Section 1 Short title
This Act may be cited as the “Early Access to Screening Act”.
Early Access to Screening Act
A BILL
To amend titles XVIII and XIX of the Social Security Act and title XXVII of the Public Health Service Act to provide no-cost coverage for annual screening mammography beginning at 30 years of age.
Sec. 2 No-cost coverage of annual screening mammography beginning at 30 years of age
Coverage under Medicare—
in paragraph (1)(A), by inserting “or (3)” after “paragraph (2)”;
in paragraph (2)—
by striking the paragraph heading and inserting “Frequency covered before January 1, 2025”; and
in subparagraph (A), by striking “Subject” and inserting “With respect to screening mammography performed before January 1, 2025, subject”; and
by adding at the end the following new paragraph:
“(3) Frequency covered on or after January 1, 2025—With respect to screening mammography performed on or after January 1, 2025—
“(A) no payment may be made under this part for screening mammography performed on a woman under 30 years of age; and
“(B) in the case of a woman over 29 years of age, payment may not be made under this part for screening mammography performed within 11 months following the month in which a previous screening mammography was performed.”
Prohibition of cost sharing— Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—
in subparagraph (Y), by inserting after “in the case of such services described in subparagraph (A)” the following: “(other than screening mammography (as defined in section 1861(jj)) performed on or after January 1, 2025)”;
in subparagraph (GG), by striking “and” at the end; and
by inserting before the semicolon at the end the following: “, and (II) with respect to screening mammography (as defined in section 1861(jj)) performed on or after January 1, 2025, the amounts paid shall be shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the fee schedule that applies to such services under this part”.
Conforming amendment— Section 1862(a)(1)(F) is amended by striking “section 1834(c)(2)” and inserting “section 1834(c)”.
Coverage under Medicaid—
Mandatory coverage—
In general— Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by inserting “(13)(D),” before “(17),”.
Medically needy— Section 1902(a)(10)(C)(iv) of the Social Security Act (42 U.S.C. 1396a(a)(10)(C)(iv)) is amended by inserting “(13)(D),” before “and (17)”.
Alternative benefit plans— Section 1937(b) of the Social Security Act (42 U.S.C. 1396u–7(b)) is amended by adding at the end the following new paragraph:
“(9) Annual screening mammography—Notwithstanding the previous provisions of this section, a State may not provide for medical assistance through enrollment of an individual with benchmark coverage or benchmark-equivalent coverage under this section unless, beginning on January 1, 2025, for any individual over age 29, such coverage includes (and does not impose any deduction, cost sharing, or similar charge for) annual screening mammography described in section 1905(a)(13)(D).”
Inclusion under diagnostic, screening, preventive, and rehabilitative services— Section 1905(a)(13) of the Social Security Act (42 U.S.C. 1396d(a)(13)) is amended—
in subparagraph (B), by striking “and” at the end;
in subparagraph (C), by adding “and” at the end; and
by adding at the end the following new subparagraph:
“(D) beginning January 1, 2025, for individuals over age 29, annual screening mammography;”
Prohibition of cost sharing—
in subsection (a)(2)—
in subparagraph (I), by striking “or” at the end;
in subparagraph (J), by striking “; and” at the end and inserting “, or”; and
by adding at the end the following new subparagraph:
“(K) beginning January 1, 2025, annual screening mammography described in section 1905(a)(13)(D); and”
in subsection (b)(2)—
in subparagraph (I), by striking “or” at the end;
in subparagraph (J), by striking “; and” at the end and inserting “, or”; and
by adding at the end the following new subparagraph:
“(K) beginning January 1, 2025, annual screening mammography described in section 1905(a)(13)(D); and”
Application to alternative cost sharing— Section 1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by adding at the end the following new clause:
“(xv) Beginning January 1, 2025, annual screening mammography described in section 1905(a)(13)(D).”
Coverage under group health plans and group and individual health insurance—
in paragraph (2), by striking at the end “and”;
in paragraph (3), by striking at the end the period and inserting “; and”; and
in paragraph (4)—
by striking at the end the period and inserting “; and”;
by striking “women, such” and inserting
“(A) such”
by adding at the end the following new subparagraph:
“(B) in the case of a woman over 29 years of age, annual mammography screening.”
Effective date— The amendments made by this subsection shall apply to plan years beginning on or after January 1, 2025.