article: SECTION 1. SHORT TITLE; FINDINGS. (a) Short Title.--This Act may be cited as the ``Mammogram Availability Act of 1999''. (b) Findings.--Congress finds the following: (1) Breast cancer is the single leading cause of death for women between the ages of 40 and 49 in the United States (2) An expert panel convened by the National Institutes of Health recommended on January 23, 1997, that all women between the ages of 40 and 49 should choose for themselves, following consultation with their health care provider, whether to undergo screening mammography. (3) The same panel unanimously recommended that for women between the ages of 40 and 49 who choose to have a screening mammogram, costs of the mammograms should be reimbursed by third-party payers or covered by health maintenance organizations. SEC. 2. COVERAGE OF ANNUAL SCREENING MAMMOGRAPHY UNDER GROUP HEALTH PLANS. (a) Public Health Service Act Amendments.-- (1) Subpart 2 of part A of title XXVII of the Public Health Service Act is amended by adding at the end the following new section: ``SEC. 2707. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY. ``(a) Requirements for Coverage of Annual Screening Mammography.-- ``(1) In general.--A group health plan, and a health insurance issuer offering group health insurance coverage, that provides coverage for diagnostic mammography for any woman who is 40 years of age or older shall provide coverage for annual screening mammography for such a woman under terms and conditions that are not less favorable than the terms and conditions for coverage of diagnostic mammography. ``(2) Diagnostic and screening mammography defined.--For purposes of this section-- ``(A) The term `diagnostic mammography' means a radiologic procedure that is medically necessary for the purpose of diagnosing breast cancer and includes a physician's interpretation of the results of the procedure. ``(B) The term `screening mammography' means a radiologic procedure provided to a woman for the purpose of early detection of breast cancer and includes a physician's interpretation of the results of the procedure. ``(b) Prohibitions.--A group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not-- ``(1) deny coverage for annual screening mammography on the basis that the coverage is not medically necessary or on the basis that the screening mammography is not pursuant to a referral, consent, or recommendation by any health care provider; ``(2) deny to a woman eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely for the purpose of avoiding the requirements of this section; ``(3) provide monetary payments or rebates to women to encourage such women to accept less than the minimum protections available under this section; ``(4) penalize or otherwise reduce or limit the reimbursement of an attending provider because such provider provided care to an individual participant or beneficiary in accordance with this section; or ``(5) provide incentives (monetary or otherwise) to an attending provider to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section. ``(c) Rules of Construction.-- ``(1) Nothing in this section shall be construed to require a woman who is a participant or beneficiary to undergo annual screening mammography. ``(2) This section shall not apply with respect to any group health plan, or any group health insurance coverage offered by a health insurance issuer, which does not provide benefits for diagnostic mammography. ``(3) Nothing in this section shall be construed as preventing a group health plan or issuer from imposing deductibles, coinsurance, or other cost-sharing in relation to benefits for screening mammography under the plan (or under health insurance coverage offered in connection with a group health plan), except that such coinsurance or other cost- sharing for any portion may not be greater than such coinsurance or cost-sharing that is otherwise applicable with respect to benefits for diagnostic mammography. ``(4) Women between the ages of 40 and 49 should (but are not required to) consult with appropriate health care practitioners before undergoing screening mammography, but nothing in this section shall be construed as requiring the approval of such a practitioner before undergoing an annual screening mammography. ``(d) Notice.--A group health plan under this part shall comply with the notice requirement under section 714(d) of the Employee Retirement Income Security Act of 1974 with respect to the requirements of this section as if such section applied to such plan. ``(e) Level and Type of Reimbursements.--Nothing in this section shall be construed to prevent a group health plan or a health insurance issuer offering group health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section. ``(f) Preemption; Exception for Health Insurance Coverage in Certain States.-- ``(1) In general.--The requirements of this section shall not apply with respect to health insurance coverage if there is a State law (as defined in section 2723(d)(1)) for a State that regulates such coverage, that requires coverage to be provided for annual screening mammography for women who are 40 years of age or older and that provides at least the protections described in subsection (b). ``(2) Construction.--Section 2723(a)(1) shall not be construed as superseding a State law described in paragraph (1).''. (2) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)) is amended by striking ``section 2704'' and inserting ``sections 2704 and 2707''. (b) ERISA Amendments.-- (1) Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended by adding at the end the following new section: ``SEC. 714. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY. ``(a) Requirements for Coverage of Annual Screening Mammography.-- ``(1) In general.--A group health plan, and a health insurance issuer offering group health insurance coverage, that provides coverage for diagnostic mammography for any woman who is 40 years of age or older shall provide coverage for annual screening mammography for such a woman under terms and conditions that are not less favorable than the terms and conditions for coverage of diagnostic mammography. ``(2) Diagnostic and screening mammography defined.--For purposes of this section-- ``(A) The term `diagnostic mammography' means a radiologic procedure that is medically necessary for the purpose of diagnosing breast cancer and includes a physician's interpretation of the results of the procedure. ``(B) The term `screening mammography' means a radiologic procedure provided to a woman for the purpose of early detection of breast cancer and includes a physician's interpretation of the results of the procedure. ``(b) Prohibitions.--A group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not-- ``(1) deny coverage described in subsection (a)(1) on the basis that the coverage is not medically necessary or on the basis that the screening mammography is not pursuant to a referral, consent, or recommendation by any health care provider; ``(2) deny to a woman eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely for the purpose of avoiding the requirements of this section; ``(3) provide monetary payments or rebates to women to encourage such women to accept less than the minimum protections available under this section; ``(4) penalize or otherwise reduce or limit the reimbursement of an attending provider because such provider provided care to an individual participant or beneficiary in accordance with this section; or ``(5) provide incentives (monetary or otherwise) to an attending provider to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section. ``(c) Rules of Construction.-- ``(1) Nothing in this section shall be construed to require a woman who is a participant or beneficiary to undergo annual screening mammography. ``(2) This section shall not apply with respect to any group health plan, or any group health insurance coverage offered by a health insurance issuer, which does not provide benefits for diagnostic mammography. ``(3) Nothing in this section shall be construed as preventing a group health plan or issuer from imposing deductibles, coinsurance, or other cost-sharing in relation to benefits for screening mammography under the plan (or under health insurance coverage offered in connection with a group health plan), except that such coinsurance or other cost- sharing for any portion may not be greater than such coinsurance or cost-sharing that is otherwise applicable with respect to benefits for diagnostic mammography. ``(4) Women between the ages of 40 and 49 should (but are not required to) consult with appropriate health care practitioners before undergoing screening mammography, but nothing in this section shall be construed as requiring the approval of such a practitioner before undergoing an annual screening mammography. ``(d) Notice Under Group Health Plan.--The imposition of the requirements of this section shall be treated as a material modification in the terms of the plan described in section 102(a)(1), for purposes of assuring notice of such requirements under the plan; except that the summary description required to be provided under the last sentence of section 104(b)(1) with respect to such modification shall be provided by not later than 60 days after the first day of the first plan year in which such requirements apply. ``(e) Level and Type of Reimbursements.--Nothing in this section shall be construed to prevent a group health plan or a health insurance issuer offering group health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section. ``(f) Preemption; Exception for Health Insurance Coverage in Certain States.-- ``(1) In general.--The requirements of this section shall not apply with respect to health insurance coverage if there is a State law (as defined in section 731(d)(1)) for a State that regulates such coverage, that requires coverage to be provided for annual screening mammography for women who are 40 years of age or older, and that provides at least the protections described in subsection (b). ``(2) Construction.--Section 731(a)(1) shall not be construed as superseding a State law described in paragraph (1).''. (2) Section 731(c) of such Act (29 U.S.C. 1191(c)) is amended by striking ``section 711'' and inserting ``sections 711 and 714''. (3) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is amended by striking ``section 711'' and inserting ``sections 711 and 714''. (4) The table of contents in section 1 of such Act is amended by inserting after the item relating to section 713 the following new item: ``Sec. 714. Standards relating to benefits for screening mammography.''. (c) Effective Dates.--(1) Subject to paragraph (2), the amendments made by this section shall apply with respect to group health plans (and health insurance coverage offered in connection with group health plans) for plan years beginning on or after January 1, 1999. (2) In the case of a group health plan maintained pursuant to 1 or more collective bargaining agreements between employee representatives and 1 or more employers ratified before the date of enactment of this Act, the amendments made by this section shall not apply to plan years beginning before the later of-- (A) the date on which the last collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of enactment of this Act), or (B) January 1, 1999. For purposes of subparagraph (A), any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by this section shall not be treated as a termination of such collective bargaining agreement. SEC. 3. COVERAGE OF ANNUAL SCREENING MAMMOGRAPHY UNDER INDIVIDUAL HEALTH COVERAGE. (a) In General.--Part B of title XXVII of the Public Health Service Act is amended by inserting after section 2751 the following new section: ``SEC. 2753. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY. ``(a) In General.--The provisions of section 2706 (other than subsections (d) and (f)) shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as it applies to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market. ``(b) Notice.--A health insurance issuer under this part shall comply with the notice requirement under section 714(d) of the Employee Retirement Income Security Act of 1974 with respect to the requirements referred to in subsection (a) as if such section applied to such issuer and such issuer were a group health plan. ``(c) Preemption; Exception for Health Insurance Coverage in Certain States.-- ``(1) In general.--The requirements of this section shall not apply with respect to health insurance coverage if there is a State law (as defined in section 2723(d)(1)) for a State that regulates such coverage, that requires coverage in the individual health insurance market to be provided for annual screening mammography for women who are 40 years of age or older and that provides at least the protections described in section 2706(b) (as applied under subsection (a)). ``(2) Construction.--Section 2762(a) shall not be construed as superseding a State law described in paragraph (1).''. (b) Conforming Amendment.--Section 2763(b)(2) of such Act (42 U.S.C. 300gg-63(b)(2)) is amended by striking ``section 2751'' and inserting ``sections 2751 and 2753''. (c) Effective Date.--The amendments made by this section shall apply with respect to health insurance coverage offered, sold, issued, or renewed in the individual market on or after such January 1, 1999.
summary: Mammogram Availability Act of 1999 - Amends the Public Health Service Act and the Employee Retirement Income Security Act of 1974 to require a group health plan, and a health insurance issuer offering group coverage, that provides coverage for diagnostic mammographies for any woman 40 years old or older to provide coverage for annual screening mammographies for such a woman. Prohibits related enrollment and renewal discrimination, monetary incentives to women, and penalties or incentives to providers. Amends the Public Health Service Act to apply those requirements and prohibitions to coverage offered by an issuer in the individual market.