HB 187 2025
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A bill to be entitled 1
An act relating to coverage for mammograms and 2
supplemental breast cancer screenings; creating s. 3
409.9064, F.S.; providing definitions; requiring the 4
Agency for Health Care Administration to provide 5
coverage for yearly mammograms and yearly supplemental 6
breast cancer screenings for certain women under the 7
Medicaid program under certain circumstances; 8
requiring the agency to seek federal approval under a 9
specified circumstance; amending ss. 627.6418, 10
627.6613, and 641.31095, F.S.; defining the term 11
"supplemental breast cancer screening"; revising 12
coverages for mammograms under certain individual 13
accident and health insurance policies, group, 14
blanket, and franchise accident and health insurance 15
policies, and health maintenance contracts, 16
respectively; requiring coverages for supplemental 17
breast cancer screenings under such policies and 18
contracts under certain circumstances; providing 19
applicability; providing an effec tive date. 20
21
Be It Enacted by the Legislature of the State of Florida: 22
23
Section 1. Section 409.9064, Florida Statutes, is created 24
to read: 25
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409.9064 Coverage for mammograms and supplemental breast 26
cancer screenings.— 27
(1) As used in this section, the term: 28
(a) "Mammogram" means an image of a radiologic examination 29
used to detect unsuspected breast cancer at an early stage in an 30
asymptomatic woman and includes the X -ray picture of the breast 31
using equipment that is dedicated specifically for mammo graphy, 32
including, but not limited to, the X -ray tube, filter, 33
compression device, screens, film, and cassettes. The radiologic 34
examination must include two views of each breast. The term also 35
includes images from digital breast tomosynthesis and the 36
professional interpretation of images from any mammography 37
equipment, but does not include any diagnostic mammography 38
image. 39
(b) "Supplemental breast cancer screening" means a 40
clinically appropriate examination, in addition to a mammogram, 41
deemed medically necessary by a treating health care provider 42
for breast cancer screening in accordance with applicable 43
American College of Radiology guidelines, which includes, but is 44
not limited to, magnetic resonance imaging, ultrasound, and 45
molecular breast imaging. 46
(2) Subject to the availability of funds and subject to 47
any limitations or directions provided in the General 48
Appropriations Act, the agency must provide the following 49
coverage each year for a Medicaid recipient who is a woman 50
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between 25 and 40 years of age, inclusive: 51
(a) One mammogram to detect the presence of breast cancer. 52
(b) One supplemental breast cancer screening to detect the 53
presence of breast cancer if: 54
1. The woman's mammogram demonstrates, based on the breast 55
imaging reporting and data syst em established by the American 56
College of Radiology, that the woman has dense breast tissue; or 57
2. The woman is at an increased risk of breast cancer due 58
to: 59
a. A personal or family history of breast cancer; 60
b. A personal history of biopsy -proven benign breast 61
disease; 62
c. Ancestry; 63
d. Genetic predisposition; 64
e. Not having given birth before the age of 30; or 65
f. Other reasons as determined by the woman's health care 66
provider. 67
(3) The agency shall seek federal approval, if needed, for 68
the implementation of this section. 69
Section 2. Section 627.6418, Florida Statutes, is amended, 70
to read: 71
627.6418 Coverage for mammograms and supplemental breast 72
cancer screenings.— 73
(1) As used in this section, the term "supplemental breast 74
cancer screening" means a clinically appropriate examination, in 75
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addition to a mammogram, deemed medically necessary by a 76
treating physician for breast cancer screening in accordance 77
with applicable American College of Radiology guidelines, which 78
includes, but is not limited to, magnetic resonance imaging, 79
ultrasound, and molecular breast imaging. 80
(2)(1) An accident or health insurance policy issued, 81
amended, delivered, or renewed in this state on or after July 1, 82
2025, must provide coverage for at least the followin g for any 83
woman between 25 and 40 years of age, inclusive : 84
(a) One A baseline mammogram each year, including a 85
digital breast tomosynthesis for any woman who is 35 years of 86
age or older, but younger than 40 years of age . 87
(b) A mammogram every 2 years f or any woman who is 40 88
years of age or older, but younger than 50 years of age, or more 89
frequently based on the patient's physician's recommendation. 90
(c) A mammogram every year for any woman who is 50 years 91
of age or older. 92
(b)(d) One supplemental breast cancer screening each or 93
more mammograms a year, based upon a physician's recommendation, 94
if the for any woman who is at risk for breast cancer because of 95
dense breast tissue as the woman's mammogram demonstrates, based 96
on the breast imaging reporting a nd data system established by 97
the American College of Radiology; because of a personal or 98
family history of breast cancer ;, because of having a personal 99
history of biopsy-proven benign breast disease ; because of 100
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ancestry; because of genetic predisposition; , because of having 101
a mother, sister, or daughter who has or has had breast cancer, 102
or because the a woman has not given birth before the age of 30 ; 103
or because of other reasons as determined by the woman's 104
physician. 105
(3)(2) Except as provided in paragrap h (1)(b), for 106
mammograms done more frequently than every 2 years for women 40 107
years of age or older but younger than 50 years of age, The 108
coverage required by subsection (2) (1) applies, with or without 109
a physician prescription, if the insured obtains a ma mmogram or, 110
if applicable, a supplemental breast cancer screening in an 111
office, facility, or health testing service that uses 112
radiological equipment registered with the Department of Health 113
for breast cancer screening. The coverage is subject to the 114
deductible and coinsurance provisions applicable to outpatient 115
visits, and is also subject to all other terms and conditions 116
applicable to other benefits. This section does not affect any 117
requirements or prohibitions relating to who may perform, 118
analyze, or interpret a mammogram or the persons to whom the 119
results of a mammogram may be furnished or released. 120
(4)(3) This section does not apply to disability income, 121
specified disease, or hospital indemnity policies. 122
(5)(4) Every insurer subject to the requiremen ts of this 123
section shall make available to the policyholder as part of the 124
application, for an appropriate additional premium, the coverage 125
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required in this section without such coverage being subject to 126
the deductible or coinsurance provisions of the poli cy. 127
Section 3. Section 627.6613, Florida Statutes, is amended 128
to read: 129
627.6613 Coverage for mammograms and supplemental breast 130
cancer screenings.— 131
(1) As used in this section, the term "supplemental breast 132
cancer screening" means a clinically appr opriate examination, in 133
addition to a mammogram, deemed medically necessary by a 134
treating physician for breast cancer screening in accordance 135
with applicable American College of Radiology guidelines, which 136
includes, but is not limited to, magnetic resonanc e imaging, 137
ultrasound, and molecular breast imaging. 138
(2)(1) A group, blanket, or franchise accident or health 139
insurance policy issued, amended, delivered, or renewed in this 140
state on or after July 1, 2025, must provide coverage for at 141
least the following for any woman between 25 and 40 years of 142
age, inclusive: 143
(a) One A baseline mammogram each year, including a 144
digital breast tomosynthesis for any woman who is 35 years of 145
age or older, but younger than 40 years of age . 146
(b) A mammogram every 2 years fo r any woman who is 40 147
years of age or older, but younger than 50 years of age, or more 148
frequently based on the patient's physician's recommendation. 149
(c) A mammogram every year for any woman who is 50 years 150
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of age or older. 151
(b)(d) One supplemental breast cancer screening each or 152
more mammograms a year, based upon a physician's recommendation, 153
if the for any woman who is at risk for breast cancer because of 154
dense breast tissue as the woman's mammogram demonstrates, based 155
on the breast imaging reporting an d data system established by 156
the American College of Radiology; because of a personal or 157
family history of breast cancer ;, because of having a personal 158
history of biopsy-proven benign breast disease ; because of 159
ancestry; because of genetic predisposition; , because of having 160
a mother, sister, or daughter who has or has had breast cancer, 161
or because the a woman has not given birth before the age of 30 ; 162
or because of other reasons as determined by the woman's 163
physician. 164
(3)(2) Except as provided in paragraph (1)(b), for 165
mammograms done more frequently than every 2 years for women 40 166
years of age or older but younger than 50 years of age, The 167
coverage required by subsection (2) (1) applies, with or without 168
a physician prescription, if the insured obtains a mam mogram or, 169
if applicable, a supplemental breast cancer screening in an 170
office, facility, or health testing service that uses 171
radiological equipment registered with the Department of Health 172
for breast cancer screening. The coverage is subject to the 173
deductible and coinsurance provisions applicable to outpatient 174
visits, and is also subject to all other terms and conditions 175
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applicable to other benefits. This section does not affect any 176
requirements or prohibitions relating to who may perform, 177
analyze, or interpret a mammogram or the persons to whom the 178
results of a mammogram may be furnished or released. 179
(4)(3) Every insurer referred to in subsection (2) (1) 180
shall make available to the policyholder as part of the 181
application, for an appropriate additional pre mium, the coverage 182
required in this section without such coverage being subject to 183
the deductible or coinsurance provisions of the policy. 184
Section 4. Section 641.31095, Florida Statutes, is amended 185
to read: 186
641.31095 Coverage for mammograms and supplemental breast 187
cancer screenings.— 188
(1) As used in this section, the term "supplemental breast 189
cancer screening" means a clinically appropriate examination, in 190
addition to a mammogram, deemed medically necessary by a 191
treating physician for breast cancer s creening in accordance 192
with applicable American College of Radiology guidelines, which 193
includes, but is not limited to, magnetic resonance imaging, 194
ultrasound, and molecular breast imaging. 195
(2)(1) Every health maintenance contract issued or renewed 196
on or after July 1, 2025, must January 1, 1996, shall provide 197
coverage for at least the following for any woman between 25 and 198
40 years of age, inclusive : 199
(a) One A baseline mammogram each year, including a 200
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digital breast tomosynthesis for any woman who is 35 years of 201
age or older, but younger than 40 years of age . 202
(b) A mammogram every 2 years for any woman who is 40 203
years of age or older, but younger than 50 years of age, or more 204
frequently based on the patient's physician's recommendations. 205
(c) A mammogram every year for any woman who is 50 years 206
of age or older. 207
(b)(d) One supplemental breast cancer screening each or 208
more mammograms a year, based upon a physician's recommendation , 209
if the for any woman who is at risk for breast cancer because of 210
dense breast tissue as the woman's mammogram demonstrates, based 211
on the breast imaging reporting and data system established by 212
the American College of Radiology; because of a personal or 213
family history of breast cancer;, because of having a personal 214
history of biopsy-proven benign breast disease ; because of 215
ancestry; because of genetic predisposition; , because of having 216
a mother, sister, or daughter who has had breast cancer, or 217
because the a woman has not given birth before the age of 30 ; or 218
because of other reasons as determined by the woman's physician . 219
(3)(2) The coverage required by this section is subject to 220
the deductible and copayment provisions applicable to outpatient 221
visits, and is also subje ct to all other terms and conditions 222
applicable to other benefits. A health maintenance organization 223
shall make available to the subscriber as part of the 224
application, for an appropriate additional premium, the coverage 225
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required in this section without suc h coverage being subject to 226
any deductible or copayment provisions in the contract. 227
Section 5. This act shall take effect July 1, 2025. 228