Assigned
to HHS AS
PASSED BY COW
ARIZONA STATE SENATE
Fifty-Sixth Legislature, First Regular Session
AMENDED
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 and digital breast tomosynthesis, magnetic resonance imaging (MRI) or ultrasound at the age and intervals as recommended by the National Comprehensive Cancer Network (NCCN).
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).
The NCCN is a not-for-profit alliance of 32 leading cancer centers devoted to patient care, research and education. The NCCN is dedicated to improving and facilitating quality, effective, equitable and accessible cancer care so all patients can live better lives. The NCCN develops resources that present valuable information to stakeholders in the health care delivery system. By defining and advancing high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers around the world (NCCN).
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 mastectomy surgical services coverage to also provide coverage for preventive mammography screening and diagnostic imaging on referral by a patient's physician, subject to the policy terms, including a mammogram and digital breast tomosynthesis, MRI, ultrasound or other modality and at such age and intervals as recommended by the NCCN.
a) family history with one or more first or second-degree relatives with breast cancer;
b) prior diagnosis of breast cancer; or
c) positive testing for hereditary gene mutations or heterogeneously or dense breast tissue based on the Breast Imaging Reporting and Data System of the American College of Radiology.
3. 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.
4. 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.
5. Includes digital breast tomosynthesis in the definition of screening mammography.
6. Makes technical and conforming changes.
7. Becomes effective on the general effective date.
Amendments Adopted by Committee
1. Removes the requirement that an insurer must provide coverage for a magnetic resonance imaging or ultrasound in outlined circumstances.
2. Requires an insurer to provide coverage for a mammogram or digital breast tomosynthesis at such age and intervals as deemed medically necessary by a woman's health care provider, if the patient is less than 40 years old and has a first degree relative diagnosed with breast cancer before the age of 50 or other breast cancer risk factors, including hereditary genetic mutation.
3. States that a patient who has a previously diagnosed first degree relative qualifies for screening mammography 10 years prior to the diagnosis of the first degree relative and in the case of genetic mutation, mammography is to start at age 30 in combination with screening magnetic resonance imaging.
Amendments Adopted by Committee of the Whole
1. Removes the requirement that an insurer provide preventative coverage for a mammogram or digital breast tomosynthesis to a woman in outlined circumstances.
2. Requires an insurer to provide coverage for preventive mammography screening and diagnostic imaging, including a mammogram and digital breast tomosynthesis, MRI, ultrasound or other modality and at such age and intervals as recommended by the NCCN.
3. Includes outlined patients in the preventive mammography screening and diagnostic imaging coverage.
Senate Action
HHS 2/14/23 DPA 7-0-0
Prepared by Senate Research
March 15, 2023
MM/MC/slp