RÉSUMÉ DIGEST
ACT 45 (SB 119) 2021 Regular Session Tarver
Prior law required that health coverage plans which are delivered or issued for delivery in
this state include benefits payable for an annual Pap test and minimum mammography
examination.
Prior law defined "minimum mammography examination" as mammographic examinations,
including but not limited to digital breast tomosynthesis, performed no less frequently than
the following schedule provides:
(1) One baseline mammogram for any woman who is 35-39 years of age.
(2) One mammogram every 24 months for any woman who is 40-49 years of age, or
more frequently if recommended by her physician.
(3) One mammogram every 12 months for any woman who is 50 years of age or older.
New law retains the schedule and provides for earlier screening based on certain criteria of
the American Society of Breast Surgeons as follows:
(1) (a) Regarding the single baseline mammogram for women 35-39, provides for
annual MRI starting at age 25 and annual mammography starting at age 30,
if there is a hereditary susceptibility from pathogenic mutation carrier status
or prior chest wall radiation. Requires that the examinations to be in
accordance with recommendations by the National Comprehensive Cancer
Network guidelines or the American Society of Breast Surgeons Position
Statement on Screening Mammography no later than the following policy or
plan year following changes in recommendations.
(b) Provides for annual mammography (DBT preferred modality) and access to
supplemental imaging (MRI preferred modality) starting at age 35 if
recommended by the woman's physician and the woman has a predicted
lifetime risk greater than 20% by any validated model published in peer
reviewed medical literature.
(2) Annual mammography (DBT preferred modality) for any woman who is 40 years of
age or older.
(a) Consideration given to supplemental imaging, (breast ultrasound initial
preferred modality, followed by MRI is inconclusive), if recommended by
her physician, for women with increased breast density (C and D density).
(b) Access to annual supplemental imaging (MRI preferred modality), if
recommended by her physician, for women with a prior history of breast
cancer below the age of 50 or with a prior history of breast cancer at any age
and dense breast (C and D density).
New law provides that coverage pertaining to prior and new law (R.S. 22:1028) regarding
early screening and detection may be subject to the health coverage plan's utilization review
using guidelines published in peer reviewed medical literature.
New law requires a policy, contract, or health coverage plan in effect prior to January 1,
2022, to convert to new law no later than by January 1, 2023.
Effective January 1, 2022.
(Amends R.S. 22:1028(A)(2))


Statutes affected:
SB119 Original: 22:1028(A)(2)
SB119 Engrossed: 22:1028(A)(2)
SB119 Enrolled: 22:1028(A)(2)
SB119 Act 45: 22:1028(A)(2)