General Assembly Committee Bill No. 5832
January Session, 2015 LCO No. 3334
*03334HB05832INS*
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
General Assembly
Committee Bill No. 5832
January Session, 2015
LCO No. 3334
*03334HB05832INS*
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR TOMOSYNTHESIS FOR BREAST CANCER SCREENINGS.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. Section 38a-503 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
(a) (1) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (10), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state shall provide benefits for mammographic examinations to any woman covered under the policy that are at least equal to the following minimum requirements: (A) A baseline mammogram for any woman who is thirty-five to thirty-nine years of age, inclusive; and (B) a mammogram every year for any woman who is forty years of age or older.
(2) Such policy shall provide additional benefits for:
(A) Comprehensive ultrasound screening or tomosynthesis of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology 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 registered nurse; and
(B) Magnetic resonance imaging of an entire breast or breasts in accordance with guidelines established by the American Cancer Society.
(b) Benefits under this section shall be subject to any policy provisions that apply to other services covered by such policy, except that no such policy shall impose a copayment that exceeds a maximum of twenty dollars for an ultrasound screening under subparagraph (A) of subdivision (2) of subsection (a) of this section.
(c) Each mammography report provided to a patient shall include information about breast density, based on the Breast Imaging Reporting and Data System established by the American College of Radiology. Where applicable, such report shall include the following notice: "If your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, which can include a breast ultrasound screening, a breast tomosynthesis, or a breast MRI examination, [or both,] depending on your individual risk factors. A report of your mammography results, which contains information about your breast density, has been sent to your physician's office and you should contact your physician if you have any questions or concerns about this report.".
Sec. 2. Section 38a-530 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2016):
(a) (1) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state shall provide benefits for mammographic examinations to any woman covered under the policy that are at least equal to the following minimum requirements: (A) A baseline mammogram for any woman who is thirty-five to thirty-nine years of age, inclusive; and (B) a mammogram every year for any woman who is forty years of age or older.
(2) Such policy shall provide additional benefits for:
(A) Comprehensive ultrasound screening or tomosynthesis of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology 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 registered nurse; and
(B) Magnetic resonance imaging of an entire breast or breasts in accordance with guidelines established by the American Cancer Society.
(b) Benefits under this section shall be subject to any policy provisions that apply to other services covered by such policy, except that no such policy shall impose a copayment that exceeds a maximum of twenty dollars for an ultrasound screening under subparagraph (A) of subdivision (2) of subsection (a) of this section.
(c) Each mammography report provided to a patient shall include information about breast density, based on the Breast Imaging Reporting and Data System established by the American College of Radiology. Where applicable, such report shall include the following notice: "If your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, which can include a breast ultrasound screening, a breast tomosynthesis, or a breast MRI examination, [or both,] depending on your individual risk factors. A report of your mammography results, which contains information about your breast density, has been sent to your physician's office and you should contact your physician if you have any questions or concerns about this report.".
This act shall take effect as follows and shall amend the following sections:
Section 1 January 1, 2016 38a-503
Sec. 2 January 1, 2016 38a-530
This act shall take effect as follows and shall amend the following sections:
Section 1
January 1, 2016
38a-503
Sec. 2
January 1, 2016
38a-530
Statement of Purpose:
To provide Connecticut women with access to comprehensive breast cancer screenings by making tomosynthesis available through health insurance coverage when an annual mammogram demonstrates heterogeneous or dense breast tissue 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 registered nurse.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]
Co-Sponsors: REP. KLARIDES, 114th Dist.
Co-Sponsors:
REP. KLARIDES, 114th Dist.
H.B. 5832