Senate Study Bill 1221 - Introduced SENATE FILE _____ BY (PROPOSED COMMITTEE ON COMMERCE BILL BY CHAIRPERSON BROWN) A BILL FOR An Act relating to insurance coverage for supplemental and 1 diagnostic breast examinations. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 1794XC (8) 90 ko/rn
S.F. _____ Section 1. NEW SECTION . 514C.4A Supplemental and diagnostic 1 breast examinations. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. Breast magnetic resonance imaging or breast MRI means 5 an examination of a breast using a powerful magnetic field, 6 radio waves, and a computer to produce detailed pictures of the 7 structures within the breast. 8 b. Breast ultrasound means a noninvasive examination of 9 a breast using high-frequency sound waves to produce detailed 10 images of the breast. 11 c. Cost-sharing means any coverage limit, copayment, 12 coinsurance, deductible, or other out-of-pocket expense 13 obligation imposed on a covered person by a policy, contract, 14 or plan providing for third-party payment or prepayment of 15 health or medical expenses. 16 d. Covered person means a policyholder, subscriber, or 17 other person participating in a policy, contract, or plan that 18 provides for third-party payment or prepayment of health or 19 medical expenses. 20 e. Diagnostic breast cancer examination means a medically 21 necessary and appropriate examination of the breast that may 22 include diagnostic mammography, breast magnetic resonance 23 imaging, or breast ultrasound, and that is performed for any of 24 the following reasons: 25 (1) To evaluate an abnormality seen or suspected during a 26 screening examination for breast cancer. 27 (2) To evaluate an abnormality detected by another means of 28 examination. 29 f. Diagnostic mammogram means a detailed examination of a 30 breast abnormality using X ray. 31 g. Health care professional means the same as defined in 32 section 514J.102. 33 h. Health care services means services for the diagnosis, 34 prevention, treatment, cure, or relief of a health condition, 35 -1- LSB 1794XC (8) 90 ko/rn 1/ 3
S.F. _____ illness, injury, or disease. 1 i. Screening mammogram means an examination of a breast 2 that aids in the early detection and diagnosis of breast 3 cancer. 4 j. Supplemental breast examination means a medically 5 necessary and appropriate examination of the breast that may 6 include breast magnetic resonance imaging or breast ultrasound, 7 and that is performed to screen for breast cancer when there is 8 no abnormality seen or suspected and based on an individuals 9 personal or family medical history, or additional factors that 10 may increase the individuals risk of breast cancer. 11 2. a. Notwithstanding the uniformity of treatment 12 requirements of section 514C.6, a policy, contract, or plan 13 providing for third-party payment or prepayment of health or 14 medical expenses shall provide coverage for supplemental breast 15 examinations and diagnostic breast cancer examinations. 16 b. Coverage required under this section shall not be less 17 favorable than coverage a health carrier offers for screening 18 mammograms. 19 c. Cost-sharing requirements shall not be imposed by a 20 health carrier for coverage required under this section. 21 3. a. This section applies to the following classes of 22 third-party payment provider contracts, policies, or plans 23 delivered, issued for delivery, continued, or renewed in this 24 state on or after January 1, 2024: 25 (1) Individual or group accident and sickness insurance 26 providing coverage on an expense-incurred basis. 27 (2) An individual or group hospital or medical service 28 contract issued pursuant to chapter 509, 514, or 514A. 29 (3) An individual or group health maintenance organization 30 contract regulated under chapter 514B. 31 (4) A plan established for public employees pursuant to 32 chapter 509A. 33 b. This section shall not apply to accident-only, specified 34 disease, short-term hospital or medical, hospital confinement 35 -2- LSB 1794XC (8) 90 ko/rn 2/ 3
S.F. _____ indemnity, credit, dental, vision, Medicare supplement, 1 long-term care, basic hospital and medical-surgical expense 2 coverage as defined by the commissioner of insurance, 3 disability income insurance coverage, coverage issued as a 4 supplement to liability insurance, workers compensation or 5 similar insurance, or automobile medical payment insurance. 6 4. The commissioner of insurance may adopt rules pursuant to 7 chapter 17A to administer this section. 8 EXPLANATION 9 The inclusion of this explanation does not constitute agreement with 10 the explanations substance by the members of the general assembly. 11 This bill relates to insurance coverage for supplemental 12 breast examinations (supplemental examinations) and diagnostic 13 breast cancer examinations (diagnostic examinations). 14 The bill requires a policy, contract, or plan providing 15 for third-party payment or prepayment of health or medical 16 expenses to provide coverage for supplemental examinations 17 and diagnostic examinations. Supplemental examination and 18 diagnostic examination are defined in the bill. Coverage 19 required under the bill shall not be less favorable than 20 coverage a health carrier offers for screening mammograms. The 21 health carrier shall not impose cost-sharing for supplemental 22 examinations or diagnostic examinations. Cost-sharing and 23 screening mammogram are defined in the bill. 24 The bill applies to the third-party payment providers 25 enumerated in the bill. The bill specifies the types of 26 specialized health-related insurance which are not subject to 27 the coverage requirements of the bill. 28 The commissioner of insurance may adopt rules to administer 29 the requirements of the bill. 30 The provisions of the bill are applicable to third-party 31 payment provider contracts, policies, or plans delivered, 32 issued for delivery, continued, or renewed in this state on or 33 after January 1, 2024. 34 -3- LSB 1794XC (8) 90 ko/rn 3/ 3