Bill Text: IA SF2164 | 2021-2022 | 89th General Assembly | Introduced
Bill Title: A bill for an act relating to insurance coverage for diagnostic breast cancer examinations, and including applicability provisions.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2022-02-01 - Subcommittee: Schultz, Mathis, and Williams. S.J. 180. [SF2164 Detail]
Download: Iowa-2021-SF2164-Introduced.html
Senate
File
2164
-
Introduced
SENATE
FILE
2164
BY
SWEENEY
A
BILL
FOR
An
Act
relating
to
insurance
coverage
for
diagnostic
breast
1
cancer
examinations,
and
including
applicability
provisions.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
NEW
SECTION
.
514C.4A
Diagnostic
examinations
1
——
breast
cancer.
2
1.
As
used
in
this
section,
unless
the
context
otherwise
3
requires:
4
a.
“Abnormality”
means
an
abnormal
feature,
characteristic,
5
or
occurrence
in
a
covered
person’s
breast
that
meets
any
of
6
the
following
requirements:
7
(1)
The
abnormality
is
identified
as
a
result
of
a
covered
8
person’s
screening
mammogram.
9
(2)
The
abnormality
is
identified
during
the
provision
10
of
health
care
services
to
a
covered
person
by
a
health
care
11
professional.
12
(3)
A
health
care
professional
determines
an
abnormality
13
exists
based
on
a
covered
person’s
medical
history
or
the
14
covered
person’s
family
medical
history.
15
b.
“Breast
magnetic
resonance
imaging”
or
“breast
MRI”
means
16
an
examination
of
a
breast
using
a
powerful
magnetic
field,
17
radio
waves,
and
a
computer
to
produce
detailed
pictures
of
the
18
structures
within
the
breast.
19
c.
“Breast
ultrasound”
means
a
noninvasive
examination
of
20
a
breast
using
high-frequency
sound
waves
to
produce
detailed
21
images
of
the
breast.
22
d.
“Cost-sharing”
means
any
coverage
limit,
copayment,
23
coinsurance,
deductible,
or
other
out-of-pocket
expense
24
obligation
imposed
on
a
covered
person
by
a
policy,
contract,
25
or
plan
providing
for
third-party
payment
or
prepayment
of
26
health
or
medical
expenses.
27
e.
“Covered
person”
means
a
policyholder,
subscriber,
or
28
other
person
participating
in
a
policy,
contract,
or
plan
that
29
provides
for
third-party
payment
or
prepayment
of
health
or
30
medical
expenses.
31
f.
“Diagnostic
breast
cancer
examination”
means
an
32
examination
of
an
abnormality,
deemed
medically
necessary
by
a
33
covered
person’s
health
care
professional,
for
the
detection
34
of
breast
cancer.
The
examination
may
be
conducted
using
a
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diagnostic
mammogram,
breast
magnetic
resonance
imaging,
or
a
1
breast
ultrasound.
2
g.
“Diagnostic
mammogram”
means
a
detailed
examination
of
a
3
breast
abnormality
using
X
ray.
4
h.
“Health
care
professional”
means
the
same
as
defined
in
5
section
514J.102.
6
i.
“Health
care
services”
means
services
for
the
diagnosis,
7
prevention,
treatment,
cure,
or
relief
of
a
health
condition,
8
illness,
injury,
or
disease.
9
j.
“Screening
mammogram”
means
an
examination
of
a
breast
10
that
aids
in
the
early
detection
and
diagnosis
of
breast
11
cancer.
12
2.
Notwithstanding
the
uniformity
of
treatment
requirements
13
of
section
514C.6,
a
policy,
contract,
or
plan
providing
14
for
third-party
payment
or
prepayment
of
health
or
medical
15
expenses
shall
provide
coverage
for
diagnostic
breast
cancer
16
examinations.
The
policy,
contract,
or
plan
shall
not
require
17
cost-sharing
greater
than
the
cost-sharing
that
the
policy,
18
contract,
or
plan
requires
for
a
screening
mammogram.
19
3.
a.
This
section
shall
apply
to
the
following
classes
of
20
third-party
payment
provider
contracts,
policies,
or
plans:
21
(1)
Individual
or
group
accident
and
sickness
insurance
22
providing
coverage
on
an
expense-incurred
basis.
23
(2)
An
individual
or
group
hospital
or
medical
service
24
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
25
(3)
An
individual
or
group
health
maintenance
organization
26
contract
regulated
under
chapter
514B.
27
(4)
A
plan
established
for
public
employees
pursuant
to
28
chapter
509A.
29
b.
This
section
shall
not
apply
to
accident-only,
specified
30
disease,
short-term
hospital
or
medical,
hospital
confinement
31
indemnity,
credit,
dental,
vision,
Medicare
supplement,
32
long-term
care,
basic
hospital
and
medical-surgical
expense
33
coverage
as
defined
by
the
commissioner
of
insurance,
34
disability
income
insurance
coverage,
coverage
issued
as
a
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supplement
to
liability
insurance,
workers’
compensation
or
1
similar
insurance,
or
automobile
medical
payment
insurance.
2
4.
The
commissioner
of
insurance
shall
adopt
rules
pursuant
3
to
chapter
17A
to
administer
this
section.
4
Sec.
2.
APPLICABILITY.
This
Act
applies
to
third-party
5
payment
provider
contracts,
policies,
or
plans
delivered,
6
issued
for
delivery,
continued,
or
renewed
in
this
state
on
or
7
after
January
1,
2023.
8
EXPLANATION
9
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
10
the
explanation’s
substance
by
the
members
of
the
general
assembly.
11
This
bill
relates
to
insurance
coverage
for
diagnostic
12
breast
cancer
examinations.
13
The
bill
requires
a
policy,
contract,
or
plan
providing
for
14
third-party
payment
or
prepayment
of
health
or
medical
expenses
15
to
provide
coverage
for
diagnostic
breast
cancer
examinations.
16
“Diagnostic
breast
cancer
examination”
is
defined
in
the
bill
17
as
an
examination
of
an
abnormality,
deemed
medically
necessary
18
by
a
covered
person’s
health
care
professional,
for
the
19
detection
of
breast
cancer.
The
examination
may
be
conducted
20
using
a
diagnostic
mammogram,
breast
magnetic
resonance
21
imaging,
or
breast
ultrasound.
“Abnormality”,
“diagnostic
22
mammogram”,
“breast
magnetic
resonance
imaging”,
and
“breast
23
ultrasound”
are
also
defined
in
the
bill.
24
The
policy,
contract,
or
plan
cannot
require
cost-sharing
25
greater
than
the
cost-sharing
that
the
policy,
contract,
or
26
plan
requires
for
a
screening
mammogram.
“Cost-sharing”
and
27
“screening
mammogram”
are
defined
in
the
bill.
28
The
bill
applies
to
third-party
payment
providers
enumerated
29
in
the
bill.
The
bill
specifies
the
types
of
specialized
30
health-related
insurance
which
are
not
subject
to
the
coverage
31
requirements
of
the
bill.
32
The
commissioner
of
insurance
is
required
to
adopt
rules
to
33
administer
the
requirements
of
the
bill.
34
The
bill
applies
to
third-party
payment
provider
contracts,
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