Section 1 Short title
This Act may be cited as the “Cardiovascular Disease Early Detection and Prevention Act of 2026”.
Cardiovascular Disease Early Detection and Prevention Act of 2026
A BILL
To amend title XXVII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to require coverage of certain cardiovascular tests without cost sharing under group health plans, group and individual health insurance coverage, and the Medicare and Medicaid programs.
Sec. 2 Findings
Congress finds the following:
Cardiovascular disease is the leading cause of death in the United States.
Routine cholesterol panels often fail to detect elevated Lipoprotein(a) (Lp(a)) and Apolipoprotein B (ApoB) levels.
Approximately 1 in 5 Americans have elevated Lp(a) levels.
Elevated ApoB levels predict cardiovascular risk better than LDL cholesterol alone.
Nearly 50 percent of heart attack survivors die within five years without effective risk management.
Sec. 3 Requiring coverage of certain cardiovascular tests without cost sharing under group health plans, group and individual health insurance coverage, and the Medicare and Medicaid programs
Public Health Service Act— Section 2713(a) of the Public Health Service Act (42 U.S.C. 300gg–13(a)) is amended—
in paragraph (2), by striking “and” at the end;
in paragraph (3), by striking the period and inserting a semicolon;
by redesignating paragraphs (4) and (5) as paragraphs (5) and (6), respectively; and
by inserting after paragraph (3) the following new paragraph:
“(4) with respect to individuals with a family history of premature cardiovascular disease, a personal history of myocardial infarction, stroke, or elevated LDL cholesterol, a diagnosis of diabetes mellitus or obesity, or other recognized cardiovascular risk factors, testing for lipoprotein(a) and apolipoprotein B levels; and”
Medicare—
by redesignating subparagraph (B) as subparagraph (C);
by inserting after subparagraph (A) the following new subparagraph:
“(B) In the case of an individual with a family history of premature cardiovascular disease, a personal history of myocardial infarction, stroke, or elevated LDL cholesterol, a diagnosis of diabetes mellitus or obesity, or other recognized cardiovascular risk factors, lipoprotein(a) and apolipoprotein B levels.”
in the flush matter at the end, by striking “subparagraph (B)” and inserting “subparagraph (C)”.
No application of cost sharing— Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended—
in subsection (a)(1)(Y), by inserting “(other than tests for levels described in section 1861(ww)(1)(B) furnished to an individual described in such section)” after “described in subparagraph (A)”; and
in subsection (b)(1), by striking “for the individual.” inserting “for the individual or that are tests for levels described in section 1861(ww)(1)(B) furnished to an individual described in such section”.
Medicaid—
in paragraph (31), by striking “and” at the end;
by redesignating paragraph (32) as paragraph (33); and
by inserting after paragraph (31) the following new paragraph:
“(32) testing for lipoprotein(a) and apolipoprotein B levels furnished to an individual with a family history of premature cardiovascular disease, a personal history of myocardial infarction, stroke, or elevated LDL cholesterol, a diagnosis of diabetes mellitus or obesity, or other recognized cardiovascular risk factors; and”
No cost sharing—
In general— Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o) are each amended—
in subparagraph (I), by striking “or” at the end;
in subparagraph (J), by striking “; and” and inserting “, or”; and
by adding at the end the following new subparagraph:
“(K) testing for lipoprotein(a) and apolipoprotein B levels furnished to an individual described in section 1905(a)(32); 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) Testing for lipoprotein(a) and apolipoprotein B levels furnished to an individual described in section 1905(a)(32).”
Mandatory coverage— Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by striking “and (30)” and inserting “(30), and (32)”.
Benchmark coverage and benchmark-equivalent coverage— 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) Coverage of certain lipid level testing—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 such coverage provides, with respect to an individual described in section 1905(a)(32), testing for lipoprotein(a) and apolipoprotein B levels.”
Effective date— The amendments made by—
subsection (a) shall apply with respect to plan years beginning on or after the date that is 180 days after the date of the enactment of this Act; and
subsections (b) and (c) shall apply with respect to items and services and medical assistance, respectively, furnished on or after such date.