2023 -- H 5283 SUBSTITUTE A

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LC000686/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES --

MAMMOGRAMS AND PAP SMEARS -- COVERAGE MANDATED

     Introduced By: Representatives Fogarty, Kazarian, Carson, Tanzi, Lima, Cotter, Spears,
Donovan, Henries, and McGaw

     Date Introduced: February 01, 2023

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18-41 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-41. Mammograms and pap smears — Coverage mandated.

     (a)(1) Every individual or group hospital or medical expense insurance policy or individual

or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this

state shall provide coverage for mammograms and pap smears, in accordance with guidelines

established by the American Cancer Society.

     (2) Notwithstanding the provisions of this chapter, every individual or group hospital or

medical insurance policy or individual or group hospital or medical services plan contract

delivered, issued for delivery, or renewed in this state shall pay for:

     (A) Two two (2) screening mammograms per year when recommended by a physician for

women who have been treated for breast cancer within the last five (5) years or are at high risk of

developing breast cancer due to genetic predisposition (BRCA gene mutation or multiple first

degree relatives) or high risk lesion on prior biopsy (lobular carcinoma in situ) or atypical ductal

hyperplasia.; and

     (B) Any screening deemed medically necessary for proper breast cancer screening in

accordance with applicable American College of Radiology guidelines including, but not limited

to, magnetic resonance imaging, ultrasound, or molecular breast imaging for any person who has

received notice pursuant to § 23-12.9-2 of the existence of dense breast tissue.

     (b) This section shall not apply to insurance coverage providing benefits for: (1) hospital

confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare

supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury

or death by accident or both; and (9) other limited benefit policies.

     SECTION 2. Section 27-19-20 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-20. Mammograms and pap smears — Coverage mandated.

     (a) Subscribers to any nonprofit hospital service plan shall be afforded coverage under the

plan for mammograms and pap smears, in accordance with guidelines established by the American

Cancer Society.

     (b) Notwithstanding the provisions of this chapter, subscribers to any nonprofit hospital

service plan shall be afforded coverage for:

     (1) Two two (2) screening mammograms per year when recommended by a physician for

women who have been treated for breast cancer within the last five (5) years or who are at high risk

of developing breast cancer due to genetic predisposition (BRCA gene mutation or multiple first

degree relatives) or high risk lesion on prior biopsy (lobular carcinoma in situ) or atypical ductal

hyperplasia.; and

     (2) Any screening deemed medically necessary for proper breast cancer screening in

accordance with applicable American College of Radiology guidelines including, but not limited

to, magnetic resonance imaging, ultrasound, or molecular breast imaging for any person who has

received notice pursuant to § 23-12.9-2 of the existence of dense breast tissue.

     SECTION 3. Section 27-20-17 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-17. Mammograms and pap smears — Coverage mandated.

     (a) Subscribers to any nonprofit medical service plan shall be afforded coverage under the

plan for mammograms and pap smears, in accordance with guidelines established by the American

Cancer Society.

     (b) Notwithstanding the provisions of this chapter, subscribers to any nonprofit medical

service plan shall be afforded coverage for:

     (1) Two two (2) paid screening mammograms per year when recommended by a physician

for women who have been treated for breast cancer within the last five (5) years or who are at high

risk of developing breast cancer due to genetic predisposition (BRCA gene mutation or multiple

first degree relatives) or high risk lesion on prior biopsy (lobular carcinoma in situ) or atypical

LC000686/SUB A - Page 2 of 4

ductal hyperplasia.; and

     (2) Any screening deemed medically necessary for proper breast cancer screening in

accordance with applicable American College of Radiology guidelines including, but not limited

to, magnetic resonance imaging, ultrasound, or molecular breast imaging for any person who has

received notice pursuant to § 23-12.9-2 of the existence of dense breast tissue.

     SECTION 4. Section 27-41-30 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-30. Mammograms and pap smears — Coverage mandated.

     (a) Subscribers to any health maintenance organization plan shall be afforded coverage

under that plan for mammograms and pap smears, in accordance with guidelines established by the

American Cancer Society.

     (b) Notwithstanding the provisions of this chapter, subscribers to any health maintenance

organization plan shall be afforded coverage for:

     (1) Two two (2) paid screening mammograms per year when recommended by a physician

for women who have been treated for breast cancer within the last five (5) years or who are at high

risk of developing breast cancer due to genetic predisposition (BRCA gene mutation or multiple

first degree relatives) or high risk lesion on prior biopsy (lobular carcinoma in situ) or atypical

ductal hyperplasia.; and

     (2) Any screening deemed medically necessary for proper breast cancer screening in

accordance with applicable American College of Radiology guidelines including, but not limited

to, magnetic resonance imaging, ultrasound, or molecular breast imaging for any person who has

received notice pursuant to § 23-12.9-2 of the existence of dense breast tissue.

     SECTION 5. This act shall take effect on January 1, 2024.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES --

MAMMOGRAMS AND PAP SMEARS -- COVERAGE MANDATED

***

     This act would mandate insurance coverage for any screenings deemed medically

necessary for any person who has received notice of dense breast tissue.

     This act would take effect on January 1, 2024.

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