Amends GS 58-51-57, which requires every policy or contract of accident or health insurance, and every preferred provider benefit plan that is issued, renewed, or amended on or after January 1, 1992, to provide coverage for examinations and laboratory tests for the screening for the early detection of cervical cancer and for low‑dose screening mammography, by making the following changes. Repeals (a1), which defined examinations and laboratory tests for the screening for the early detection of cervical cancer to mean conventional PAP smear screening, liquid‑based cytology, and human papilloma virus (HPV) detection methods for women with equivocal findings on cervical cytologic analysis subject to the approval of and have been approved by the US Food and Drug Administration. Repeals (b), which defined low‑dose screening mammography as a radiologic procedure for the early detection of breast cancer provided to an asymptomatic woman using equipment dedicated specifically for mammography, including a physician's interpretation of the results of the procedure. Repeals (c), which required the following coverage for low‑dose screening mammography: (1) one or more mammograms a year, as recommended by a physician, for any woman who is at risk (as defined) for breast cancer; (2) one baseline mammogram for any woman 35 through 39 years of age, inclusive; (3) a mammogram every other year for any woman 40 through 49 years of age, inclusive, or more frequently upon recommendation of a physician; and (4) a mammogram every year for any woman 50 years of age or older. Recodifies the remaining provisions under new GS 58-3-271, and makes the following changes.
Adds and defines the terms breast magnetic resonance imaging, breast ultrasound, cost-sharing requirement, diagnostic examination for breast cancer, insurer, low-dose mammography, screening examination for breast cancer, screening of early detection of cervical cancer, and supplemental examination for breast cancer.
Requires every health benefit plan offered by an insurer in this state to provide coverage for examinations and laboratory tests, including the laboratory fee and the interpretation of the laboratory results, for the screening for the early detection of cervical cancer and for low-dose screening mammography. Requires every health benefit plan offered by an insurer in this state that provides benefits for a diagnostic or supplemental examination for breast cancer to ensure that the cost-sharing requirements applicable to a diagnostic or supplemental examination for breast cancer are no less favorable than the cost-sharing requirements applicable to low-dose screening mammography for breast cancer. Requires coverage for screening examinations for breast cancer and early detection of cervical cancer to be provided at least in a manner that adheres to the most recent United States Preventative Task Force A, B, and C recommendations. Makes conforming changes.
Amends GS 135-48.51 by making new GS 58-3-271 applicable to the State Health Plan.
Repeals GS 58-65-92, coverage for mammograms and cervical cancer screening by insurance certificate or subscriber contract under any hospital service plan or medical service plan. Repeals GS 58-67-76, Coverage for mammograms and cervical cancer screening by health care plans.
Appropriates $900,000 in recurring funds for 2024-25 from the General Fund to the Department of State Treasurer to ensure compliance by the State Health Plan. Effective July 1, 2024.
Amends GS 130A-215.5 by requiring the summary of a mammography report to include the specified notice if the facility performing the mammogram determines that a patient does not have heterogeneously or extremely dense breasts. Amends the content of the notice that must be provided to patients determined to have heterogeneously or extremely dense breasts by making the determination of density more definite and notifying the patient they might benefit from supplementary screening, as described. Also amends the notice to refer to "healthcare providers" instead of "physicians."
Appropriates $100,000 for 2024-25 from the General Fund to the Department of Health and Human Services to educate healthcare providers about the changes to coverage and notification requirements. Requires DHHS to ensure that relevant information is provided to any North Carolina-based organization that includes obstetric and gynecological practitioners as part of its membership.
Effective October 1, 2023, and applies to insurance contracts issued, renewed, or amended on or after that date.
DIAGNOSTIC IMAGING PARITY.
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View NCGA Bill Details | 2023-2024 Session |
AN ACT PROVIDING HEALTH COVERAGE PARITY FOR BREAST CANCER DIAGNOSTIC IMAGING, MAKING TECHNICAL AND CONFORMING CHANGES TO THE GENERAL STATUTES RELATED TO BREAST CANCER SCREENING, UPDATING MAMMOGRAPHIC BREAST DENSITY PATIENT NOTIFICATION REQUIREMENTS, AND APPROPRIATING FUNDS TO THE DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR THE PURPOSES OF EDUCATING HEALTHCARE PROVIDERS ABOUT THE CHANGES TO HEALTH INSURANCE COVERAGE OF BREAST CANCER SCREENING AND DIAGNOSIS AND THE UPDATES TO THE MAMMOGRAPHIC BREAST DENSITY PATIENT NOTIFICATION REQUIREMENTS.Intro. by Batch, Mayfield, Chaudhuri.
Status: Ref To Com On Rules and Operations of the Senate (Senate action) (May 6 2024)
Bill History:
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Thu, 2 May 2024 Senate: Filed
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Mon, 6 May 2024 Senate: Passed 1st Reading
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Mon, 6 May 2024 Senate: Ref To Com On Rules and Operations of the Senate
S 899
Bill Summaries:
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Bill S 899 (2023-2024)Summary date: May 6 2024 - View Summary
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