breast cancer.
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136	136	(ii) Detected by another means of examination.
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138	138	3. "Supplemental breast examination":
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140	140	(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
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142	142	(b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following:
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144	144	(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
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146	146	(ii) Based on a personal or family medical history.
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148	148	(iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE
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150	150	Sec. 3. Title 20, chapter 6, article 4, Arizona Revised Statutes, is amended by adding section 20-1376.11, to read:
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152	152	START_STATUTE20-1376.11. Breast examinations; cost sharing; high deductible health plan; exception; definitions
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154	154	A. a disability insurer that issues, amends, delivers or renews a policy On or after January 1, 2025 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations.
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156	156	b. A disability insurer that provides a policy to an insured that is intended to qualify as a high deductible health plan as defined in 26 United States Code section 223(c)(2) may impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations and for items or services that are classified as preventive care until the minimum deductible is met.
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158	158	c. For the purposes of this section:
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160	160	1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense.
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162	162	2. "Diagnostic Breast Examination":
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164	164	(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
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166	166	(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either:
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168	168	(i) Seen or suspected from a screening examination for breast cancer.
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170	170	(ii) Detected by another means of examination.
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172	172	3. "Supplemental breast examination":
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174	174	(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
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176	176	(b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following:
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178	178	(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
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180	180	(ii) Based on a personal or family medical history.
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182	182	(iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE
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184	184	Sec. 4. Title 20, chapter 6, article 5, Arizona Revised Statutes, is amended by adding section 20-1406.11, to read:
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186	186	START_STATUTE20-1406.11. Breast examinations; cost sharing; high deductible health plan; exception; definitions
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188	188	A. a group or blanket disability insurer that issues, amends, delivers or renews a policy On or after January 1, 2025 may not impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations.
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190	190	b. A group or blanket disability insurer that provides a policy to an insured that is intended to qualify as a high deductible health plan as defined in 26 United States Code section 223(c)(2) may impose cost sharing requirements for diagnostic breast examinations and supplemental breast examinations and for items or services that are classified as preventive care until the minimum deductible is met.
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192	192	c. For the purposes of this section:
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194	194	1. "Cost sharing" means a deductible, coinsurance, copayment or similar out-of-pocket expense.
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196	196	2. "Diagnostic Breast Examination":
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198	198	(a) Means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network Guidelines.
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200	200	(b) Includes an examination of the breast using contrast enhanced mammography, diagnostic mammography, magnetic resonance imaging or ultrasound that is used to evaluate an abnormality that is either:
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202	202	(i) Seen or suspected from a screening examination for breast cancer.
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204	204	(ii) Detected by another means of examination.
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206	206	3. "Supplemental breast examination":
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208	208	(a) means a medically necessary and appropriate examination of the breast in accordance with the National Comprehensive Cancer Network guidelines.
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210	210	(b) Includes an examination of the breast using contrast enhanced mammography, magnetic resonance imaging or ultrasound that is any of the following:
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212	212	(i) Used to screen for breast cancer when there is no abnormality seen or suspected.
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214	214	(ii) Based on a personal or family medical history.
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216	216	(iii) Based on additional factors that may increase an individual's risk of breast cancer. END_STATUTE