HOUSE . . . . . . . No. 4918
The Commonwealth of Massachusetts
______________________________________
HOUSE OF REPRESENTATIVES, July 25, 2024.
The committee on Ways and Means, to whom was referred the Bill
relative to breast cancer equity and early detection (House, No. 4410),
reports recommending that the same ought to pass with an amendment
substituting therefor the accompanying bill (House, No. 4918).
For the committee,
AARON MICHLEWITZ. 1 of 11
FILED ON: 7/25/2024
HOUSE . . . . . . . . . . . . . . . No. 4918
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
An Act relative to medically necessary breast screenings and exams for equity and early
detection.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Chapter 32A of the General Laws is hereby amended by adding the
2following section:-
3 Section 34. (a) As used in this section, the following words shall, unless the context
4clearly requires otherwise, have the following meanings:
5 “Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the
6application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
7 “Diagnostic examinations for breast cancer”, a medically necessary and appropriate
8examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected
9from a screening examination for breast cancer, detected by another means of examination or
10suspected based on the medical history or family medical history of the individual. 2 of 11
11 “Examination for breast cancer”, an examination used to evaluate an abnormality in a
12breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance
13imaging or breast ultrasound.
14 “HSA-qualified health insurance policy”, a policy of individual or group health insurance
15coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as
16implemented and interpreted by the United States Department of the Treasury in the regulations
17and guidance in effect at the time the policy is issued.
18 (b) Any coverage offered by the commission to an active or retired employee of the
19commonwealth insured through the commission that provides medical expense coverage for
20screening mammograms shall provide coverage for diagnostic examinations for breast cancer,
21digital breast tomosynthesis screening and medically necessary and appropriate screening with
22breast magnetic resonance imaging or screening breast ultrasound on a basis not less favorable
23than screening mammograms that are covered as medical benefits. There shall be no increase in
24patient cost sharing for: (i) screening mammograms; (ii) digital breast tomosynthesis; (iii)
25screening breast magnetic resonance imaging; (iv) screening breast ultrasound; or (v) diagnostic
26examinations for breast cancer.
27 (c)(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy
28shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required
29under any general or special law to the extent that the exemption is necessary to allow the policy
30to be an HSA-qualified health insurance policy.
31 (2) The exemption provided in paragraph (1) shall not apply to any coverage required
32under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223, 3 of 11
33with respect to any HSA-qualified health insurance policy issued, delivered, amended or
34renewed while such regulation or guidance is effective.
35 SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after
36section 10Q the following section:-
37 Section 10R. (a) As used in this section, the following words shall, unless the context
38clearly requires otherwise, have the following meanings:
39 “Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the
40application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
41 “Diagnostic examinations for breast cancer”, a medically necessary and appropriate
42examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected
43from a screening examination for breast cancer, detected by another means of examination or
44suspected based on the medical history or family medical history of the individual.
45 “Examination for breast cancer”, an examination used to evaluate an abnormality in a
46breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance
47imaging or breast ultrasound.
48 “HSA-qualified health insurance policy”, a policy of individual or group health insurance
49coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as
50implemented and interpreted by the United States Department of the Treasury in the regulations
51and guidance in effect at the time the policy is issued.
52 (b) The division and its contracted health insurers, health plans, health maintenance
53organizations and third-party administrators under contract to a Medicaid managed care 4 of 11
54organization, primary care clinician plan or an accountable care organization shall provide
55coverage for diagnostic examinations for breast cancer, digital breast tomosynthesis screening
56and medically necessary and appropriate screening with breast magnetic resonance imaging or
57screening breast ultrasound on a basis not less favorable than screening mammograms that are
58covered as medical benefits. There shall be no increase in patient cost sharing for: (i) screening
59mammograms; (ii) digital breast tomosynthesis; (iii) screening breast magnetic resonance
60imaging; (iv) screening breast ultrasound; or (v) diagnostic examinations for breast cancer.
61 (c)(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy
62shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required
63under any general or special law to the extent that the exemption is necessary to allow the policy
64to be an HSA-qualified health insurance policy.
65 (2) The exemption provided in paragraph (1) shall not apply to any coverage required
66under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223,
67with respect to any HSA-qualified health insurance policy issued, delivered, amended or
68renewed while such regulation or guidance is effective.
69 SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after
70section 47UU the following section:-
71 Section 47VV. (a) As used in this section, the following words shall, unless the context
72clearly requires otherwise, have the following meanings:
73 “Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the
74application of such a deductible, coinsurance, copayment or similar out-of-pocket expense. 5 of 11
75 “Diagnostic examinations for breast cancer”, a medically necessary and appropriate
76examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected
77from a screening examination for breast cancer, detected by another means of examination or
78suspected based on the medical history or family medical history of the individual.
79 “Examination for breast cancer”, an examination used to evaluate an abnormality in a
80breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance
81imaging or breast ultrasound.
82 “HSA-qualified health insurance policy”, a policy of individual or group health insurance
83coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as
84implemented and interpreted by the United States Department of the Treasury in the regulations
85and guidance in effect at the time the policy is issued.
86 (b) Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
87renewed within the commonwealth, that provides medical expense coverage for screening
88mammograms shall provide coverage for diagnostic examinations for breast cancer, digital breast
89tomosynthesis screening and medically necessary and appropriate screening with breast magnetic
90resonance imaging or screening breast ultrasound on a basis not less favorable than screening
91mammograms that are covered as medical benefits. There shall be no increase in patient cost
92sharing for: (i) screening mammograms; (ii) digital breast tomosynthesis; (iii) screening breast
93magnetic resonance imaging; (iv) screening breast ultrasound; or (v) diagnostic examinations for
94breast cancer.
95 (c)(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy
96shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required 6 of 11
97under any general or special law to the extent that the exemption is necessary to allow the policy
98to be an HSA-qualified health insurance policy.
99 (2) The exemption provided in paragraph (1) shall not apply to any coverage required
100under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223,
101with respect to any HSA-qualified health insurance policy issued, delivered, amended or
102renewed while such regulation or guidance is effective.
103 SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after
104section 8VV the following section:-
105 Section 8WW. (a) As used in this section, the following words shall, unless the context
106clearly requires otherwise, have the following meanings:
107 “Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the
108application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
109 “Diagnostic examinations for breast cancer”, a medically necessary and appropriate
110examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected
111from a screening examination for breast cancer, detected by another means of examination or
112suspected based on the medical history or family medical history of the individual.
113 “Examination for breast cancer”, an examination used to evaluate an abnormality in a
114breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance
115imaging or breast ultrasound.
116 “HSA-qualified health insurance policy”, a policy of individual or group health insurance
117coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as 7 of 11
118implemented and interpreted by the United States Department of the Treasury in the regulations
119and guidance in effect at the time the policy is issued.
120 (b) Any contract between a subscriber and a corporation under an individual or group
121hospital service plan which is delivered, issued or renewed within the commonwealth that
122provides coverage for screening mammograms shall provide coverage for diagnostic
123examinations for breast cancer, digital breast tomosynthesis screening and medically necessary
124and appropriate screening with breast magnetic resonance imaging or screening breast ultrasound
125on a basis not less favorable than screening mammograms that are covered as medical benefits.
126There shall be no increase in patient cost sharing for: (i) screening mammograms; (ii) digital
127breast tomosynthesis; (iii) screening breast magnetic resonance imaging; (iv) screening breast
128ultrasound; or (v) diagnostic examinations for breast cancer.
129 (c)(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy
130shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required
131under any general or special law to the extent that the exemption is necessary to allow the policy
132to be an HSA-qualified health insurance policy.
133 (2) The exemption provided in paragraph (1) shall not apply to any coverage required
134under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223,
135with respect to any HSA-qualified health insurance policy issued, delivered, amended or
136renewed while such regulation or guidance is effective.
137 SECTION 5. Chapter 176B of the General Laws is hereby amended by inserting after
138section 4VV the following section:- 8 of 11
139 Section 4WW. (a) As used in this section, the following words shall, unless the context
140clearly requires otherwise, have the following meanings:
141 “Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the
142application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
143 “Diagnostic examinations for breast cancer”, a medically necessary and appropriate
144examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected
145from a screening examination for breast cancer, detected by another means of examination or
146suspected based on the medical history or family medical history of the individual.
147 “Examination for breast cancer”, an examination used to evaluate an abnormality in a
148breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance
149imaging or breast ultrasound.
150 “HSA-qualified health insurance policy”, a policy of individual or group health insurance
151coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as
152implemented and interpreted by the United States Department of the Treasury in the regulations
153and guidance in effect at the time the policy is issued.
154 (b) Any subscription certificate under an individual or group medical service agreement
155delivered, issued or renewed within the commonwealth that provides coverage for screening
156mammograms shall provide coverage for diagnostic examinations for breast cancer, digital breast
157tomosynthesis screening and medically necessary and appropriate screening with breast magnetic
158resonance imaging or screening breast ultrasound on a basis not less favorable than screening
159mammograms that are covered as medical benefits. There shall be no increase in patient cost
160sharing for: (i) screening mammograms; (ii) digital breast tomosynthesis; (iii) screening breast 9 of 11
161magnetic resonance imaging; (iv) screening breast ultrasound; or (v) diagnostic examinations for
162breast cancer.
163 (c)(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy
164shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required
165under any general or special law to the extent that the exemption is necessary to allow the policy
166to be an HSA-qualified health insurance policy.
167 (2) The exemption provided in paragraph (1) shall not apply to any coverage required
168under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223,
169with respect to any HSA-qualified health insurance policy issued, delivered, amended or
170renewed while such regulation or guidance is effective.
171 SECTION 6. Chapter 176G of the General Laws is hereby amended by inserting after
172section 4NN the following section:-
173 Section 4OO. (a) As used in this section, the following words shall, unless the context
174clearly requires otherwise, have the following meanings:
175 “Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the
176application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
177 “Diagnostic examinations for breast cancer”, a medically necessary and appropriate
178examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected
179from a screening examination for breast cancer, detected by another means of examination or
180suspected based on the medical history or family medical history of the individual. 10 of 11
181 “Examination for breast cancer”, an examination used to evaluate an abnormality in a
182breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance
183imaging or breast ultrasound.
184 “HSA-qualified health insurance policy”, a policy of individual or group health insurance
185coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as
186implemented and interpreted by the United States Department of the Treasury in the regulations
187and guidance in effect at the time the policy is issued.
188 (b) Any individual or group health maintenance contract that provides coverage for
189screening mammograms shall provide coverage for diagnostic examinations for breast cancer,
190digital breast tomosynthesis screening and medically necessary and appropriate screening with
191breast magnetic resonance imaging or screening breast ultrasound on a basis not less favorable
192than screening mammograms that are covered as medical benefits. There shall be no increase in
193patient cost sharing for: (i) screening mammograms; (ii) digital breast tomosynthesis; (iii)
194screening breast magnetic resonance imaging; (iv) screening breast ultrasound; or (v) diagnostic
195examinations for breast cancer.
196 (c)(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy
197shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required
198under any general or special law to the extent that the exemption is necessary to allow the policy
199to be an HSA-qualified health insurance policy.
200 (2) The exemption provided in paragraph (1) shall not apply to any coverage required
201under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223, 11 of 11
202with respect to any HSA-qualified health insurance policy issued, delivered, amended or
203renewed while such regulation or guidance is effective.
204 SECTION 7. This act shall be effective for all contracts entered into, renewed or
205amended on or after January 1, 2025.