text: SECTION 1. SHORT TITLE; FINDINGS.
  
      (a) Short Title.--This Act may be cited as the ``Mammogram 
  Availability Act of 1999''.
      (b) Findings.--Congress finds the following:
              (1) Breast cancer is the single leading cause of death for 
          women between the ages of 40 and 49 in the United States
              (2) An expert panel convened by the National Institutes of 
          Health recommended on January 23, 1997, that all women between 
          the ages of 40 and 49 should choose for themselves, following 
          consultation with their health care provider, whether to 
          undergo screening mammography.
              (3) The same panel unanimously recommended that for women 
          between the ages of 40 and 49 who choose to have a screening 
          mammogram, costs of the mammograms should be reimbursed by 
          third-party payers or covered by health maintenance 
          organizations.
  
  SEC. 2. COVERAGE OF ANNUAL SCREENING MAMMOGRAPHY UNDER GROUP HEALTH 
                PLANS.
  
      (a) Public Health Service Act Amendments.--
              (1) Subpart 2 of part A of title XXVII of the Public Health 
          Service Act is amended by adding at the end the following new 
          section:
  
  ``SEC. 2707. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY.
  
      ``(a) Requirements for Coverage of Annual Screening Mammography.--
              ``(1) In general.--A group health plan, and a health 
          insurance issuer offering group health insurance coverage, that 
          provides coverage for diagnostic mammography for any woman who 
          is 40 years of age or older shall provide coverage for annual 
          screening mammography for such a woman under terms and 
          conditions that are not less favorable than the terms and 
          conditions for coverage of diagnostic mammography.
              ``(2) Diagnostic and screening mammography defined.--For 
          purposes of this section--
                      ``(A) The term `diagnostic mammography' means a 
                  radiologic procedure that is medically necessary for 
                  the purpose of diagnosing breast cancer and includes a 
                  physician's interpretation of the results of the 
                  procedure.
                      ``(B) The term `screening mammography' means a 
                  radiologic procedure provided to a woman for the 
                  purpose of early detection of breast cancer and 
                  includes a physician's interpretation of the results of 
                  the procedure.
      ``(b) Prohibitions.--A group health plan, and a health insurance 
  issuer offering group health insurance coverage in connection with a 
  group health plan, may not--
              ``(1) deny coverage for annual screening mammography on the 
          basis that the coverage is not medically necessary or on the 
          basis that the screening mammography is not pursuant to a 
          referral, consent, or recommendation by any health care 
          provider;
              ``(2) deny to a woman eligibility, or continued 
          eligibility, to enroll or to renew coverage under the terms of 
          the plan, solely for the purpose of avoiding the requirements 
          of this section;
              ``(3) provide monetary payments or rebates to women to 
          encourage such women to accept less than the minimum 
          protections available under this section;
              ``(4) penalize or otherwise reduce or limit the 
          reimbursement of an attending provider because such provider 
          provided care to an individual participant or beneficiary in 
          accordance with this section; or
              ``(5) provide incentives (monetary or otherwise) to an 
          attending provider to induce such provider to provide care to 
  an individual participant or beneficiary in a manner inconsistent with 
  this section.
      ``(c) Rules of Construction.--
              ``(1) Nothing in this section shall be construed to require 
          a woman who is a participant or beneficiary to undergo annual 
          screening mammography.
              ``(2) This section shall not apply with respect to any 
          group health plan, or any group health insurance coverage 
          offered by a health insurance issuer, which does not provide 
          benefits for diagnostic mammography.
              ``(3) Nothing in this section shall be construed as 
          preventing a group health plan or issuer from imposing 
          deductibles, coinsurance, or other cost-sharing in relation to 
          benefits for screening mammography under the plan (or under 
          health insurance coverage offered in connection with a group 
          health plan), except that such coinsurance or other cost-
          sharing for any portion may not be greater than such 
          coinsurance or cost-sharing that is otherwise applicable with 
          respect to benefits for diagnostic mammography.
              ``(4) Women between the ages of 40 and 49 should (but are 
          not required to) consult with appropriate health care 
          practitioners before undergoing screening mammography, but 
          nothing in this section shall be construed as requiring the 
          approval of such a practitioner before undergoing an annual 
          screening mammography.
      ``(d) Notice.--A group health plan under this part shall comply 
  with the notice requirement under section 714(d) of the Employee 
  Retirement Income Security Act of 1974 with respect to the requirements 
  of this section as if such section applied to such plan.
      ``(e) Level and Type of Reimbursements.--Nothing in this section 
  shall be construed to prevent a group health plan or a health insurance 
  issuer offering group health insurance coverage from negotiating the 
  level and type of reimbursement with a provider for care provided in 
  accordance with this section.
      ``(f) Preemption; Exception for Health Insurance Coverage in 
  Certain States.--
              ``(1) In general.--The requirements of this section shall 
          not apply with respect to health insurance coverage if there is 
          a State law (as defined in section 2723(d)(1)) for a State that 
          regulates such coverage, that requires coverage to be provided 
          for annual screening mammography for women who are 40 years of 
          age or older and that provides at least the protections 
          described in subsection (b).
              ``(2) Construction.--Section 2723(a)(1) shall not be 
          construed as superseding a State law described in paragraph 
          (1).''.
              (2) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)) is 
          amended by striking ``section 2704'' and inserting ``sections 
          2704 and 2707''.
      (b) ERISA Amendments.--
              (1) Subpart B of part 7 of subtitle B of title I of the 
          Employee Retirement Income Security Act of 1974 is amended by 
          adding at the end the following new section:
  
  ``SEC. 714. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY.
  
      ``(a) Requirements for Coverage of Annual Screening Mammography.--
              ``(1) In general.--A group health plan, and a health 
          insurance issuer offering group health insurance coverage, that 
          provides coverage for diagnostic mammography for any woman who 
          is 40 years of age or older shall provide coverage for annual 
          screening mammography for such a woman under terms and 
          conditions that are not less favorable than the terms and 
          conditions for coverage of diagnostic mammography.
              ``(2) Diagnostic and screening mammography defined.--For 
          purposes of this section--
                      ``(A) The term `diagnostic mammography' means a 
                  radiologic procedure that is medically necessary for 
                  the purpose of diagnosing breast cancer and includes a 
                  physician's interpretation of the results of the 
                  procedure.
                      ``(B) The term `screening mammography' means a 
                  radiologic procedure provided to a woman for the 
                  purpose of early detection of breast cancer and 
                  includes a physician's interpretation of the results of 
                  the procedure.
      ``(b) Prohibitions.--A group health plan, and a health insurance 
  issuer offering group health insurance coverage in connection with a 
  group health plan, may not--
              ``(1) deny coverage described in subsection (a)(1) on the 
          basis that the coverage is not medically necessary or on the 
          basis that the screening mammography is not pursuant to a 
          referral, consent, or recommendation by any health care 
          provider;
              ``(2) deny to a woman eligibility, or continued 
          eligibility, to enroll or to renew coverage under the terms of 
          the plan, solely for the purpose of avoiding the requirements 
          of this section;
              ``(3) provide monetary payments or rebates to women to 
          encourage such women to accept less than the minimum 
          protections available under this section;
              ``(4) penalize or otherwise reduce or limit the 
          reimbursement of an attending provider because such provider 
          provided care to an individual participant or beneficiary in 
          accordance with this section; or
              ``(5) provide incentives (monetary or otherwise) to an 
          attending provider to induce such provider to provide care to 
          an individual participant or beneficiary in a manner 
          inconsistent with this section.
      ``(c) Rules of Construction.--
              ``(1) Nothing in this section shall be construed to require 
          a woman who is a participant or beneficiary to undergo annual 
          screening mammography.
              ``(2) This section shall not apply with respect to any 
          group health plan, or any group health insurance coverage 
          offered by a health insurance issuer, which does not provide 
          benefits for diagnostic mammography.
              ``(3) Nothing in this section shall be construed as 
          preventing a group health plan or issuer from imposing 
          deductibles, coinsurance, or other cost-sharing in relation to 
          benefits for screening mammography under the plan (or under 
          health insurance coverage offered in connection with a group 
          health plan), except that such coinsurance or other cost-
          sharing for any portion may not be greater than such 
          coinsurance or cost-sharing that is otherwise applicable with 
          respect to benefits for diagnostic mammography.
              ``(4) Women between the ages of 40 and 49 should (but are 
          not required to) consult with appropriate health care 
          practitioners before undergoing screening mammography, but 
          nothing in this section shall be construed as requiring the 
          approval of such a practitioner before undergoing an annual 
          screening mammography.
      ``(d) Notice Under Group Health Plan.--The imposition of the 
  requirements of this section shall be treated as a material 
  modification in the terms of the plan described in section 102(a)(1), 
  for purposes of assuring notice of such requirements under the plan; 
  except that the summary description required to be provided under the 
  last sentence of section 104(b)(1) with respect to such modification 
  shall be provided by not later than 60 days after the first day of the 
  first plan year in which such requirements apply.
      ``(e) Level and Type of Reimbursements.--Nothing in this section 
  shall be construed to prevent a group health plan or a health insurance 
  issuer offering group health insurance coverage from negotiating the 
  level and type of reimbursement with a provider for care provided in 
  accordance with this section.
      ``(f) Preemption; Exception for Health Insurance Coverage in 
  Certain States.--
              ``(1) In general.--The requirements of this section shall 
          not apply with respect to health insurance coverage if there is 
          a State law (as defined in section 731(d)(1)) for a State that 
          regulates such coverage, that requires coverage to be provided 
          for annual screening mammography for women who are 40 years of 
          age or older, and that provides at least the protections 
          described in subsection (b).
              ``(2) Construction.--Section 731(a)(1) shall not be 
          construed as superseding a State law described in paragraph 
          (1).''.
              (2) Section 731(c) of such Act (29 U.S.C. 1191(c)) is 
          amended by striking ``section 711'' and inserting ``sections 
          711 and 714''.
              (3) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is 
          amended by striking ``section 711'' and inserting ``sections 
          711 and 714''.
              (4) The table of contents in section 1 of such Act is 
          amended by inserting after the item relating to section 713 the 
          following new item:
  
  ``Sec. 714. Standards relating to benefits for screening 
                              mammography.''.
      (c) Effective Dates.--(1) Subject to paragraph (2), the amendments 
  made by this section shall apply with respect to group health plans 
  (and health insurance coverage offered in connection with group health 
  plans) for plan years beginning on or after January 1, 1999.
      (2) In the case of a group health plan maintained pursuant to 1 or 
  more collective bargaining agreements between employee representatives 
  and 1 or more employers ratified before the date of enactment of this 
  Act, the amendments made by this section shall not apply to plan years 
  beginning before the later of--
              (A) the date on which the last collective bargaining 
          agreements relating to the plan terminates (determined without 
          regard to any extension thereof agreed to after the date of 
          enactment of this Act), or
              (B) January 1, 1999.
  For purposes of subparagraph (A), any plan amendment made pursuant to a 
  collective bargaining agreement relating to the plan which amends the 
  plan solely to conform to any requirement added by this section shall 
  not be treated as a termination of such collective bargaining 
  agreement.
  
  SEC. 3. COVERAGE OF ANNUAL SCREENING MAMMOGRAPHY UNDER INDIVIDUAL 
                HEALTH COVERAGE.
  
      (a) In General.--Part B of title XXVII of the Public Health Service 
  Act is amended by inserting after section 2751 the following new 
  section:
  
  ``SEC. 2753. STANDARDS RELATING TO BENEFITS FOR SCREENING MAMMOGRAPHY.
  
      ``(a) In General.--The provisions of section 2706 (other than 
  subsections (d) and (f)) shall apply to health insurance coverage 
  offered by a health insurance issuer in the individual market in the 
  same manner as it applies to health insurance coverage offered by a 
  health insurance issuer in connection with a group health plan in the 
  small or large group market.
      ``(b) Notice.--A health insurance issuer under this part shall 
  comply with the notice requirement under section 714(d) of the Employee 
  Retirement Income Security Act of 1974 with respect to the requirements 
  referred to in subsection (a) as if such section applied to such issuer 
  and such issuer were a group health plan.
      ``(c) Preemption; Exception for Health Insurance Coverage in 
  Certain States.--
              ``(1) In general.--The requirements of this section shall 
          not apply with respect to health insurance coverage if there is 
          a State law (as defined in section 2723(d)(1)) for a State that 
          regulates such coverage, that requires coverage in the 
          individual health insurance market to be provided for annual 
          screening mammography for women who are 40 years of age or 
          older and that provides at least the protections described in 
          section 2706(b) (as applied under subsection (a)).
              ``(2) Construction.--Section 2762(a) shall not be construed 
          as superseding a State law described in paragraph (1).''.
      (b) Conforming Amendment.--Section 2763(b)(2) of such Act (42 
  U.S.C. 300gg-63(b)(2)) is amended by striking ``section 2751'' and 
  inserting ``sections 2751 and 2753''.
      (c) Effective Date.--The amendments made by this section shall 
  apply with respect to health insurance coverage offered, sold, issued, 
  or renewed in the individual market on or after such January 1, 1999.
target: Mammogram Availability Act of 1999 - Amends the Public Health Service Act and the Employee Retirement Income Security Act of 1974 to require a group health plan, and a health insurance issuer offering group coverage, that provides coverage for diagnostic mammographies for any woman 40 years old or older to provide coverage for annual screening mammographies for such a woman.  Prohibits related enrollment and renewal discrimination, monetary incentives to women, and penalties or incentives to providers.  Amends the Public Health Service Act to apply those requirements and prohibitions to coverage offered by an issuer in the individual market.
feat_title: Mammogram Availability Act of 1999