3 more states pass legislation bolstering breast imaging coverage
Three more states recently passed legislation to bolster reimbursement for breast imaging services, with about half now mandating that private payers cover supplemental services.
New Hampshire is one of the latest after Republican Gov. Chris Sununu signed House Bill 1296 into law May 31. The measure eliminates patient out-of-pocket costs for medically necessary diagnostic and supplemental breast imaging.
While the Affordable Care Act already requires payers to cover regular mammography screenings, some women with dense breasts or facing other factors may need additional exams such as ultrasound or MRI. Coverage gaps can force some to pay out-of-pocket charges at upward of $1,000, according to Susan G. Komen.
“We thank the legislature and Gov. Sununu for eliminating barriers to care so that people with state-regulated health plans receive their medically necessary diagnostic and supplemental imaging without any patient cost sharing,” Molly Guthrie, VP of policy and advocacy at the nonprofit, said in a statement issued June 3.
Louisiana also recently passed its own legislation, with Republican Gov. Jeff Landry signing Senate Bill 338 into law May 23. Susan G. Komen in 2019 worked to pass legislation that provided no-cost coverage for diagnostic breast imaging following an abnormal finding. This latest update expands on that coverage to now include supplemental imaging, “a critical form of breast cancer screening for individuals at a higher risk,” SGK said in a separate announcement June 3.
Finally, Republican Iowa Gov. Kim Reynolds also signed House File 2489 into law last month. The bill requires insurance coverage for supplemental and diagnostic breast examinations, the American College of Radiology reported May 30. Starting next year, health insurance policies, contracts and plans must cover breast imaging without less favorable terms than those for screening mammography, ACR noted.
“The coverage includes breast MRIs, ultrasounds and diagnostic mammograms aimed at evaluating abnormalities or based on risk factors such as personal or family medical history,” the college noted. “This requirement applies to various individual and group health plans, including those for public employees, but excludes accident-only, specified disease, short-term and other specialized insurance types.”
The action comes after Vermont lawmakers approved a similar bill in April. Numerous states have introduced breast imaging bills, among them, Alaska, Arizona, Florida, Indiana, Kansas, Massachusetts, Michigan, Mississippi, Nebraska, North Carolina, Pennsylvania, Rhode Island, South Dakota, Virginia, West Virginia and Wisconsin, ACR added. A national version of the legislation is pending in Washington, D.C., eliminating cost for patients insured by federally regulated health plans.
“Komen will continue to advocate for legislation that ensures fair and equitable access to high-quality breast care for all, no matter their age, race, ethnicity, sexual orientation, gender identity, cancer stage or socio-economic status,” SGK’s Guthrie said Monday.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.