WEST virginia Legislature
2017 regular session
By
[
to the Committee on Banking and Insurance then Health and Human Resources
A BILL to amend the Code
of West Virginia, 1931, as amended, by adding thereto a new section, designated
§5-16-7b; to amend said code by adding thereto a new section, designated §16-5a-6;
to amend said code by adding thereto a new section, designated §33-15-4p; to
amend and reenact §33-16-3g of said
code; to amend said code by adding thereto a new section, designated §33-16-3bb;
to amend and reenact §33-24-7b of said code; to amend said code by adding
thereto a new section, designated §33-24-7q; to amend said code by adding
thereto a new section, designated §33-25-8n; and to amend said code by adding
thereto a new section, designated §33-25A-8p, all relating to insurance
coverage for breast cancer screening.
Be it enacted by the
Legislature of West Virginia:
That the Code of West
Virginia, 1931, as amended, be amended by adding thereto a new section,
designated §5-16-7b; that said code be amended by adding thereto a new section,
designated §16-5a-6; that said code be amended by adding thereto a new section,
designated §33-15-4p; that §33-16-3g of said code be amended and reenacted;
that said code be amended by adding thereto a new section, designated §33-16-3bb;
that §33-24-7b of said code be amended and reenacted; that said code be amended
by adding thereto a new section, designated §33-24-7q; that said code be
amended by adding thereto a new section, designated §33-25-8n; that said code
be amended by adding thereto a new section, designated §33-25A-8p, all to read
as follows:
CHAPTER
5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR, SECRETARY OF STATE AND
ATTORNEY GENERAL; BOARD OF PUBLIC WORKS; MISCELLANEOUS AGENCIES,
COMMISSIONS,OFFICES, PROGRAMS, ETC.
ARTICLE
16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7b. Required coverage for breast cancer
screenings.
(a) The agency shall provide coverage for the cost of health
care services pursuant to this article for the cost of the following health
care services:
(1) One baseline mammogram
examination for women who are at least thirty but less than forty years of age;
a mammogram examination every year for women age forty and over; and, in the
case of a woman who is under forty years of age and has a family history of
breast cancer or other breast cancer risk factors, a mammogram examination at
such age and intervals as deemed medically necessary by the woman's health care
provider; and
(2) A comprehensive
ultrasound screening of an entire breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue based on the Breast Imaging Reporting and
Data System established by the American College of Radiology or if a woman is
believed to be at increased risk for breast cancer due to family history or
prior personal history of breast cancer, positive genetic testing, or other
indications as determined by a woman's physician or advanced practice nurse.
(b) This section applies to
all coverage issued by this agency delivered, issued for delivery, reissued, or
extended in the state on and after January 1, 2018, or at any time thereafter
when any term of the policy, contract, or plan is changed or any premium
adjustment is made.
CHAPTER
16. PUBLIC HEALTH.
ARTICLE
5A. CANCER CONTROL.
§16-5A-6. Notification of breast density.
(a) A
radiologist or mammography facility that is certified by the United States Food
and Drug Administration or by a certification agency approved by the United
States Food and Drug Administration shall include in the mammography summary
information that identifies a patient's breast density. This information shall
be based upon the Breast Imaging Reporting and Data
System established by the American College of
Radiology.
(b) The information
included:
(1) Shall state that high
density breast tissue is not abnormal;
(2) Should provide detail
of the potential risks from high breast density;
(3) Provide information on
the benefits of additional screening; and
(4) Shall suggest that the
patient speak with the patient's primary care physician.
(c) The patient may be
provided with any other materials concerning breast density which may include,
but is not limited to, the American College of Radiology's most current
brochure on the subject of breast density.
(d) This
section does not create a standard of care, obligation or duty that would
provide the basis for a private cause of action.
chapter33. insurance.
ARTICLE
15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4p. Required coverage for breast cancer screenings.
(a) An
insurance policy issued by an insurer pursuant to this article that provides
reimbursement or indemnity for laboratory or X-ray services shall provide
coverage for the cost of the following health care services:
(1) One baseline mammogram
examination for women who are at least thirty but less than forty years of age;
a mammogram examination every year for women age forty and over; and, in the
case of a woman who is under forty years of age and has a family history of
breast cancer or other breast cancer risk factors, a mammogram examination at
such age and intervals as deemed medically necessary by the woman's health care
provider; and
(2) A comprehensive
ultrasound screening of an entire breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue based on the Breast Imaging Reporting and
Data System established by the American College of Radiology or if a woman is
believed to be at increased risk for breast cancer due to family history or prior
personal history of breast cancer, positive genetic testing, or other
indications as determined by a woman's physician or advanced practice nurse.
(b) The requirements of
this section shall apply to all insurance policies issued by an insurer
pursuant to this article delivered, issued for delivery, reissued, or extended
in the state on and after January 1, 2017, or at any time thereafter when any
term of the policy, contract, or plan is changed or any premium adjustment is
made.
ARTICLE 16. GROUP
ACCIDENT AND SICKNESS INSURANCE.
§33-16-3g. Third party
reimbursement for mammography, pap smear or human papilloma virus testing.
(a)
Notwithstanding any provision of any policy, provision, contract, plan or
agreement to which this article applies, whenever If reimbursement
or indemnity for laboratory or X-ray services are covered, reimbursement or
indemnification shall may not be denied for any of the
following when performed for cancer screening or diagnostic purposes at the
direction of a person licensed to practice medicine and surgery by the board of
Medicine:
(1) Mammograms when medically appropriate and consistent
with the current guidelines from the United States Preventive Services Task
Force.
(2) A pap smear, either
conventional or liquid-based cytology, whichever is medically appropriate
and consistent with the current guidelines from the United States Preventive
Services Task Force or The American College of Obstetricians and Gynecologists,
for women age eighteen or over; and
(3) (2) A test for the
human papilloma virus (HPV) for women age eighteen or over, when medically
appropriate and consistent with the current guidelines from either the United
States Preventive Services Task Force or The American College of Obstetricians
and Gynecologists for women age eighteen and over.
(b) A policy, provision,
contract, plan or agreement may apply to mammograms, pap smears or human
papilloma virus (HPV) test the same deductibles, coinsurance and other
limitations as apply to other covered services.
§33-16-3bb. Required coverage for breast cancer
screenings.
An insurance
policy issued by an insurer pursuant to this article that provides
reimbursement or indemnity for laboratory or X-ray services shall provide
coverage for the cost of the following health care services:
(1) One baseline mammogram
examination for women who are at least thirty but less than forty years of age;
a mammogram examination every year for women age forty and over; and, in the
case of a woman who is under forty years of age and has a family history of
breast cancer or other breast cancer risk factors, a mammogram examination at
such age and intervals as deemed medically necessary by the woman's health care
provider; and
(2) A comprehensive
ultrasound screening of an entire breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue based on the Breast Imaging Reporting and
Data System established by the American College of Radiology or if a woman is
believed to be at increased risk for breast cancer due to family history or
prior personal history of breast cancer, positive genetic testing, or other
indications as determined by a woman's physician or advanced practice nurse.
(b) The requirements of
this section shall apply to all insurance policies issued by an insurer
pursuant to this article delivered, issued for delivery, reissued, or extended
in the state on and after January 1, 2017, or at any time thereafter when any
term of the policy, contract, or plan is changed or any premium adjustment is made.
ARTICLE 24. HOSPITAL
SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS
AND HEALTH SERVICE CORPORATIONS.
§33-24-7b. Third party
reimbursement for mammography, pap smear or human papilloma virus testing.
(a) Notwithstanding any
provision of any policy, provision, contract, plan or agreement to which this
article applies, whenever If reimbursement or indemnity for
laboratory or X-ray services are covered, reimbursement or indemnification shall
may not be denied for any of the following when performed for cancer
screening or diagnostic purposes, at the direction of a person licensed to
practice medicine and surgery by the board of Medicine:
(1) Mammograms when medically appropriate and
consistent with the current guidelines from the United States Preventive
Services Task Force;
(2) (1) A pap smear, either
conventional or liquid-based cytology, whichever is medically appropriate
and consistent with the current guidelines from either the United States
Preventive Services Task Force or The American College of Obstetricians and
Gynecologists, for women age eighteen or over; or
(3) (2) A test for the
human papilloma virus (HPV), when medically appropriate and consistent with the
current guidelines from either the United States Preventive Services Task Force
or The American College of Obstetricians and Gynecologists, for women age eighteen
or over.
(b) A policy, provision,
contract, plan or agreement may apply to mammograms, pap smears or human
papilloma virus (HPV) test the same deductibles, coinsurance and other
limitations as apply to other covered services.
§33-24-7q. Required
coverage for breast cancer screenings.
(a) A contract,
plan or agreement issued by an insurer pursuant to this article that provides
reimbursement or indemnity for laboratory or X-ray services shall provide
coverage for the cost of the following health care services:
(1) One baseline mammogram
examination for women who are at least thirty but less than forty years of age;
a mammogram examination every year for women age forty and over; and, in the
case of a woman who is under forty years of age and has a family history of
breast cancer or other breast cancer risk factors, a mammogram examination at
such age and intervals as deemed medically necessary by the woman's health care
provider; and
(2) A comprehensive
ultrasound screening of an entire breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue based on the Breast Imaging Reporting and
Data System established by the American College of Radiology or if a woman is
believed to be at increased risk for breast cancer due to family history or
prior personal history of breast cancer, positive genetic testing, or other
indications as determined by a woman's physician or advanced practice nurse.
(b) The requirements of
this section shall apply to all insurance policies issued by an insurer
pursuant to this article delivered, issued for delivery, reissued, or extended
in the state on and after January 1, 2018, or at any time thereafter when any
term of the policy, contract, or plan is changed or any premium adjustment is
made.
ARTICLE
25. HEALTH CARE CORPORATIONS.
§33-25-8n.
Required coverage for breast cancer screenings.
(a) A contract,
plan or agreement issued by an insurer pursuant to this article that provides
reimbursement or indemnity for laboratory or X-ray services shall provide
coverage for the cost of the following health care services:
(1) One baseline mammogram
examination for women who are at least thirty but less than forty years of age;
a mammogram examination every year for women age forty and over; and, in the
case of a woman who is under forty years of age and has a family history of
breast cancer or other breast cancer risk factors, a mammogram examination at
such age and intervals as deemed medically necessary by the woman's health care
provider; and
(2) A comprehensive
ultrasound screening of an entire breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue based on the Breast Imaging Reporting and
Data System established by the American College of Radiology or if a woman is
believed to be at increased risk for breast cancer due to family history or
prior personal history of breast cancer, positive genetic testing, or other
indications as determined by a woman's physician or advanced practice nurse.
(b) The requirements of
this section shall apply to all insurance policies issued by an insurer
pursuant to this article delivered, issued for delivery, reissued, or extended
in the state on and after January 1, 2018, or at any time thereafter when any
term of the policy, contract, or plan is changed or any premium adjustment is
made.
ARTICLE
25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-8p. Required coverage for breast cancer
screenings.
(a) A contract,
plan or agreement issued by an insurer pursuant to this article that provides
reimbursement or indemnity for laboratory or X-ray services shall provide
coverage for the cost of the following health care services:
(1) One baseline mammogram
examination for women who are at least thirty but less than forty years of age;
a mammogram examination every year for women age forty and over; and, in the
case of a woman who is under forty years of age and has a family history of
breast cancer or other breast cancer risk factors, a mammogram examination at
such age and intervals as deemed medically necessary by the woman's health care
provider; and
(2) A comprehensive
ultrasound screening of an entire breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue based on the Breast Imaging Reporting and
Data System established by the American College of Radiology or if a woman is
believed to be at increased risk for breast cancer due to family history or
prior personal history of breast cancer, positive genetic testing, or other
indications as determined by a woman's physician or advanced practice nurse.
(b) The requirements of
this section shall apply to all insurance policies issued by an insurer
pursuant to this article delivered, issued for delivery, reissued, or extended
in the state on and after January 1, 2018, or at any time thereafter when any
term of the policy, contract, or plan is changed or any premium adjustment is made.
NOTE: The purpose of this bill is
to establish insurance provisions required relating to breast cancer
screenings.
Strike-throughs indicate language
that would be stricken from a heading or the present law and underscoring
indicates new language that would be added.