[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5141 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
2d Session
S. 5141
To provide for health coverage with no cost-sharing for additional
breast screenings for certain individuals at greater risk for breast
cancer.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 23, 2024
Ms. Klobuchar (for herself and Mr. Marshall) introduced the following
bill; which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To provide for health coverage with no cost-sharing for additional
breast screenings for certain individuals at greater risk for breast
cancer.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Find It Early Act''.
SEC. 2. COVERAGE WITH NO COST-SHARING FOR ADDITIONAL BREAST SCREENINGS
FOR CERTAIN INDIVIDUALS AT GREATER RISK FOR BREAST
CANCER.
(a) Coverage Under Group Health Plans and Group and Individual
Health Insurance Coverage.--
(1) In general.--Section 2713(a) of the Public Health
Service Act (42 U.S.C. 300gg-13(a)) is amended--
(A) in paragraph (2), by striking ``and'' at the
end;
(B) in paragraph (3), by striking the period at the
end and inserting a semicolon;
(C) in paragraph (4), by striking the period at the
end and inserting ``and as described in subparagraph
(E); and'';
(D) by redesignating paragraphs (1) through (5) as
subparagraphs (A) through (E), respectively, and
adjusting the margins accordingly;
(E) by striking the subsection designation and
heading and all that follows through ``A group health
plan'' and inserting the following:
``(a) Requirements.--
``(1) In general.--A group health plan'';
(F) in the undesignated matter following
subparagraph (E) of paragraph (1) (as so redesignated),
by striking ``Nothing in this subsection'' and
inserting the following:
``(3) Rule of construction.--Nothing in this subsection'';
(G) in subparagraph (E) of paragraph (1) (as so
redesignated), by striking ``(E) for the purposes of
this Act,'' and inserting the following:
``(2) Recommendations.--For the purposes of this Act,'';
(H) in paragraph (1) (as so redesignated), by
adding at the end the following:
``(E)(i) with respect to an individual who is at
increased risk of breast cancer (as determined in
accordance with the most recent applicable American
College of Radiology Appropriateness Criteria or the
most recent applicable guidelines of the National
Comprehensive Cancer Network) or with heterogeneously
or extremely dense breast tissue (as defined by the
Breast Imaging Reporting and Data System established by
the American College of Radiology), screening and
diagnostic imaging (with no limitation applied on
frequency) for the detection of breast cancer,
including 2D or 3D mammograms, breast ultrasounds,
breast magnetic resonance imaging, molecular breast
imaging, or other technologies (as determined in
accordance with such applicable criteria or
guidelines); and
``(ii) with respect to an individual who is not
described in subparagraph (A) and who is determined by
a health care provider (in accordance with such most
recent applicable criteria or guidelines) to require
screening or diagnostic breast imaging by reason of
factors, including age, race, ethnicity, or personal or
family medical history, screening and diagnostic
imaging (with no limitation applied on frequency) for
the detection of breast cancer, including 2D or 3D
mammograms, breast ultrasounds, breast magnetic
resonance imaging, molecular breast imaging, or other
technologies (as determined in accordance with such
applicable criteria or guidelines).''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply with respect to plan years beginning on or after
January 1, 2025.
(3) Application to grandfathered health plans.--Section
1251(a)(4)(A) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18011(a)(4)(A)) is amended--
(A) by striking ``title)'' and inserting ``title,
or as added after the date of the enactment of this
Act)'';
(B) by redesignating clause (iv) as clause (v); and
(C) by inserting after clause (iii) the following:
``(iv) Section 2713(a)(1)(E) (relating to
screening and diagnostic imaging for the
detection of breast cancer).''.
(b) Coverage Under Medicare.--
(1) In general.--Section 1861(ddd)(1)(B) of the Social
Security Act (42 U.S.C. 1395x(ddd)(1)(B)) is amended--
(A) by striking ``(B) recommended'' and inserting
``(B)(i) recommended'';
(B) by striking ``Task Force; and'' and inserting
``Task Force; or''; and
(C) by adding at the end the following new clause:
``(i) beginning on January 1, 2025, in addition to any
other items or services described in this paragraph, screening
and diagnostic imaging (with no limitation applied on
frequency) for the detection of breast cancer, including 2D or
3D mammograms, breast ultrasounds, breast magnetic resonance
imaging, molecular breast imaging, or other technologies (as
determined in accordance with the most recent applicable
American College of Radiology Appropriateness Criteria or the
most recent applicable guidelines of the National Comprehensive
Cancer Network) for--
``(I) an individual who is at increased risk of
breast cancer (as determined in accordance with such
applicable criteria or guidelines) or with
heterogeneously or extremely dense breast tissue (as
defined by the Breast Imaging Reporting and Data System
established by the American College of Radiology); and
``(II) an individual who is not described in
subclause (I) and who is determined by a health care
provider (in accordance with such most recent
applicable criteria or guidelines) to require such
screening or diagnostic breast imaging by reason of
factors determined by the Secretary, including age,
race, ethnicity, or personal or family medical history;
and''.
(2) Application of no cost-sharing under medicare advantage
plans.--Section 1852(a)(1)(B) of the Social Security Act (42
U.S.C. 1395w-22(a)(1)(B)) is amended--
(A) in clause (iv)--
(i) by redesignating subclause (VIII) as
subclause (IX); and
(ii) inserting after subclause (VII) the
following:
``(VIII) Beginning on January 1,
2024, screening and diagnostic imaging
and other technologies described in
section 1861(ddd)(1)(B)(ii) furnished
to an individual described in such
section.''; and
(B) in clause (v), by striking ``and (VI)'' and
inserting ``(VI), and (VIII)''.
(c) Coverage Under Medicaid.--
(1) In general.--Section 1905(a) of the Social Security Act
(42 U.S.C. 1396d(a)) is amended--
(A) in paragraph (4)--
(i) by striking ``; and (D)'' and inserting
``; (D)'';
(ii) by striking ``; and (E)'' and
inserting ``; (E)'';
(iii) by striking ``; and (F)'' and
inserting ``; (F)''; and
(iv) by inserting before the semicolon at
the end the following: ``; and (G)(i) with
respect to an individual who is at increased
risk of breast cancer (as determined in
accordance with the most recent applicable
American College of Radiology Appropriateness
Criteria or the most recent applicable
guidelines of the National Comprehensive Cancer
Network) or with heterogeneously or extremely
dense breast tissue (as defined by the Breast
Imaging Reporting and Data System established
by the American College of Radiology), in
addition to any other item or service described
in this subsection, screening and diagnostic
imaging (with no limitation applied on
frequency) for the detection of breast cancer,
including 2D or 3D mammograms, breast
ultrasounds, breast magnetic resonance imaging,
molecular breast imaging, or other technologies
(as determined in accordance with such
applicable criteria or guidelines); and (ii)
with respect to an individual who is not
described in clause (i) and who is determined
by a health care provider (in accordance with
such most recent applicable criteria or
guidelines) to require screening or diagnostic
breast imaging by reason of factors, including
age, race, ethnicity, or personal or family
medical history, screening and diagnostic
imaging (with no limitation applied on
frequency) for the detection of breast cancer,
including 2D or 3D mammograms, breast
ultrasounds, breast magnetic resonance imaging,
molecular breast imaging, or other technologies
(as determined in accordance with such
applicable criteria or guidelines)''; and
(B) in paragraph (13), in the matter preceding
subparagraph (A), by inserting ``(other than an item or
service for which medical assistance is provided
pursuant to paragraph (4)(G))'' after ``services''.
(2) No cost-sharing for certain breast cancer screening and
diagnostic imaging.--
(A) In general.--Subsections (a)(2) and (b)(2) of
section 1916 of the Social Security Act (42 U.S.C.
1396o(a)(2)(D)) are each amended--
(i) in the last subparagraph, by striking
at the end ``; and'' and inserting ``, or'';
and
(ii) by adding at the end the following
subparagraph:
``(K) with respect to an individual described in
clause (i) or (ii) of section 1905(a)(4)(G), screening
and diagnostic imaging and other technologies described
in such clause (i) or (ii), respectively; and''.
(B) Application to alternative cost-sharing.--
Section 1916A(b)(3)(B) of the Social Security Act (42
U.S.C. 1396o-1(b)(3)(B)) is amended by adding at the
end the following new clause:
``(xv) With respect to an individual
described in clause (i) or (ii) of section
1905(a)(4)(G), screening and diagnostic imaging
and other technologies described in such clause
(i) or (ii), respectively.''.
(3) Inclusion in benchmark coverage.--Section 1937(b) of
the Social Security Act (42 U.S.C. 1396u-7(b)) is amended by
adding at the end the following new paragraph:
``(9) Coverage of certain breast cancer screening and
diagnostic imaging for certain individuals.--Notwithstanding
the previous provisions of this section, a State may not
provide for medical assistance through enrollment of an
individual with benchmark coverage or benchmark-equivalent
coverage under this section unless such coverage includes
medical assistance, with respect to an individual described in
clause (i) or (ii) of section 1905(a)(4)(G), for screening and
diagnostic imaging and other technologies described in such
clause (i) or (ii), respectively.''.
(4) Effective date.--
(A) In general.--Except as provided in subparagraph
(B), the amendments made by this subsection shall take
effect on January 1, 2024.
(B) Delay permitted if state legislation
required.--In the case of a State plan approved under
title XIX of the Social Security Act which the
Secretary of Health and Human Services determines
requires State legislation (other than legislation
appropriating funds) in order for the plan to meet the
additional requirements imposed by this section, the
State plan shall not be regarded as failing to comply
with the requirements of such title solely on the basis
of the failure of the plan to meet such additional
requirements before the first day of the first calendar
quarter beginning after the close of the first regular
session of the State legislature that ends after the 1-
year period beginning with the date of the enactment of
this section. For purposes of the preceding sentence,
in the case of a State that has a 2-year legislative
session, each year of the session is deemed to be a
separate regular session of the State legislature.
(d) Coverage and Elimination of Cost-Sharing Under TRICARE.--
(1) Coverage.--Title 10, United States Code, is amended--
(A) in section 1074d(a), by adding at the end the
following new paragraph:
``(3) Any member or former member of the uniformed services who is
entitled to medical care under section 1074 or 1074a of this title and
is an individual described in subparagraph (B) of section 1079(a)(20)
of this title shall also be entitled to the items and services
described in subparagraph (A) of such section (subject to the same
limitations specified in such subparagraph), as part of such medical
care.''; and
(B) in section 1079(a), by adding at the end the
following new paragraph:
``(20)(A) Screening and diagnostic imaging (with no
limitation applied on frequency) for the detection of breast
cancer, including 2D or 3D mammograms, breast ultrasounds,
breast magnetic resonance imaging, molecular breast imaging, or
other technologies (as determined in accordance with the most
recent applicable criteria or guidelines described in
subparagraph (B)), shall be provided if the patient is an
individual described in subparagraph (B).
``(B) An individual described in this subparagraph is--
``(i) an individual who is at increased risk of
breast cancer (as determined in accordance with the
most recent applicable American College of Radiology
Appropriateness Criteria or the most recent applicable
guidelines of the National Comprehensive Cancer
Network) or with heterogeneously or extremely dense
breast tissue (as defined by the Breast Imaging
Reporting and Data System established by the American
College of Radiology); or
``(ii) an individual who is not described in clause
(i) and who is determined by a health care provider (in
accordance with such most recent applicable criteria or
guidelines) to require screening or diagnostic breast
imaging by reason of factors including age, race,
ethnicity, or personal or family medical history.''.
(2) Elimination of cost-sharing.--Such title is further
amended--
(A) in section 1075a, by adding at the end the
following new subsection:
``(d) Elimination of Cost-Sharing for Certain Breast Cancer-Related
Items and Services.--Notwithstanding any other provision of this
section, cost-sharing requirements may not be imposed or collected with
respect to any beneficiary enrolled in TRICARE Prime for any item or
service described in subparagraph (A) of section 1079(a)(20) of this
title provided under TRICARE Prime, in accordance with the limitations
specified in such subparagraph, if the beneficiary is an individual
described in subparagraph (B) of such section.'';
(B) in section 1075(c), by adding at the end the
following new paragraph:
``(4) Notwithstanding any other provision of this section,
cost-sharing requirements may not be imposed or collected with
respect to any beneficiary enrolled in TRICARE Select for any
item or service described in subparagraph (A) of section
1079(a)(20) of this title provided under TRICARE Select, in
accordance with the limitations specified in such subparagraph,
if the beneficiary is an individual described in subparagraph
(B) of such section.''; and
(C) in section 1086(d)(3)--
(i) by redesignating subparagraph (C) as
subparagraph (D); and
(i