Bill Text: IA SSB1221 | 2023-2024 | 90th General Assembly | Introduced
Bill Title: A bill for an act relating to and making appropriations to state departments and agencies following state government realignment from the rebuild Iowa infrastructure fund and the technology reinvestment fund, and providing for related matters.(See SF 577.)
Sponsorship: Committee Bill
Status: (Introduced - Dead) 2023-05-02 - NOBA: Senate Sub [SSB1221 Detail]
Download: Iowa-2023-SSB1221-Introduced.html
Senate
Study
Bill
1221
-
Introduced
SENATE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
COMMERCE
BILL
BY
CHAIRPERSON
BROWN)
A
BILL
FOR
An
Act
relating
to
insurance
coverage
for
supplemental
and
1
diagnostic
breast
examinations.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
TLSB
1794XC
(8)
90
ko/rn
S.F.
_____
Section
1.
NEW
SECTION
.
514C.4A
Supplemental
and
diagnostic
1
breast
examinations.
2
1.
As
used
in
this
section,
unless
the
context
otherwise
3
requires:
4
a.
“Breast
magnetic
resonance
imaging”
or
“breast
MRI”
means
5
an
examination
of
a
breast
using
a
powerful
magnetic
field,
6
radio
waves,
and
a
computer
to
produce
detailed
pictures
of
the
7
structures
within
the
breast.
8
b.
“Breast
ultrasound”
means
a
noninvasive
examination
of
9
a
breast
using
high-frequency
sound
waves
to
produce
detailed
10
images
of
the
breast.
11
c.
“Cost-sharing”
means
any
coverage
limit,
copayment,
12
coinsurance,
deductible,
or
other
out-of-pocket
expense
13
obligation
imposed
on
a
covered
person
by
a
policy,
contract,
14
or
plan
providing
for
third-party
payment
or
prepayment
of
15
health
or
medical
expenses.
16
d.
“Covered
person”
means
a
policyholder,
subscriber,
or
17
other
person
participating
in
a
policy,
contract,
or
plan
that
18
provides
for
third-party
payment
or
prepayment
of
health
or
19
medical
expenses.
20
e.
“Diagnostic
breast
cancer
examination”
means
a
medically
21
necessary
and
appropriate
examination
of
the
breast
that
may
22
include
diagnostic
mammography,
breast
magnetic
resonance
23
imaging,
or
breast
ultrasound,
and
that
is
performed
for
any
of
24
the
following
reasons:
25
(1)
To
evaluate
an
abnormality
seen
or
suspected
during
a
26
screening
examination
for
breast
cancer.
27
(2)
To
evaluate
an
abnormality
detected
by
another
means
of
28
examination.
29
f.
“Diagnostic
mammogram”
means
a
detailed
examination
of
a
30
breast
abnormality
using
X
ray.
31
g.
“Health
care
professional”
means
the
same
as
defined
in
32
section
514J.102.
33
h.
“Health
care
services”
means
services
for
the
diagnosis,
34
prevention,
treatment,
cure,
or
relief
of
a
health
condition,
35
-1-
LSB
1794XC
(8)
90
ko/rn
1/
3
S.F.
_____
illness,
injury,
or
disease.
1
i.
“Screening
mammogram”
means
an
examination
of
a
breast
2
that
aids
in
the
early
detection
and
diagnosis
of
breast
3
cancer.
4
j.
“Supplemental
breast
examination”
means
a
medically
5
necessary
and
appropriate
examination
of
the
breast
that
may
6
include
breast
magnetic
resonance
imaging
or
breast
ultrasound,
7
and
that
is
performed
to
screen
for
breast
cancer
when
there
is
8
no
abnormality
seen
or
suspected
and
based
on
an
individual’s
9
personal
or
family
medical
history,
or
additional
factors
that
10
may
increase
the
individual’s
risk
of
breast
cancer.
11
2.
a.
Notwithstanding
the
uniformity
of
treatment
12
requirements
of
section
514C.6,
a
policy,
contract,
or
plan
13
providing
for
third-party
payment
or
prepayment
of
health
or
14
medical
expenses
shall
provide
coverage
for
supplemental
breast
15
examinations
and
diagnostic
breast
cancer
examinations.
16
b.
Coverage
required
under
this
section
shall
not
be
less
17
favorable
than
coverage
a
health
carrier
offers
for
screening
18
mammograms.
19
c.
Cost-sharing
requirements
shall
not
be
imposed
by
a
20
health
carrier
for
coverage
required
under
this
section.
21
3.
a.
This
section
applies
to
the
following
classes
of
22
third-party
payment
provider
contracts,
policies,
or
plans
23
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
24
state
on
or
after
January
1,
2024:
25
(1)
Individual
or
group
accident
and
sickness
insurance
26
providing
coverage
on
an
expense-incurred
basis.
27
(2)
An
individual
or
group
hospital
or
medical
service
28
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
29
(3)
An
individual
or
group
health
maintenance
organization
30
contract
regulated
under
chapter
514B.
31
(4)
A
plan
established
for
public
employees
pursuant
to
32
chapter
509A.
33
b.
This
section
shall
not
apply
to
accident-only,
specified
34
disease,
short-term
hospital
or
medical,
hospital
confinement
35
-2-
LSB
1794XC
(8)
90
ko/rn
2/
3
S.F.
_____
indemnity,
credit,
dental,
vision,
Medicare
supplement,
1
long-term
care,
basic
hospital
and
medical-surgical
expense
2
coverage
as
defined
by
the
commissioner
of
insurance,
3
disability
income
insurance
coverage,
coverage
issued
as
a
4
supplement
to
liability
insurance,
workers’
compensation
or
5
similar
insurance,
or
automobile
medical
payment
insurance.
6
4.
The
commissioner
of
insurance
may
adopt
rules
pursuant
to
7
chapter
17A
to
administer
this
section.
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
supplemental
12
breast
examinations
(supplemental
examinations)
and
diagnostic
13
breast
cancer
examinations
(diagnostic
examinations).
14
The
bill
requires
a
policy,
contract,
or
plan
providing
15
for
third-party
payment
or
prepayment
of
health
or
medical
16
expenses
to
provide
coverage
for
supplemental
examinations
17
and
diagnostic
examinations.
“Supplemental
examination”
and
18
“diagnostic
examination”
are
defined
in
the
bill.
Coverage
19
required
under
the
bill
shall
not
be
less
favorable
than
20
coverage
a
health
carrier
offers
for
screening
mammograms.
The
21
health
carrier
shall
not
impose
cost-sharing
for
supplemental
22
examinations
or
diagnostic
examinations.
“Cost-sharing”
and
23
“screening
mammogram”
are
defined
in
the
bill.
24
The
bill
applies
to
the
third-party
payment
providers
25
enumerated
in
the
bill.
The
bill
specifies
the
types
of
26
specialized
health-related
insurance
which
are
not
subject
to
27
the
coverage
requirements
of
the
bill.
28
The
commissioner
of
insurance
may
adopt
rules
to
administer
29
the
requirements
of
the
bill.
30
The
provisions
of
the
bill
are
applicable
to
third-party
31
payment
provider
contracts,
policies,
or
plans
delivered,
32
issued
for
delivery,
continued,
or
renewed
in
this
state
on
or
33
after
January
1,
2024.
34
-3-
LSB
1794XC
(8)
90
ko/rn
3/
3
