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ARIZONA STATE SENATE
Fifty-Sixth Legislature, First Regular Session
breast examinations; cancer screenings; age
Purpose
Requires corporations, health care services organizations, disability insurers, group disability insurers and blanket disability insurers (insurers) to provide coverage for a mammogram, digital breast tomosynthesis, magnetic resonance imaging or ultrasound in outlined circumstances.
Background
Contracts
between certain insurers and the insured that provides coverage for surgical
services for a mastectomy must also provide coverage for mammography screening
performed on dedicated equipment for diagnostic purposes on referral by a
patient's physician, subject to the policy terms and conditions and outlined
guidelines. An insurer must provide coverage for a:
1) baseline mammogram for a woman from age 35 to 39; 2) mammogram for a woman
from age 40 to 49 every two years or more frequently based on the
recommendation of the woman's physician; and 3) mammogram every year for a
woman 50 years of age and over.
Any contract issued by corporations, disability insurance and group disability insurers to the insured that provides coverage for maternity benefits must also provide that the maternity benefits apply to the costs of the birth of any child legally adopted by the insured if outlined criteria is met. This coverage is excess to any other coverage the natural mother may have for maternity benefits, not including coverage made available to the following eligible persons: 1) a full-time officer or employee of Arizona or of a city, town or school district of Arizona or other person who is eligible for hospitalization and medical care; 2) a full-time officer or employee of any county in Arizona or other persons authorized by the county to participate in county medical care and hospitalization programs if the county in which such officer or employee is employed has authorized participation in the system by resolution of the county board of supervisors; 3) an Arizona business employee; and 4) a dependent of an officer or employee who is participating in the system (A.R.S. §§ 20-826; 20-1057; 20-1342; 20-1402; and 20-1404).
A diagnostic mammography is an x-ray imaging of the breast performed on persons who have symptoms or physical signs indicative of breast disease. A screening mammography is an x-ray imaging of the breast of asymptomatic persons (A.R.S. § 30-651).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Requires an insurer that has a contract that provides coverage for surgical services for a mastectomy to also provide coverage for preventative mammography screening and diagnostic imaging on referral by a patient's physician, subject to the policy terms and outlined guidelines.
2. Requires an insurer to provide coverage for a mammogram, digital breast tomosynthesis, magnetic resonance imaging or ultrasound:
a) to a woman who is at least 40, rather than 50 years of age, annually;
b) at such age and intervals as deemed medically necessary by the woman's health care provider;
c) if the patient has a history of breast cancer.
3. Requires an insurer to provide coverage of the entire breast or both breasts, if:
a) a screening mammogram reveals any abnormality where an additional examination is deemed medically necessary by the interpreting radiologist;
b) the patient presents with symptoms, including a palpable lump, pain or discharge;
c) a health care provider deems further imaging is medically necessary based on prior diagnostic imaging;
d) there is deemed to be at an increased lifetime risk for breast cancer as defined by medically established risk models that evaluate a lifetime greater than 20 percent risk of breast cancer; or
e) there are additional risk factors for breast cancer, including family history or prior history of breast cancer, positive genetic testing, heterogeneously or extremely dense breast tissue based on the Breast Imaging Reporting and Data System of the American College of Radiology, or other risk factors as determined by the patient's health care provider.
4. Includes outlined eligible persons in the insurance contract by corporations, disability insurance and group disability insurers that covers the costs of the birth of any child legally adopted by the insured.
5. Defines digital breast tomosynthesis as multiple low dose images of the breast as an x-ray tube moves around an arc, in which the images are then reconstructed to produce a volume rendering of the breast.
6. Includes digital breast tomosynthesis in the definition of screening mammography.
7. Makes technical and conforming changes.
8. Becomes effective on the general effective date.
Prepared by Senate Research
February 10, 2023
MM/MC/slp