No. HB 137
Filed under Insurance.
Coverage for Mammograms and Supplemental Breast Cancer Screenings; Requires AHCA to provide coverage for yearly mammograms & yearly supplemental breast cancer screenings for certain women; revises coverages for mammograms under certain individual accident & health insurance policies, group, blanket, & franchise accident & health insurance policies, & health maintenance contracts; requires coverages for supplemental breast cancer screenings under such policies & contracts under certain circumstances.
Plain English Summary
AI-GENERATEDInsurers must now cover one mammogram a year, including digital breast tomosynthesis, for any woman between 25 and 40 years old.
That replaces the old schedule, which started coverage at 35 and required annual mammograms for every woman 50 or older, with no upper age limit.
Women 25 to 40 who are at risk, due to dense breast tissue, family history, ancestry, genetic predisposition, or a reason their own physician cites, must also get a yearly MRI, ultrasound, or similar supplemental screening covered.
Medicaid gains a matching mammogram and supplemental-screening benefit for recipients 25 to 40, but only subject to available state funding, not as an unconditional guarantee.
AIAHCA must provide one mammogram and, if warranted, one supplemental breast cancer screening each year for Medicaid recipients who are women 25 to 40, subject to available appropriations and any needed federal approval.
AIThe prior tiered schedule, baseline mammograms at 35, biennial from 40, and annual from 50 with no upper limit, is struck from individual, group/blanket/franchise, and HMO coverage law. The replacement mandate reaches only women between 25 and 40, inclusive.
AIBeyond the standard mammogram, insurers must now cover one supplemental breast cancer screening a year, such as an MRI, ultrasound, or molecular breast imaging exam, for any woman 25 to 40 whom a physician identifies as at risk.
AIThe required annual mammogram must now include digital breast tomosynthesis (3-D mammography), which was not part of the coverage floor under the prior statute's baseline and tiered mammogram schedule.
AIThe list of risk factors that trigger mandatory supplemental screening grows to include dense breast tissue shown on a woman's own mammogram, her ancestry, and genetic predisposition, alongside the pre-existing family-history and biopsy criteria.