HOUSE . . . . . . . . No. 4410
The Commonwealth of Massachusetts
________________________________________
HOUSE OF REPRESENTATIVES, February 20, 2024.
The committee on Financial Services, to whom was referred the
petition (accompanied by bill, House, No. 1103) of James M. Murphy and
others relative to insurance coverage for mammograms and breast cancer
screening, reports recommending that the accompanying bill (House, No.
4410) ought to pass.
For the committee,
JAMES M. MURPHY.
 FILED ON: 2/7/2024
HOUSE . . . . . . . . . . . . . . . No. 4410
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
An Act relative to breast cancer equity and early detection.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Chapter 32A of the General Laws is hereby amended by inserting after
2 section 30 thereof the following section: -
3 Section 31. Notwithstanding any general or special law or rule or regulation to the
4 contrary, any coverage offered by the commission to an active or retired employee of the
5 commonwealth insured under the group insurance commission that provides medical expense
6 coverage for screening mammograms shall provide coverage for diagnostic examinations for
7 breast cancer, for digital breast tomosynthesis screening and medically necessary and appropriate
8 screening with breast magnetic resonance imaging or breast ultrasound on a basis not less
9 favorable than screening mammograms that are covered as medical benefits. An increase in
10 patient cost sharing for screening mammograms, for digital breast tomosynthesis, for screening
11 breast magnetic resonance imaging, for screening breast ultrasound or for diagnostic
12 examinations for breast cancer shall not be allowed to achieve compliance with this section. For
13 the purposes of this section, “diagnostic examinations for breast cancer” means a medically
14 necessary and appropriate examination for breast cancer to evaluate the abnormality in the breast
1 of 10
15 that is seen or suspected from a screening examination for breast cancer, detected by another
16 means of examination; or suspected based on the medical history or family medical history of the
17 individual. “Examination for breast cancer” includes an examination used to evaluate an
18 abnormality in a breast using diagnostic mammography, digital breast tomosynthesis, breast
19 magnetic resonance imaging or breast ultrasound. “Cost sharing” shall mean a deductible,
20 coinsurance, copayment, and any maximum limitation on the application of such a deductible,
21 coinsurance, copayment, or similar out-of-pocket expense.
22 (a) As used in this Section, "HSA-qualified health insurance policy" means a policy
23 of individual or group health insurance coverage that satisfies the criteria for a "high-deductible
24 health plan" under 26 U.S.C. 223 as implemented and interpreted by the U.S. Department of the
25 Treasury in the regulations and guidance in effect at the time the policy is issued.
26 (b) Except as provided in (c), an HSA-qualified health insurance policy is exempt from
27 any prohibition on cost-sharing requirements for a covered benefit required under Massachusetts
28 law to the extent the exemption is necessary to allow the policy to be an “HSA-qualified health
29 insurance policy.”
30 (c) The exemption provided in (b) shall not apply to any coverage required by
31 Massachusetts statute that pertains to preventive care as that term is defined by regulation or
32 guidance by the U.S. Department of the Treasury under 26 U.S.C. 223 with respect to any HSA-
33 qualified health insurance policy issued, delivered, amended, or renewed while such regulation
34 or guidance is effective.
35 SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after
36 section 10M thereof the following new section: -
2 of 10
37 Section 10N. Notwithstanding any general or special law or rule or regulation to the
38 contrary, the Executive Office of Health and Human Services shall provide coverage under its
39 Medicaid contracted health insurers, health plans, health maintenance organizations, and third
40 party administrators under contract to a Medicaid managed care organization, the Medicaid
41 primary care clinician plan, or an accountable care organization for diagnostic examinations for
42 breast cancer and for digital breast tomosynthesis screening and medically necessary and
43 appropriate screening with breast magnetic resonance imaging or screening breast ultrasound on
44 a basis not less favorable than screening mammograms that are covered as medical benefits. An
45 increase in patient cost sharing for screening mammograms, for digital breast tomosynthesis, for
46 screening breast magnetic resonance imaging, for screening breast ultrasound or for diagnostic
47 examinations for breast cancer shall not be allowed to achieve compliance with this section. For
48 the purposes of this section, “diagnostic examinations for breast cancer” means a medically
49 necessary and appropriate examination for breast cancer to evaluate the abnormality in the breast
50 that is seen or suspected from a screening examination for breast cancer, detected by another
51 means of examination; or suspected based on the medical history or family medical history of the
52 individual. “Examination for breast cancer” includes an examination used to evaluate an
53 abnormality in a breast using diagnostic mammography, digital breast tomosynthesis, breast
54 magnetic resonance imaging or breast ultrasound. “Cost sharing” shall mean a deductible,
55 coinsurance, copayment, and any maximum limitation on the application of such a deductible,
56 coinsurance, copayment, or similar out-of-pocket expense.
57 (a) As used in this Section, "HSA-qualified health insurance policy" means a policy
58 of individual or group health insurance coverage that satisfies the criteria for a "high-deductible
3 of 10
59 health plan" under 26 U.S.C. 223 as implemented and interpreted by the U.S. Department of the
60 Treasury in the regulations and guidance in effect at the time the policy is issued.
61 (b) Except as provided in (c), an HSA-qualified health insurance policy is exempt from
62 any prohibition on cost-sharing requirements for a covered benefit required under Massachusetts
63 law to the extent the exemption is necessary to allow the policy to be an “HSA-qualified health
64 insurance policy.”
65 (c) The exemption provided in (b) shall not apply to any coverage required by
66 Massachusetts statute that pertains to preventive care as that term is defined by regulation or
67 guidance by the U.S. Department of the Treasury under 26 U.S.C. 223 with respect to any HSA-
68 qualified health insurance policy issued, delivered, amended, or renewed while such regulation
69 or guidance is effective.
70 SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after
71 section 47LL thereof the following section: -
72 Section 47MM. Notwithstanding any general or special law or rule or regulation to the
73 contrary, any policy, contract, agreement, plan or certificate of insurance issued, delivered or
74 renewed within the commonwealth that provides medical expense coverage for screening
75 mammograms shall provide coverage for diagnostic examinations for breast cancer and for
76 digital breast tomosynthesis screening and medically necessary and appropriate screening with
77 breast magnetic resonance imaging or breast ultrasound on a basis not less favorable than
78 screening mammograms that are covered as medical benefits. An increase in patient cost sharing
79 for screening mammograms, for digital breast tomosynthesis, for screening breast magnetic
80 resonance imaging, for screening breast ultrasound or for diagnostic examinations for breast
4 of 10
 81 cancer shall not be allowed to achieve compliance with this section. For the purposes of this
82 section, “diagnostic examinations for breast cancer” means a medically necessary and
83 appropriate examination for breast cancer to evaluate the abnormality in the breast that is seen or
84 suspected from a screening examination for breast cancer, detected by another means of
85 examination; or suspected based on the medical history or family medical history of the
86 individual. “Examination for breast cancer” includes an examination used to evaluate an
87 abnormality in a breast using diagnostic mammography, digital breast tomosynthesis, breast
88 magnetic resonance imaging or breast ultrasound. “Cost sharing” shall mean a deductible,
89 coinsurance, copayment, and any maximum limitation on the application of such a deductible,
90 coinsurance, copayment, or similar out-of-pocket expense.
91 (a) As used in this Section, "HSA-qualified health insurance policy" means a policy
92 of individual or group health insurance coverage that satisfies the criteria for a "high-deductible
93 health plan" under 26 U.S.C. 223 as implemented and interpreted by the U.S. Department of the
94 Treasury in the regulations and guidance in effect at the time the policy is issued.
95 (b) Except as provided in (c), an HSA-qualified health insurance policy is exempt from
96 any prohibition on cost-sharing requirements for a covered benefit required under Massachusetts
97 law to the extent the exemption is necessary to allow the policy to be an “HSA-qualified health
98 insurance policy.”
99 (c) The exemption provided in (b) shall not apply to any coverage required by
100 Massachusetts statute that pertains to preventive care as that term is defined by regulation or
101 guidance by the U.S. Department of the Treasury under 26 U.S.C. 223 with respect to any HSA-
5 of 10
102 qualified health insurance policy issued, delivered, amended, or renewed while such regulation
103 or guidance is effective.
104 SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after
105 section 8NN thereof the following section: -
106 Section 8OO. Notwithstanding any general or special law or rule or regulation to the
107 contrary, any contract between a subscriber and the corporation under an individual or group
108 hospital service plan which is delivered, issued or renewed within the commonwealth that
109 provides coverage for screening mammograms shall provide coverage for diagnostic
110 examinations for breast cancer and for digital breast tomosynthesis screening and medically
111 necessary and appropriate screening with breast magnetic resonance imaging or screening breast
112 ultrasound on a basis not less favorable than screening mammograms that are covered as medical
113 benefits. An increase in patient cost sharing for screening mammograms, for digital breast
114 tomosynthesis, for screening breast magnetic resonance imaging, for screening breast ultrasound
115 or for diagnostic examinations for breast cancer shall not be allowed to achieve compliance with
116 this section. For the purposes of this section, “diagnostic examinations for breast cancer” means
117 a medically necessary and appropriate examination for breast cancer to evaluate the abnormality
118 in the breast that is seen or suspected from a screening examination for breast cancer, detected by
119 another means of examination; or suspected based on the medical history or family medical
120 history of the individual. “Examination for breast cancer” includes an examination used to
121 evaluate an abnormality in a breast using diagnostic mammography, digital breast tomosynthesis,
122 breast magnetic resonance imaging or breast ultrasound. “Cost sharing” shall mean a deductible,
123 coinsurance, copayment, and any maximum limitation on the application of such a deductible,
124 coinsurance, copayment, or similar out-of-pocket expense.
6 of 10
125 (a) As used in this Section, "HSA-qualified health insurance policy" means a
126 policy of individual or group health insurance coverage that satisfies the criteria for a "high-
127 deductible health plan" under 26 U.S.C. 223 as implemented and interpreted by the U.S.
128 Department of the Treasury in the regulations and guidance in effect at the time the policy is
129 issued.
130 (b) Except as provided in (c), an HSA-qualified health insurance policy is exempt from
131 any prohibition on cost-sharing requirements for a covered benefit required under Massachusetts
132 law to the extent the exemption is necessary to allow the policy to be an “HSA-qualified health
133 insurance policy.”
134 (c) The exemption provided in (b) shall not apply to any coverage required by
135 Massachusetts statute that pertains to preventive care as that term is defined by regulation or
136 guidance by the U.S. Department of the Treasury under 26 U.S.C. 223 with respect to any HSA-
137 qualified health insurance policy issued, delivered, amended, or renewed while such regulation
138 or guidance is effective.
139 SECTION 5. Chapter 176B of the General Laws is hereby amended by inserting after
140 section 4NN thereof the following section: -
141 Section 4OO. Notwithstanding any general or special law or rule or regulation to the
142 contrary, any subscription certificate under an individual or group medical service agreement
143 delivered, issued or renewed within the commonwealth that provides coverage for screening
144 mammograms shall provide coverage for diagnostic examinations for breast cancer and for
145 digital breast tomosynthesis screening and medically necessary and appropriate screening with
146 breast magnetic resonance imaging or breast ultrasound on a basis not less favorable than
7 of 10
147 screening mammograms that are covered as medical benefits. An increase in patient cost sharing
148 for screening mammograms, for digital breast tomosynthesis, for screening breast magnetic
149 resonance imaging, for screening breast ultrasound or for diagnostic examinations for breast
150 cancer shall not be allowed to achieve compliance with this section. For the purposes of this
151 section, “diagnostic examinations for breast cancer” means a medically necessary and
152 appropriate examination for breast cancer to evaluate the abnormality in the breast that is seen or
153 suspected from a screening examination for breast cancer, detected by another means of
154 examination; or suspected based on the medical history or family medical history of the
155 individual. “Examination for breast cancer” includes an examination used to evaluate an
156 abnormality in a breast using diagnostic mammography, digital breast tomosynthesis, breast
157 magnetic resonance imaging or breast ultrasound. “Cost sharing” shall mean a deductible,
158 coinsurance, copayment, and any maximum limitation on the application of such a deductible,
159 coinsurance, copayment, or similar out-of-pocket expense.
160 (a) As used in this Section, "HSA-qualified health insurance policy" means a policy
161 of individual or group health insurance coverage that satisfies the criteria for a "high-deductible
162 health plan" under 26 U.S.C. 223 as implemented and interpreted by the U.S. Department of the
163 Treasury in the regulations and guidance in effect at the time the policy is issued.
164 (b) Except as provided in (c), an HSA-qualified health insurance policy is exempt from
165 any prohibition on cost-sharing requirements for a covered benefit required under Massachusetts
166 law to the extent the exemption is necessary to allow the policy to be an “HSA-qualified health
167 insurance policy.”
8 of 10
168 (c) The exemption provided in (b) shall not apply to any coverage required by
169 Massachusetts statute that pertains to preventive care as that term is defined by regulation or
170 guidance by the U.S. Department of the Treasury under 26 U.S.C. 223 with respect to any HSA-
171 qualified health insurance policy issued, delivered, amended, or renewed while such regulation
172 or guidance is effective.
173 SECTION 6. Chapter 176G of the General Laws is hereby amended by inserting after
174 section 4FF thereof the following section: -
175 Section 4GG. Notwithstanding any general or special law or rule or regulation to the
176 contrary, any individual or group health maintenance contract that provides coverage for
177 screening mammograms shall provide coverage for diagnostic examinations for breast cancer
178 and for digital breast tomosynthesis screening and medically necessary and appropriate screening
179 with breast magnetic resonance imaging or screening breast ultrasound on a basis not less
180 favorable than screening mammograms that are covered as medical benefits. An increase in
181 patient cost sharing for screening mammograms, for digital breast tomosynthesis, for screening
182 breast magnetic resonance imaging, for screening breast ultrasound or for diagnostic
183 examinations for breast cancer shall not be allowed to achieve compliance with this section. For
184 the purposes of this section, “diagnostic examinations for breast cancer” means a medically
185 necessary and appropriate examination for breast cancer to evaluate the abnormality in the