Bill Summary – FastDemocracy

       Florida Senate - 2024                                     SB 670



       By Senator Davis





       5-00610A-24                                            2024670__
                      A bill to be entitled                      
       An act relating to coverage for mammograms and
       supplemental breast cancer screenings; creating s.
       409.9064, F.S.; defining the terms “mammogram” and
       “supplemental breast cancer screening”; requiring the
       Agency for Health Care Administration to provide
       Medicaid coverage for annual mammograms and
       supplemental breast cancer screenings for certain
       women under certain circumstances; requiring the
       agency to seek federal approval, if needed, to
       implement specified provisions; amending ss. 627.6418,
       627.6613, and 641.31095, F.S.; defining the term
       “supplemental breast cancer screening”; revising
       coverage for mammograms under certain individual
       accident and health insurance policies, group,
       blanket, and franchise accident and health insurance
       policies, and health maintenance contracts,
       respectively; requiring coverage for supplemental
       breast cancer screenings under such policies and
       contracts under certain circumstances; revising
       applicability; providing an effective date.
        
Be It Enacted by the Legislature of the State of Florida:

       Section 1. Section 409.9064, Florida Statutes, is created
to read:
       409.9064 Coverage for mammograms and supplemental breast
cancer screenings.—
       (1) As used in this section, the term:
       (a) “Mammogram” means an image of a radiologic examination
used to detect unsuspected breast cancer at an early stage in an
asymptomatic woman and includes the X-ray picture of the breast
captured using equipment that is dedicated specifically for
mammography, including, but not limited to, the X-ray tube,
filter, compression device, screens, film, and cassettes. The
radiologic examination must include two views of each breast.
The term also includes images from digital breast tomosynthesis
and the professional interpretation of images from any
mammography equipment, but does not include any diagnostic
mammography image.
       (b) “Supplemental breast cancer screening” means a
clinically appropriate examination, in addition to a mammogram,
deemed medically necessary by a treating health care provider
for breast cancer screening in accordance with applicable
American College of Radiology guidelines, which examination
includes, but is not limited to, magnetic resonance imaging,
ultrasound, and molecular breast imaging.
       (2) Subject to the availability of funds and subject to any
limitations or directions provided in the General Appropriations
Act, the agency must provide coverage for the following every
year for a Medicaid recipient who is a woman 25 years of age or
older:
       (a) One mammogram to detect the presence of breast cancer.
       (b) One supplemental breast cancer screening to detect the
presence of breast cancer if:
       1. Based on the breast imaging reporting and data system
established by the American College of Radiology, the woman’s
mammogram demonstrates that the woman has dense breast tissue;
or
       2. The woman is at an increased risk of breast cancer due
to:
       a. A personal or family history of breast cancer;
       b. A personal history of biopsy-proven benign breast
disease;
       c. Ancestry;
       d. Genetic predisposition;
       e. Not having given birth before the age of 30; or
       f. Other reasons as determined by the woman’s health care
provider.
       (3) The agency shall seek federal approval, if needed, for
the implementation of this section.
       Section 2. Section 627.6418, Florida Statutes, is amended
to read:
       627.6418 Coverage for mammograms and supplemental breast
cancer screenings.—
       (1) As used in this section, the term “supplemental breast
cancer screening” means a clinically appropriate examination, in
addition to a mammogram, deemed medically necessary by a
treating health care provider for breast cancer screening in
accordance with applicable American College of Radiology
guidelines, which examination includes, but is not limited to,
magnetic resonance imaging, ultrasound, and molecular breast
imaging.
       (2) An accident or health insurance policy issued, amended,
delivered, or renewed in this state on or after July 1, 2024,
must provide coverage for at least the following for any woman
who is 25 years of age or older:
       (a) One A baseline mammogram a year, including a digital
breast tomosynthesis mammogram for any woman who is 35 years of
age or older, but younger than 40 years of age.
       (b) A mammogram every 2 years for any woman who is 40 years
of age or older, but younger than 50 years of age, or more
frequently based on the patient’s physician’s recommendation.
       (c) A mammogram every year for any woman who is 50 years of
age or older.
       (d) One supplemental breast cancer screening or more
mammograms a year, based upon a physician’s recommendation, if
the for any woman who is at risk for breast cancer because of
dense breast tissue, as demonstrated by the woman’s mammogram
and based on the breast imaging reporting and data system
established by the American College of Radiology; because of a
personal or family history of breast cancer;, because of having
a personal history of biopsy-proven benign breast disease;
because of ancestry; because of genetic predisposition;, because
of having a mother, sister, or daughter who has or has had
breast cancer, or because the a woman has not given birth before
the age of 30; or because of other reasons as determined by the
woman’s physician.
       (3)(2) Except as provided in paragraph (1)(b), for
mammograms done more frequently than every 2 years for women 40
years of age or older but younger than 50 years of age, The
coverage required by subsection (2) (1) applies, with or without
a physician prescription, if the insured obtains a mammogram
and, if applicable, a supplemental breast cancer screening in an
office, facility, or health testing service that uses
radiological equipment registered with the Department of Health
for breast cancer screening. The coverage is subject to the
deductible and coinsurance provisions applicable to outpatient
visits, and is also subject to all other terms and conditions
applicable to other benefits. This section does not affect any
requirements or prohibitions relating to who may perform,
analyze, or interpret a mammogram or the persons to whom the
results of a mammogram may be furnished or released.
       (4)(3) This section does not apply to disability income,
specified disease, or hospital indemnity policies.
       (5)(4) Every insurer subject to the requirements of this
section shall make available to the policyholder as part of the
application, for an appropriate additional premium, the coverage
required in this section without such coverage being subject to
the deductible or coinsurance provisions of the policy.
       Section 3. Section 627.6613, Florida Statutes, is amended
to read:
       627.6613 Coverage for mammograms and supplemental breast
cancer screenings.—
       (1) As used in this section, the term “supplemental breast
cancer screening” means a clinically appropriate examination, in
addition to a mammogram, deemed medically necessary by a
treating physician for breast cancer screening in accordance
with applicable American College of Radiology guidelines, which
examination includes, but is not limited to, magnetic resonance
imaging, ultrasound, and molecular breast imaging.
       (2) A group, blanket, or franchise accident or health
insurance policy issued, amended, delivered, or renewed in this
state on or after July 1, 2024, must provide coverage for at
least the following for any woman who is 25 years of age or
older:
       (a) One A baseline mammogram a year, including a digital
breast tomosynthesis mammogram for any woman who is 35 years of
age or older, but younger than 40 years of age.
       (b) A mammogram every 2 years for any woman who is 40 years
of age or older, but younger than 50 years of age, or more
frequently based on the patient’s physician’s recommendation.
       (c) A mammogram every year for any woman who is 50 years of
age or older.
       (d) One supplemental breast cancer screening or more
mammograms a year, based upon a physician’s recommendation, if
the for any woman who is at risk for breast cancer because of
dense breast tissue as demonstrated by the woman’s mammogram and
based on the breast imaging reporting and data system
established by the American College of Radiology; because of a
personal or family history of breast cancer;, because of having
a personal history of biopsy-proven benign breast disease;
because of ancestry; because of genetic predisposition;, because
of having a mother, sister, or daughter who has or has had
breast cancer, or because the a woman has not given birth before
the age of 30; or because of other reasons as determined by the
woman’s physician.
       (3)(2) Except as provided in paragraph (1)(b), for
mammograms done more frequently than every 2 years for women 40
years of age or older but younger than 50 years of age, The
coverage required by subsection (2) (1) applies, with or without
a physician prescription, if the insured obtains a mammogram
and, if applicable, a supplemental breast cancer screening in an
office, facility, or health testing service that uses
radiological equipment registered with the Department of Health
for breast cancer screening. The coverage is subject to the
deductible and coinsurance provisions applicable to outpatient
visits, and is also subject to all other terms and conditions
applicable to other benefits. This section does not affect any
requirements or prohibitions relating to who may perform,
analyze, or interpret a mammogram or the persons to whom the
results of a mammogram may be furnished or released.
       (4)(3) Every insurer referred to in subsection (2) (1)
shall make available to the policyholder as part of the
application, for an appropriate additional premium, the coverage
required in this section without such coverage being subject to
the deductible or coinsurance provisions of the policy.
       Section 4. Section 641.31095, Florida Statutes, is amended
to read:
       641.31095 Coverage for mammograms and supplemental breast
cancer screenings.—
       (1) As used in this section, the term “supplemental breast
cancer screening” means a clinically appropriate examination, in
addition to a mammogram, deemed medically necessary by a
treating physician for breast cancer screening in accordance
with applicable American College of Radiology guidelines, which
examination includes, but is not limited to, magnetic resonance
imaging, ultrasound, and molecular breast imaging.
       (2) Every health maintenance contract issued or renewed on
or after July 1, 2024, must January 1, 1996, shall provide
coverage for at least the following for any woman who is 25
years of age or older:
       (a) One A baseline mammogram a year, including a digital
breast tomosynthesis mammogram for any woman who is 35 years of
age or older, but younger than 40 years of age.
       (b) A mammogram every 2 years for any woman who is 40 years
of age or older, but younger than 50 years of age, or more
frequently based on the patient’s physician’s recommendations.
       (c) A mammogram every year for any woman who is 50 years of
age or older.
       (d) One supplemental breast cancer screening or more
mammograms a year, based upon a physician’s recommendation, if
the for any woman who is at risk for breast cancer because of
dense breast tissue as demonstrated by the woman’s mammogram and
based on the breast imaging reporting and data system
established by the American College of Radiology; because of a
personal or family history of breast cancer;, because of having
a personal history of biopsy-proven benign breast disease;
because of ancestry; because of genetic predisposition;, because
of having a mother, sister, or daughter who has had breast
cancer, or because the a woman has not given birth before the
age of 30; or because of other reasons as determined by the
woman’s physician.
       (3)(2) The coverage required by this section is subject to
the deductible and copayment provisions applicable to outpatient
visits, and is also subject to all other terms and conditions
applicable to other benefits. A health maintenance organization
shall make available to the subscriber as part of the
application, for an appropriate additional premium, the coverage
required in this section without such coverage being subject to
any deductible or copayment provisions in the contract.
       Section 5. This act shall take effect July 1, 2024.
Statutes affected: 
S 670 Filed: 627.6418, 627.6613, 641.31095