Section 376.782

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 2023, 4 histories   

  376.782.  Mammography — low-dose screening, defined — health care policies to provide required coverage — no physician referral, when. — 1.  As used in this section, the term "low-dose mammography screening" means the X-ray examination of the breast using equipment specifically designed and dedicated for mammography, including the X-ray tube, filter, compression device, detector, films, and cassettes, with an average radiation exposure delivery of less than one rad mid-breast, with two views for each breast, and any fee charged by a radiologist or other physician for reading, interpreting or diagnosing based on such X-ray.  As used in this section, the term "low-dose mammography screening" shall also include digital mammography and breast tomosynthesis.  As used in this section, the term "breast tomosynthesis" shall mean a radiologic procedure that involves the acquisition of projection images over the stationary breast to produce cross-sectional digital three-dimensional images of the breast.

  2.  All individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued by a nonprofit corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group arrangements to the extent not preempted by federal law and all managed health care delivery entities of any type or description, that are delivered, issued for delivery, continued or renewed on or after August 28, 1991, and providing coverage to any resident of this state shall provide benefits or coverage for low-dose mammography screening for any nonsymptomatic woman covered under such policy or contract which meets the minimum requirements of this section.  Such benefits or coverage shall include at least the following:

  (1)  A baseline mammogram for women age thirty-five to thirty-nine, inclusive;

  (2)  A mammogram every year for women age forty and over;

  (3)  A mammogram every year for any woman deemed by a treating physician to have an above-average risk for breast cancer in accordance with the American College of Radiology guidelines for breast cancer screening;

  (4)  Any additional or supplemental imaging, such as breast magnetic resonance imaging or ultrasound, deemed medically necessary by a treating physician for proper breast cancer screening or evaluation in accordance with applicable American College of Radiology guidelines; and

  (5)  Ultrasound or magnetic resonance imaging services, if determined by a treating physician to be medically necessary for the screening or evaluation of breast cancer for any woman deemed by the treating physician to have an above-average risk for breast cancer in accordance with American College of Radiology guidelines for breast cancer screening.

  3.  Coverage and benefits required under this section shall be at least as favorable and subject to the same dollar limits, deductibles, and co-payments as other radiological examinations; provided, however, that:

  (1)  On and after January 1, 2019, providers of health care services specified under this section shall be reimbursed at rates accurately reflecting the resource costs specific to each modality, including any increased resource cost; and

  (2)  Cost-sharing requirements shall not apply if the provisions of section 376.1183 prohibit cost-sharing requirements with respect to such coverage.

  4.  A policy providing the coverage and benefits required under this section shall not require any person covered under the policy who is entitled to a screening mammogram under subdivision (1) or (2) of subsection 2 of this section to obtain a referral from a primary care provider or other physician in order to receive the screening mammogram.

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(L. 1990 S.B. 742 § 1, A.L. 1991 H.B. 385, et al., A.L. 1995 S.B. 27, A.L. 2018 H.B. 1252, A.L. 2020 H.B. 1682 merged with S.B. 551, A.L. 2023 S.B. 106)

CROSS REFERENCE:

Mammography and other services also required coverage, 376.995