F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 711 2024
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.; providing definitions; requiring the
5 Agency for Health Care Administration to provide
6 coverage for yearly mammograms and yearly supplemental
7 breast cancer screenings for certain women under
8 certain circumstances; requiring the agency to seek
9 federal approval under a specified circumstance;
10 amending ss. 627.6418, 627.6613, and 641.31095, F.S.;
11 defining the term "supplemental breast cancer
12 screening"; revising coverages for mammograms under
13 certain individual accident and health insurance
14 policies, group, blanket, and franchise accident and
15 health insurance policies, and health maintenance
16 contracts, respectively; requiring coverages for
17 supplemental breast cancer screenings under such
18 policies and contracts under certain circumstances;
19 providing applicability; providing an effective date.
20
21 Be It Enacted by the Legislature of the State of Florida:
22
23 Section 1. Section 409.9064, Florida Statutes, is created
24 to read:
25 409.9064 Coverage for mammograms and supplemental breast
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26 cancer screenings.—
27 (1) As used in this section, the term:
28 (a) "Mammogram" means an image of a radiologic examination
29 used to detect unsuspected breast cancer at an early stage in an
30 asymptomatic woman and includes the X-ray picture of the breast
31 using equipment that is dedicated specifically for mammography,
32 including, but not limited to, the X-ray tube, filter,
33 compression device, screens, film, and cassettes. The radiologic
34 examination must include two views of each breast. The term also
35 includes images from digital breast tomosynthesis and the
36 professional interpretation of images from any mammography
37 equipment, but does not include any diagnostic mammography
38 image.
39 (b) "Supplemental breast cancer screening" means a
40 clinically appropriate examination, in addition to a mammogram,
41 deemed medically necessary by a treating health care provider
42 for breast cancer screening in accordance with applicable
43 American College of Radiology guidelines, which includes, but is
44 not limited to, magnetic resonance imaging, ultrasound, and
45 molecular breast imaging.
46 (2) Subject to the availability of funds and subject to
47 any limitations or directions provided in the General
48 Appropriations Act, the agency must provide the following
49 coverage every year for a Medicaid recipient who is a woman 25
50 years of age or older:
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51 (a) One mammogram to detect the presence of breast cancer.
52 (b) One supplemental breast cancer screening to detect the
53 presence of breast cancer if:
54 1. The woman's mammogram demonstrates, based on the breast
55 imaging reporting and data system established by the American
56 College of Radiology, that the woman has dense breast tissue; or
57 2. The woman is at an increased risk of breast cancer due
58 to:
59 a. A personal or family history of breast cancer;
60 b. A personal history of biopsy-proven benign breast
61 disease;
62 c. Ancestry;
63 d. Genetic predisposition;
64 e. Not having given birth before the age of 30; or
65 f. Other reasons as determined by the woman's health care
66 provider.
67 (3) The agency shall seek federal approval, if needed, for
68 the implementation of this section.
69 Section 2. Section 627.6418, Florida Statutes, is amended,
70 to read:
71 627.6418 Coverage for mammograms and supplemental breast
72 cancer screenings.—
73 (1) As used in this section, the term "supplemental breast
74 cancer screening" means a clinically appropriate examina tion, in
75 addition to a mammogram, deemed medically necessary by a
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76 treating health care provider for breast cancer screening in
77 accordance with applicable American College of Radiology
78 guidelines, which includes, but is not limited to, magnetic
79 resonance imaging, ultrasound, and molecular breast imaging.
80 (2)(1) An accident or health insurance policy issued,
81 amended, delivered, or renewed in this state on or after July 1,
82 2024, must provide coverage for at least the following for any
83 woman who is 25 years of age or older:
84 (a) One A baseline mammogram a year, including a digital
85 breast tomosynthesis mammogram for any woman who is 35 years of
86 age or older, but younger than 40 years of age.
87 (b) A mammogram every 2 years for any woman who is 40
88 years of age or older, but younger than 50 years of age, or more
89 frequently based on the patient's physician's recommendation.
90 (c) A mammogram every year for any woman who is 50 years
91 of age or older.
92 (b)(d) One supplemental breast cancer screening or more
93 mammograms a year, based upon a physician's recommendation, if
94 the for any woman who is at risk for breast cancer because of
95 dense breast tissue as demonstrated by the woman's mammogram,
96 based on the breast imaging reporting and data system
97 established by the American College of Radiology; because of a
98 personal or family history of breast cancer;, because of having
99 a personal history of biopsy-proven benign breast disease;
100 because of ancestry; because of genetic predisposition; , because
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101 of having a mother, sister, or daughter who has or has had
102 breast cancer, or because the a woman has not given birth before
103 the age of 30; or because of other reasons as determined by the
104 woman's physician.
105 (3)(2) Except as provided in paragraph (1)(b), for
106 mammograms done more frequently than every 2 years for women 40
107 years of age or older but younger than 50 years of age, The
108 coverage required by subsection (2) (1) applies, with or without
109 a physician prescription, if the insured obtains a mammogram or,
110 if applicable, a supplemental breast cancer screening in an
111 office, facility, or health testing service that uses
112 radiological equipment registered with the Department of Health
113 for breast cancer screening. The coverage is subject to the
114 deductible and coinsurance provisions applicable to outpatient
115 visits, and is also subject to all other terms and conditions
116 applicable to other benefits. This section does not affect any
117 requirements or prohibitions relating to who may perform,
118 analyze, or interpret a mammogram or the persons to whom the
119 results of a mammogram may be furnished or released.
120 (4)(3) This section does not apply to disability income,
121 specified disease, or hospital indemnity policies.
122 (5)(4) Every insurer subject to the requirements of this
123 section shall make available to the policyholder as part of the
124 application, for an appropriate additional premium, the coverage
125 required in this section without such coverage being subject to
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126 the deductible or coinsurance provisions of the policy.
127 Section 3. Section 627.6613, Florida Statutes, is amended
128 to read:
129 627.6613 Coverage for mammograms and supplemental breast
130 cancer screenings.—
131 (1) As used in this section, the term "supplemental breast
132 cancer screening" means a clinically appropriate examination, in
133 addition to a mammogram, deemed medically necessary by a
134 treating physician for breast cancer screening in accordance
135 with applicable American College of Radiology guidelines, which
136 includes, but is not limited to, magnetic resonance imaging,
137 ultrasound, and molecular breast imaging.
138 (2)(1) A group, blanket, or franchise accident or health
139 insurance policy issued, amended, delivered, or renewed in this
140 state on or after July 1, 2024, must provide coverage for at
141 least the following for any woman who is 25 years of age or
142 older:
143 (a) One A baseline mammogram a year, including a digital
144 breast tomosynthesis mammogram for any woman who is 35 years of
145 age or older, but younger than 40 years of age.
146 (b) A mammogram every 2 years for any woman who is 40
147 years of age or older, but younger than 50 years of age, or more
148 frequently based on the patient's physician's recommendation.
149 (c) A mammogram every year for any woman who is 50 years
150 of age or older.
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151 (b)(d) One supplemental breast cancer screening or more
152 mammograms a year, based upon a physician's recommendation, if
153 the for any woman who is at risk for breast cancer because of
154 dense breast tissue as demonstrated by the woman's mammogram,
155 based on the breast imaging reporting and data system
156 established by the American College of Radiology; because of a
157 personal or family history of breast cancer;, because of having
158 a personal history of biopsy-proven benign breast disease;
159 because of ancestry; because of genetic predisposition; , because
160 of having a mother, sister, or daughter who has or has had
161 breast cancer, or because the a woman has not given birth before
162 the age of 30; or because of other reasons as determined by the
163 woman's physician.
164 (3)(2) Except as provided in paragraph (1)(b), for
165 mammograms done more frequently than every 2 years for women 40
166 years of age or older but younger than 50 years of age, The
167 coverage required by subsection (2) (1) applies, with or without
168 a physician prescription, if the insured obtains a mammogram or,
169 if applicable, a supplemental breast cancer screening in an
170 office, facility, or health testing service that uses
171 radiological equipment registered with the Department of Health
172 for breast cancer screening. The coverage is subject to the
173 deductible and coinsurance provisions applicable to outpatient
174 visits, and is also subject to all other terms and conditions
175 applicable to other benefits. This section does not affect any
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176 requirements or prohibitions relating to who may perform,
177 analyze, or interpret a mammogram or the persons to whom t he
178 results of a mammogram may be furnished or released.
179 (4)(3) Every insurer referred to in subsection (2) (1)
180 shall make available to the policyholder as part of the
181 application, for an appropriate additional premium, the coverage
182 required in this section without such coverage being subject to
183 the deductible or coinsurance provisions of the policy.
184 Section 4. Section 641.31095, Florida Statutes, is amended
185 to read:
186 641.31095 Coverage for mammograms and supplemental breast
187 cancer screenings.—
188 (1) As used in this section, the term "supplemental breast
189 cancer screening" means a clinically appropriate examination, in
190 addition to a mammogram, deemed medically necessary by a
191 treating physician for breast cancer screening in accordance
192 with applicable American College of Radiology guidelines, which
193 includes, but is not limited to, magnetic resonance imaging,
194 ultrasound, and molecular breast imaging.
195 (2)(1) Every health maintenance contract issued or renewed
196 on or after July 1, 2024, must January 1, 1996, shall provide
197 coverage for at least the following for any woman who is 25
198 years of age or older:
199 (a) One A baseline mammogram a year, including a digital
200 breast tomosynthesis mammogram for any woman who is 35 years of
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201 age or older, but younger than 40 years of age.
202 (b) A mammogram every 2 years for any woman who is 40
203 years of age or older, but younger than 50 years of age, or more
204 frequently based on the patient's physician's recommendations.
205 (c) A mammogram every year for any woman who is 50 y ears
206 of age or older.
207 (b)(d) One supplemental breast cancer screening or more
208 mammograms a year, based upon a physician's recommendation, if
209 the for any woman who is at risk for breast cancer because of
210 dense breast tissue as demonstrated by the woman's mammogram,
211 based on the breast imaging reporting and data system
212 established by the American College of Radiology; because of a
213 personal or family history of breast cancer;, because of having
214 a personal history of biopsy-proven benign breast disease;