HF 71 (LSB 1437YH (2) 90)

HOUSE FILE 71

BY  A. MEYER

A BILL FOR

An Act relating to insurance coverage for diagnostic breast cancer examinations.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514C.4A  Diagnostic examinations —— breast cancer.
   1.  As used in this section, unless the context otherwise requires:
   a.  “Abnormality” means an abnormal feature, characteristic, or occurrence in a covered person’s breast that meets any of the following requirements:
   (1)  The abnormality is identified as a result of a covered person’s screening mammogram.
   (2)  The abnormality is identified during the provision of health care services to a covered person by a health care professional.
   (3)  A health care professional determines an abnormality exists based on a covered person’s medical history or the covered person’s family medical history.
   b.  “Breast magnetic resonance imaging” or “breast MRI” means an examination of a breast using a powerful magnetic field, radio waves, and a computer to produce detailed pictures of the structures within the breast.
   c.  “Breast ultrasound” means a noninvasive examination of a breast using high-frequency sound waves to produce detailed images of the breast.
   d.  “Cost-sharing” means any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense obligation imposed on a covered person by a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses.
   e.  “Covered person” means a policyholder, subscriber, or other person participating in a policy, contract, or plan that provides for third-party payment or prepayment of health or medical expenses.
   f.  “Diagnostic breast cancer examination” means an examination of an abnormality, deemed medically necessary and appropriate by a covered person’s health care professional, for the detection of breast cancer. The examination may be conducted using a diagnostic mammogram, breast magnetic resonance imaging, or a breast ultrasound.
   g.  “Diagnostic mammogram” means a detailed examination of a breast abnormality using X ray.
   h.  “Health care professional” means the same as defined in section 514J.102.
   i.  “Health care services” means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease.
   j.  “Screening mammogram” means an examination of a breast that aids in the early detection and diagnosis of breast cancer.
   2.  a.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall provide coverage for diagnostic breast cancer examinations.
   b.  Coverage required under this section shall not be less favorable than coverage a health carrier offers for screening mammograms.
   c.  Cost-sharing requirements imposed for coverage required under this section shall not be less favorable than cost-sharing requirements imposed by a health carrier for screening mammograms.
   3.  a.  This section applies to the following classes of third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2024:
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  A plan established for public employees pursuant to chapter 509A.
   b.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner of insurance, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   4.  The commissioner of insurance shall adopt rules pursuant to chapter 17A to administer this section.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to insurance coverage for diagnostic breast cancer examinations.
   The bill requires a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses to provide coverage for diagnostic breast cancer examinations. “Diagnostic breast cancer examination” is defined in the bill as an examination of an abnormality, deemed medically necessary by a covered person’s health care professional, for the detection of breast cancer. The examination may be conducted using a diagnostic mammogram, breast magnetic resonance imaging, or breast ultrasound. “Abnormality”, “diagnostic mammogram”, “breast magnetic resonance imaging”, and “breast ultrasound” are also defined in the bill.
   Coverage required under the bill shall not be less favorable than coverage a health carrier offers for screening mammograms. The policy, contract, or plan cannot impose cost-sharing greater than the cost-sharing that the policy, contract, or plan imposes for a screening mammogram. “Cost-sharing” and “screening mammogram” are defined in the bill.
   The bill applies to third-party payment providers enumerated in the bill. The bill specifies the types of specialized health-related insurance which are not subject to the coverage requirements of the bill.
   The commissioner of insurance is required to adopt rules to administer the requirements of the bill.
   The bill applies to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2024.