Amends TCA Title 56, Chapter 7.
Generally under present law, health insurers that provide 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 according to the following guidelines: (1) A baseline mammogram for women 35 to 40 years of age; (2) A mammogram every two years, or more frequently based on the recommendation of the woman's physician for women 40 to 50 years of age; and (3) A mammogram every year for woman 50 years of age and over. This bill rewrites the above provision to instead require a health benefit plan that provides coverage to a patient who is 35 years of age or older to include coverage for an annual screening by all forms of low dose mammography for the presence of breast cancer. This bill specifies that a health benefit plan that provides coverage for a screening mammogram must provide coverage for diagnostic imaging and supplemental breast screening. ON APRIL 27, 2022, THE HOUSE ADOPTED AMENDMENT #1 AND PASSED HOUSE BILL 2544, AS AMENDED. AMENDMENT #1 revises the required coverage to require a health benefit plan that provides coverage for imaging services for screening mammography to provide coverage to a patient for low-dose mammography according to the following guidelines: (1) A baseline mammogram for a woman 35 to 40 years of age; (2) A yearly mammogram for a woman 35 to 40 years of age if the woman is at high risk based upon personal family medical history, dense breast tissue, or additional factors that may increase the individual's risk of breast cancer; and (3) A yearly mammogram for a woman 40 years of age or older based on the recommendation of the woman's physician.
Generally under present law, health insurers that provide 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 according to the following guidelines: (1) A baseline mammogram for women 35 to 40 years of age; (2) A mammogram every two years, or more frequently based on the recommendation of the woman's physician for women 40 to 50 years of age; and (3) A mammogram every year for woman 50 years of age and over. This bill rewrites the above provision to instead require a health benefit plan that provides coverage to a patient who is 35 years of age or older to include coverage for an annual screening by all forms of low dose mammography for the presence of breast cancer. This bill specifies that a health benefit plan that provides coverage for a screening mammogram must provide coverage for diagnostic imaging and supplemental breast screening. ON APRIL 27, 2022, THE HOUSE ADOPTED AMENDMENT #1 AND PASSED HOUSE BILL 2544, AS AMENDED. AMENDMENT #1 revises the required coverage to require a health benefit plan that provides coverage for imaging services for screening mammography to provide coverage to a patient for low-dose mammography according to the following guidelines: (1) A baseline mammogram for a woman 35 to 40 years of age; (2) A yearly mammogram for a woman 35 to 40 years of age if the woman is at high risk based upon personal family medical history, dense breast tissue, or additional factors that may increase the individual's risk of breast cancer; and (3) A yearly mammogram for a woman 40 years of age or older based on the recommendation of the woman's physician.
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