Florida Senate - 2025 SB 1578 By Senator Davis 5-00578-25 20251578__ 1 A bill to be entitled 2 An act relating to coverage for mammograms and 3 supplemental breast cancer screenings; creating s. 4 409.9064, F.S.; defining the terms mammogram and 5 supplemental breast cancer screening; requiring the 6 Agency for Health Care Administration to provide 7 Medicaid coverage for annual mammograms and 8 supplemental breast cancer screenings for certain 9 women meeting specified criteria, subject to the 10 availability of funds and any limitations or 11 directions the Legislature provides in the General 12 Appropriations Act; requiring the agency to seek 13 federal approval, if needed, to implement specified 14 provisions; amending ss. 627.6418, 627.6613, and 15 641.31095, F.S.; defining the term supplemental 16 breast cancer screening; revising coverage for 17 mammograms under certain individual accident and 18 health insurance policies, certain group, blanket, and 19 franchise accident and health insurance policies, and 20 certain health maintenance contracts, respectively; 21 requiring coverages for supplemental breast cancer 22 screenings under such policies and contracts under 23 certain circumstances; revising applicability; 24 providing an effective date. 25 26 Be It Enacted by the Legislature of the State of Florida: 27 28 Section 1.Section 409.9064, Florida Statutes, is created 29 to read: 30 409.9064Coverage for mammograms and supplemental breast 31 cancer screenings. 32 (1)As used in this section, the term: 33 (a)Mammogram means an image of a radiologic examination 34 used to detect unsuspected breast cancer at an early stage in an 35 asymptomatic woman and includes the X-ray picture of the breast 36 captured using equipment dedicated specifically for mammography, 37 including, but not limited to, the X-ray tube, filter, 38 compression device, screens, film, and cassettes. The radiologic 39 examination must include two views of each breast. The term also 40 includes images from digital breast tomosynthesis and the 41 professional interpretation of images from any mammography 42 equipment but does not include any diagnostic mammography image. 43 (b)Supplemental breast cancer screening means a 44 clinically appropriate examination, in addition to a mammogram, 45 deemed medically necessary by a treating health care provider 46 for breast cancer screening in accordance with applicable 47 American College of Radiology guidelines, which examination 48 includes, but is not limited to, magnetic resonance imaging, 49 ultrasound, and molecular breast imaging. 50 (2)Subject to the availability of funds and subject to any 51 limitations or directions provided in the General Appropriations 52 Act, the agency shall provide coverage for the following every 53 year for a Medicaid recipient who is a woman 25 years of age or 54 older: 55 (a)One mammogram to detect the presence of breast cancer. 56 (b)One supplemental breast cancer screening to detect the 57 presence of breast cancer if: 58 1.Based on the breast imaging reporting and data system 59 established by the American College of Radiology, the womans 60 mammogram demonstrates that the woman has dense breast tissue; 61 or 62 2.The woman is at an increased risk of breast cancer due 63 to any of the following: 64 a.A personal or family history of breast cancer. 65 b.A personal history of biopsy-proven benign breast 66 disease. 67 c.Ancestry. 68 d.Genetic predisposition. 69 e.Not having given birth before the age of 30. 70 f.Other reasons as determined by the womans health care 71 provider. 72 (3)The agency shall seek federal approval, if needed, for 73 the implementation of this section. 74 Section 2.Section 627.6418, Florida Statutes, is amended 75 to read: 76 627.6418Coverage for mammograms and supplemental breast 77 cancer screenings. 78 (1)As used in this section, the term supplemental breast 79 cancer screening means a clinically appropriate examination, in 80 addition to a mammogram, deemed medically necessary by a 81 treating health care provider for breast cancer screening in 82 accordance with applicable American College of Radiology 83 guidelines, which examination includes, but is not limited to, 84 magnetic resonance imaging, ultrasound, and molecular breast 85 imaging. 86 (2)An accident or health insurance policy issued, amended, 87 delivered, or renewed in this state on or after July 1, 2025, 88 must provide coverage for at least the following for any woman 89 who is 25 years of age or older: 90 (a)One A baseline mammogram a year, including a digital 91 breast tomosynthesis mammogram for any woman who is 35 years of 92 age or older, but younger than 40 years of age. 93 (b)A mammogram every 2 years for any woman who is 40 years 94 of age or older, but younger than 50 years of age, or more 95 frequently based on the patients physicians recommendation. 96 (c)A mammogram every year for any woman who is 50 years of 97 age or older. 98 (d)One supplemental breast cancer screening or more 99 mammograms a year, based upon a physicians recommendation, if 100 the for any woman who is at risk for breast cancer because of 101 dense breast tissue, as demonstrated by the womans mammogram 102 and based on the breast imaging reporting and data system 103 established by the American College of Radiology; because of a 104 personal or family history of breast cancer;, because of having 105 a personal history of biopsy-proven benign breast disease; 106 because of ancestry; because of genetic predisposition;, because 107 of having a mother, sister, or daughter who has or has had 108 breast cancer, or because the a woman has not given birth before 109 the age of 30; or because of other reasons as determined by the 110 womans physician. 111 (3)(2)Except as provided in paragraph (1)(b), for 112 mammograms done more frequently than every 2 years for women 40 113 years of age or older but younger than 50 years of age, The 114 coverage required by subsection (2) (1) applies, with or without 115 a physician prescription, if the insured obtains a mammogram 116 and, if applicable, a supplemental breast cancer screening in an 117 office, facility, or health testing service that uses 118 radiological equipment registered with the Department of Health 119 for breast cancer screening. The coverage is subject to the 120 deductible and coinsurance provisions applicable to outpatient 121 visits, and is also subject to all other terms and conditions 122 applicable to other benefits. This section does not affect any 123 requirements or prohibitions relating to who may perform, 124 analyze, or interpret a mammogram or the persons to whom the 125 results of a mammogram may be furnished or released. 126 (4)(3)This section does not apply to disability income, 127 specified disease, or hospital indemnity policies. 128 (5)(4)Every insurer subject to the requirements of this 129 section shall make available to the policyholder as part of the 130 application, for an appropriate additional premium, the coverage 131 required in this section without such coverage being subject to 132 the deductible or coinsurance provisions of the policy. 133 Section 3.Section 627.6613, Florida Statutes, is amended 134 to read: 135 627.6613Coverage for mammograms and supplemental breast 136 cancer screenings. 137 (1)As used in this section, the term supplemental breast 138 cancer screening means a clinically appropriate examination, in 139 addition to a mammogram, deemed medically necessary by a 140 treating physician for breast cancer screening in accordance 141 with applicable American College of Radiology guidelines, which 142 examination includes, but is not limited to, magnetic resonance 143 imaging, ultrasound, and molecular breast imaging. 144 (2)A group, blanket, or franchise accident or health 145 insurance policy issued, amended, delivered, or renewed in this 146 state on or after July 1, 2025, must provide coverage for at 147 least the following for any woman who is 25 years of age or 148 older: 149 (a)One A baseline mammogram a year, including a digital 150 breast tomosynthesis mammogram for any woman who is 35 years of 151 age or older, but younger than 40 years of age. 152 (b)A mammogram every 2 years for any woman who is 40 years 153 of age or older, but younger than 50 years of age, or more 154 frequently based on the patients physicians recommendation. 155 (c)A mammogram every year for any woman who is 50 years of 156 age or older. 157 (d)One supplemental breast cancer screening or more 158 mammograms a year, based upon a physicians recommendation, if 159 the for any woman who is at risk for breast cancer because of 160 dense breast tissue as demonstrated by the womans mammogram and 161 based on the breast imaging reporting and data system 162 established by the American College of Radiology; because of a 163 personal or family history of breast cancer;, because of having 164 a personal history of biopsy-proven benign breast disease; 165 because of ancestry; because of genetic predisposition;, because 166 of having a mother, sister, or daughter who has or has had 167 breast cancer, or because the a woman has not given birth before 168 the age of 30; or because of other reasons as determined by the 169 womans physician. 170 (3)(2)Except as provided in paragraph (1)(b), for 171 mammograms done more frequently than every 2 years for women 40 172 years of age or older but younger than 50 years of age, The 173 coverage required by subsection (2) (1) applies, with or without 174 a physician prescription, if the insured obtains a mammogram 175 and, if applicable, a supplemental breast cancer screening in an 176 office, facility, or health testing service that uses 177 radiological equipment registered with the Department of Health 178 for breast cancer screening. The coverage is subject to the 179 deductible and coinsurance provisions applicable to outpatient 180 visits, and is also subject to all other terms and conditions 181 applicable to other benefits. This section does not affect any 182 requirements or prohibitions relating to who may perform, 183 analyze, or interpret a mammogram or the persons to whom the 184 results of a mammogram may be furnished or released. 185 (4)(3)Every insurer referred to in subsection (2) (1) 186 shall make available to the policyholder as part of the 187 application, for an appropriate additional premium, the coverage 188 required in this section without such coverage being subject to 189 the deductible or coinsurance provisions of the policy. 190 Section 4.Section 641.31095, Florida Statutes, is amended 191 to read: 192 641.31095Coverage for mammograms and supplemental breast 193 cancer screenings. 194 (1)As used in this section, the term supplemental breast 195 cancer screening means a clinically appropriate examination, in 196 addition to a mammogram, deemed medically necessary by a 197 treating physician for breast cancer screening in accordance 198 with applicable American College of Radiology guidelines, which 199 examination includes, but is not limited to, magnetic resonance 200 imaging, ultrasound, and molecular breast imaging. 201 (2)Every health maintenance contract issued or renewed on 202 or after July 1, 2025, must January 1, 1996, shall provide 203 coverage for at least the following for any woman who is 25 204 years of age or older: 205 (a)One A baseline mammogram a year, including a digital 206 breast tomosynthesis mammogram for any woman who is 35 years of 207 age or older, but younger than 40 years of age. 208 (b)A mammogram every 2 years for any woman who is 40 years 209 of age or older, but younger than 50 years of age, or more 210 frequently based on the patients physicians recommendations. 211 (c)A mammogram every year for any woman who is 50 years of 212 age or older. 213 (d)One supplemental breast cancer screening or more 214 mammograms a year, based upon a physicians recommendation, if 215 the for any woman who is at risk for breast cancer because of 216 dense breast tissue as demonstrated by the womans mammogram and 217 based on the breast imaging reporting and data system 218 established by the American College of Radiology; because of a 219 personal or family history of breast cancer;, because of having 220 a personal history of biopsy-proven benign breast disease; 221 because of ancestry; because of genetic predisposition;, because 222 of having a mother, sister, or daughter who has had breast 223 cancer, or because the a woman has not given birth before the 224 age of 30; or because of other reasons as determined by the 225 womans physician. 226 (3)(2)The coverage required by this section is subject to 227 the deductible and copayment provisions applicable to outpatient 228 visits, and is also subject to all other terms and conditions 229 applicable to other benefits. A health maintenance organization 230 shall make available to the subscriber as part of the 231 application, for an appropriate additional premium, the coverage 232 required in this section without such coverage being subject to 233 any deductible or copayment provisions in the contract. 234 Section 5.This act shall take effect July 1, 2025.