Florida 2025 Regular Session

Florida House Bill H0187 Compare Versions

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

Old	New	Differences
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3	3	HB 187 2025
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6	6
7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb187-00
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10	10	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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12	12
13	13
14	14	A bill to be entitled 1
15	15	An act relating to coverage for mammograms and 2
16	16	supplemental breast cancer screenings; creating s. 3
17	17	409.9064, F.S.; providing definitions; requiring the 4
18	18	Agency for Health Care Administration to provide 5
19	19	coverage for yearly mammograms and yearly supplemental 6
20	20	breast cancer screenings for certain women under the 7
21	21	Medicaid program under certain circumstances; 8
22	22	requiring the agency to seek federal approval under a 9
23	23	specified circumstance; amending ss. 627.6418, 10
24	24	627.6613, and 641.31095, F.S.; defining the term 11
25	25	"supplemental breast cancer screening"; revising 12
26	26	coverages for mammograms under certain individual 13
27	27	accident and health insurance policies, group, 14
28	28	blanket, and franchise accident and health insurance 15
29	29	policies, and health maintenance contracts, 16
30	30	respectively; requiring coverages for supplemental 17
31	31	breast cancer screenings under such policies and 18
32	32	contracts under certain circumstances; providing 19
33	33	applicability; providing an effec tive date. 20
34	34	21
35	35	Be It Enacted by the Legislature of the State of Florida: 22
36	36	23
37	37	Section 1. Section 409.9064, Florida Statutes, is created 24
38	38	to read: 25
39	39
40	40	HB 187 2025
41	41
42	42
43	43
44	44	CODING: Words stricken are deletions; words underlined are additions.
45	45	hb187-00
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47	47	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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51	51	409.9064 Coverage for mammograms and supplemental breast 26
52	52	cancer screenings.— 27
53	53	(1) As used in this section, the term: 28
54	54	(a) "Mammogram" means an image of a radiologic examination 29
55	55	used to detect unsuspected breast cancer at an early stage in an 30
56	56	asymptomatic woman and includes the X -ray picture of the breast 31
57	57	using equipment that is dedicated specifically for mammo graphy, 32
58	58	including, but not limited to, the X -ray tube, filter, 33
59	59	compression device, screens, film, and cassettes. The radiologic 34
60	60	examination must include two views of each breast. The term also 35
61	61	includes images from digital breast tomosynthesis and the 36
62	62	professional interpretation of images from any mammography 37
63	63	equipment, but does not include any diagnostic mammography 38
64	64	image. 39
65	65	(b) "Supplemental breast cancer screening" means a 40
66	66	clinically appropriate examination, in addition to a mammogram, 41
67	67	deemed medically necessary by a treating health care provider 42
68	68	for breast cancer screening in accordance with applicable 43
69	69	American College of Radiology guidelines, which includes, but is 44
70	70	not limited to, magnetic resonance imaging, ultrasound, and 45
71	71	molecular breast imaging. 46
72	72	(2) Subject to the availability of funds and subject to 47
73	73	any limitations or directions provided in the General 48
74	74	Appropriations Act, the agency must provide the following 49
75	75	coverage each year for a Medicaid recipient who is a woman 50
76	76
77	77	HB 187 2025
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79	79
80	80
81	81	CODING: Words stricken are deletions; words underlined are additions.
82	82	hb187-00
83	83	Page 3 of 10
84	84	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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86	86
87	87
88	88	between 25 and 40 years of age, inclusive: 51
89	89	(a) One mammogram to detect the presence of breast cancer. 52
90	90	(b) One supplemental breast cancer screening to detect the 53
91	91	presence of breast cancer if: 54
92	92	1. The woman's mammogram demonstrates, based on the breast 55
93	93	imaging reporting and data syst em established by the American 56
94	94	College of Radiology, that the woman has dense breast tissue; or 57
95	95	2. The woman is at an increased risk of breast cancer due 58
96	96	to: 59
97	97	a. A personal or family history of breast cancer; 60
98	98	b. A personal history of biopsy -proven benign breast 61
99	99	disease; 62
100	100	c. Ancestry; 63
101	101	d. Genetic predisposition; 64
102	102	e. Not having given birth before the age of 30; or 65
103	103	f. Other reasons as determined by the woman's health care 66
104	104	provider. 67
105	105	(3) The agency shall seek federal approval, if needed, for 68
106	106	the implementation of this section. 69
107	107	Section 2. Section 627.6418, Florida Statutes, is amended, 70
108	108	to read: 71
109	109	627.6418 Coverage for mammograms and supplemental breast 72
110	110	cancer screenings.— 73
111	111	(1) As used in this section, the term "supplemental breast 74
112	112	cancer screening" means a clinically appropriate examination, in 75
113	113
114	114	HB 187 2025
115	115
116	116
117	117
118	118	CODING: Words stricken are deletions; words underlined are additions.
119	119	hb187-00
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121	121	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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123	123
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125	125	addition to a mammogram, deemed medically necessary by a 76
126	126	treating physician for breast cancer screening in accordance 77
127	127	with applicable American College of Radiology guidelines, which 78
128	128	includes, but is not limited to, magnetic resonance imaging, 79
129	129	ultrasound, and molecular breast imaging. 80
130	130	(2)(1) An accident or health insurance policy issued, 81
131	131	amended, delivered, or renewed in this state on or after July 1, 82
132	132	2025, must provide coverage for at least the followin g for any 83
133	133	woman between 25 and 40 years of age, inclusive : 84
134	134	(a) One A baseline mammogram each year, including a 85
135	135	digital breast tomosynthesis for any woman who is 35 years of 86
136	136	age or older, but younger than 40 years of age . 87
137	137	(b) A mammogram every 2 years f or any woman who is 40 88
138	138	years of age or older, but younger than 50 years of age, or more 89
139	139	frequently based on the patient's physician's recommendation. 90
140	140	(c) A mammogram every year for any woman who is 50 years 91
141	141	of age or older. 92
142	142	(b)(d) One supplemental breast cancer screening each or 93
143	143	more mammograms a year, based upon a physician's recommendation, 94
144	144	if the for any woman who is at risk for breast cancer because of 95
145	145	dense breast tissue as the woman's mammogram demonstrates, based 96
146	146	on the breast imaging reporting a nd data system established by 97
147	147	the American College of Radiology; because of a personal or 98
148	148	family history of breast cancer ;, because of having a personal 99
149	149	history of biopsy-proven benign breast disease ; because of 100
150	150
151	151	HB 187 2025
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153	153
154	154
155	155	CODING: Words stricken are deletions; words underlined are additions.
156	156	hb187-00
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158	158	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
159	159
160	160
161	161
162	162	ancestry; because of genetic predisposition; , because of having 101
163	163	a mother, sister, or daughter who has or has had breast cancer, 102
164	164	or because the a woman has not given birth before the age of 30 ; 103
165	165	or because of other reasons as determined by the woman's 104
166	166	physician. 105
167	167	(3)(2) Except as provided in paragrap h (1)(b), for 106
168	168	mammograms done more frequently than every 2 years for women 40 107
169	169	years of age or older but younger than 50 years of age, The 108
170	170	coverage required by subsection (2) (1) applies, with or without 109
171	171	a physician prescription, if the insured obtains a ma mmogram or, 110
172	172	if applicable, a supplemental breast cancer screening in an 111
173	173	office, facility, or health testing service that uses 112
174	174	radiological equipment registered with the Department of Health 113
175	175	for breast cancer screening. The coverage is subject to the 114
176	176	deductible and coinsurance provisions applicable to outpatient 115
177	177	visits, and is also subject to all other terms and conditions 116
178	178	applicable to other benefits. This section does not affect any 117
179	179	requirements or prohibitions relating to who may perform, 118
180	180	analyze, or interpret a mammogram or the persons to whom the 119
181	181	results of a mammogram may be furnished or released. 120
182	182	(4)(3) This section does not apply to disability income, 121
183	183	specified disease, or hospital indemnity policies. 122
184	184	(5)(4) Every insurer subject to the requiremen ts of this 123
185	185	section shall make available to the policyholder as part of the 124
186	186	application, for an appropriate additional premium, the coverage 125
187	187
188	188	HB 187 2025
189	189
190	190
191	191
192	192	CODING: Words stricken are deletions; words underlined are additions.
193	193	hb187-00
194	194	Page 6 of 10
195	195	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
196	196
197	197
198	198
199	199	required in this section without such coverage being subject to 126
200	200	the deductible or coinsurance provisions of the poli cy. 127
201	201	Section 3. Section 627.6613, Florida Statutes, is amended 128
202	202	to read: 129
203	203	627.6613 Coverage for mammograms and supplemental breast 130
204	204	cancer screenings.— 131
205	205	(1) As used in this section, the term "supplemental breast 132
206	206	cancer screening" means a clinically appr opriate examination, in 133
207	207	addition to a mammogram, deemed medically necessary by a 134
208	208	treating physician for breast cancer screening in accordance 135
209	209	with applicable American College of Radiology guidelines, which 136
210	210	includes, but is not limited to, magnetic resonanc e imaging, 137
211	211	ultrasound, and molecular breast imaging. 138
212	212	(2)(1) A group, blanket, or franchise accident or health 139
213	213	insurance policy issued, amended, delivered, or renewed in this 140
214	214	state on or after July 1, 2025, must provide coverage for at 141
215	215	least the following for any woman between 25 and 40 years of 142
216	216	age, inclusive: 143
217	217	(a) One A baseline mammogram each year, including a 144
218	218	digital breast tomosynthesis for any woman who is 35 years of 145
219	219	age or older, but younger than 40 years of age . 146
220	220	(b) A mammogram every 2 years fo r any woman who is 40 147
221	221	years of age or older, but younger than 50 years of age, or more 148
222	222	frequently based on the patient's physician's recommendation. 149
223	223	(c) A mammogram every year for any woman who is 50 years 150
224	224
225	225	HB 187 2025
226	226
227	227
228	228
229	229	CODING: Words stricken are deletions; words underlined are additions.
230	230	hb187-00
231	231	Page 7 of 10
232	232	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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234	234
235	235
236	236	of age or older. 151
237	237	(b)(d) One supplemental breast cancer screening each or 152
238	238	more mammograms a year, based upon a physician's recommendation, 153
239	239	if the for any woman who is at risk for breast cancer because of 154
240	240	dense breast tissue as the woman's mammogram demonstrates, based 155
241	241	on the breast imaging reporting an d data system established by 156
242	242	the American College of Radiology; because of a personal or 157
243	243	family history of breast cancer ;, because of having a personal 158
244	244	history of biopsy-proven benign breast disease ; because of 159
245	245	ancestry; because of genetic predisposition; , because of having 160
246	246	a mother, sister, or daughter who has or has had breast cancer, 161
247	247	or because the a woman has not given birth before the age of 30 ; 162
248	248	or because of other reasons as determined by the woman's 163
249	249	physician. 164
250	250	(3)(2) Except as provided in paragraph (1)(b), for 165
251	251	mammograms done more frequently than every 2 years for women 40 166
252	252	years of age or older but younger than 50 years of age, The 167
253	253	coverage required by subsection (2) (1) applies, with or without 168
254	254	a physician prescription, if the insured obtains a mam mogram or, 169
255	255	if applicable, a supplemental breast cancer screening in an 170
256	256	office, facility, or health testing service that uses 171
257	257	radiological equipment registered with the Department of Health 172
258	258	for breast cancer screening. The coverage is subject to the 173
259	259	deductible and coinsurance provisions applicable to outpatient 174
260	260	visits, and is also subject to all other terms and conditions 175
261	261
262	262	HB 187 2025
263	263
264	264
265	265
266	266	CODING: Words stricken are deletions; words underlined are additions.
267	267	hb187-00
268	268	Page 8 of 10
269	269	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
270	270
271	271
272	272
273	273	applicable to other benefits. This section does not affect any 176
274	274	requirements or prohibitions relating to who may perform, 177
275	275	analyze, or interpret a mammogram or the persons to whom the 178
276	276	results of a mammogram may be furnished or released. 179
277	277	(4)(3) Every insurer referred to in subsection (2) (1) 180
278	278	shall make available to the policyholder as part of the 181
279	279	application, for an appropriate additional pre mium, the coverage 182
280	280	required in this section without such coverage being subject to 183
281	281	the deductible or coinsurance provisions of the policy. 184
282	282	Section 4. Section 641.31095, Florida Statutes, is amended 185
283	283	to read: 186
284	284	641.31095 Coverage for mammograms and supplemental breast 187
285	285	cancer screenings.— 188
286	286	(1) As used in this section, the term "supplemental breast 189
287	287	cancer screening" means a clinically appropriate examination, in 190
288	288	addition to a mammogram, deemed medically necessary by a 191
289	289	treating physician for breast cancer s creening in accordance 192
290	290	with applicable American College of Radiology guidelines, which 193
291	291	includes, but is not limited to, magnetic resonance imaging, 194
292	292	ultrasound, and molecular breast imaging. 195
293	293	(2)(1) Every health maintenance contract issued or renewed 196
294	294	on or after July 1, 2025, must January 1, 1996, shall provide 197
295	295	coverage for at least the following for any woman between 25 and 198
296	296	40 years of age, inclusive : 199
297	297	(a) One A baseline mammogram each year, including a 200
298	298
299	299	HB 187 2025
300	300
301	301
302	302
303	303	CODING: Words stricken are deletions; words underlined are additions.
304	304	hb187-00
305	305	Page 9 of 10
306	306	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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308	308
309	309
310	310	digital breast tomosynthesis for any woman who is 35 years of 201
311	311	age or older, but younger than 40 years of age . 202
312	312	(b) A mammogram every 2 years for any woman who is 40 203
313	313	years of age or older, but younger than 50 years of age, or more 204
314	314	frequently based on the patient's physician's recommendations. 205
315	315	(c) A mammogram every year for any woman who is 50 years 206
316	316	of age or older. 207
317	317	(b)(d) One supplemental breast cancer screening each or 208
318	318	more mammograms a year, based upon a physician's recommendation , 209
319	319	if the for any woman who is at risk for breast cancer because of 210
320	320	dense breast tissue as the woman's mammogram demonstrates, based 211
321	321	on the breast imaging reporting and data system established by 212
322	322	the American College of Radiology; because of a personal or 213
323	323	family history of breast cancer;, because of having a personal 214
324	324	history of biopsy-proven benign breast disease ; because of 215
325	325	ancestry; because of genetic predisposition; , because of having 216
326	326	a mother, sister, or daughter who has had breast cancer, or 217
327	327	because the a woman has not given birth before the age of 30 ; or 218
328	328	because of other reasons as determined by the woman's physician . 219
329	329	(3)(2) The coverage required by this section is subject to 220
330	330	the deductible and copayment provisions applicable to outpatient 221
331	331	visits, and is also subje ct to all other terms and conditions 222
332	332	applicable to other benefits. A health maintenance organization 223
333	333	shall make available to the subscriber as part of the 224
334	334	application, for an appropriate additional premium, the coverage 225
335	335
336	336	HB 187 2025
337	337
338	338
339	339
340	340	CODING: Words stricken are deletions; words underlined are additions.
341	341	hb187-00
342	342	Page 10 of 10
343	343	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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345	345
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347	347	required in this section without suc h coverage being subject to 226
348	348	any deductible or copayment provisions in the contract. 227
349	349	Section 5. This act shall take effect July 1, 2025. 228