2019 -- H 5567

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LC001987

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO HEALTH AND SAFETY -- THE BREAST CANCER ACT

     Introduced By: Representatives Solomon, Phillips, Johnston, Casimiro, and Edwards

     Date Introduced: February 27, 2019

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 23-12.7-3 of the General Laws in Chapter 23-12.7 entitled "The

Breast Cancer Act" is hereby amended to read as follows:

     23-12.7-3. Program established.

     (a) Through funding from the Rhode Island Cancer Council, the Rhode Island department

of health is required to establish a program of free mammography and digital breast

tomosynthesis (dbt) screening according to American Cancer Society standards, and, where

required, follow-up, diagnostic testing, and case management for women in the state who are

uninsured or underinsured.

     (b) The screening program shall:

     (1) Secure radiology facilities to participate in the screening program;

     (2) Pay for screening mammograms and digital breast tomosynthesis (dbt) screenings;

     (3) Ensure that screening results are sent directly to the patient in a timely manner;

     (4) Provide diagnostic tests as required to diagnose breast cancer;

     (5) Provide case management facilitating appropriate contact to breast surgeons, medical

oncologists, and radiation oncologists; and

     (6) Provide follow-up support to women who are found to have breast cancer as a result

of this screening program.

     (c) The director of the Rhode Island department of health is required to provide a

quarterly report to the general assembly on the program of free mammography screening, follow

up diagnostic testing and case management, and public education. An advisory committee

concerned with advocacy, outreach, and public education shall meet on a quarterly basis and

report to the director.

     SECTION 2. Section 23-12.9-2 of the General Laws in Chapter 23-12.9 entitled "Dense

Breast Notification and Education" is hereby amended to read as follows:

     23-12.9-2. Public policy goals -- Department of health.

     The department of health, through the Rhode Island Cancer Council, is authorized and

mandated to implement the following public health policy goals as they relate to dense breast

notification in Rhode Island. Commencing on October 1, 2014, all health care facilities that

perform mammography examinations and digital breast tomosynthesis (dbt) screenings shall

include in the summary of the mammography report to be provided to a patient, information that

identifies the patient's individual Breast Tissue Classification based on the Breast Imaging

Reporting and Data System established by the American College of Radiology. If the facility

determines that a patient has heterogeneously or extremely dense breasts, the summary of the

mammography report shall also include the following notice:

     "Your mammogram indicates that you have dense breast tissue. Dense breast tissue is

relatively common and is found in about forty percent (40%) of women. The presence of dense

tissue can make it more difficult to detect cancers in the breast by mammography because it can

hide small abnormalities and may be associated with an increased risk. Hence, you may benefit

from supplementary screening tests, which may include a breast ultrasound screening, or a breast

MRI examination, or both, depending on your individual risk factors.

     We are providing this information to raise your awareness of this important factor and to

encourage you to discuss your dense breast tissue, as well as other breast cancer risk factors, with

your health care provider. Together, you can decide which screening options are right for you.

     A report of your results was sent to your physician. You should contact your physician if

you have any questions or concerns about this report."

     SECTION 3. Section 23-17-32 of the General Laws in Chapter 23-17 entitled "Licensing

of Health-Care Facilities" is hereby amended to read as follows:

     23-17-32. Mammograms -- Quality assurance standards Mammograms and digital

breast tomosynthesis (dbt) -- Quality assurance standards.

     Any licensed health care facility performing a mammogram shall meet state-approved

quality assurance standards for taking and processing mammograms and digital breast

tomosynthesis (dbt) screenings. The director of health shall have the authority to promulgate rules

and regulations necessary to carry out the provisions of this section.

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     SECTION 4. Section 27-18-41 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-41. Mammograms and pap smears -- Coverage mandated Mammograms,

digital breast tomosynthesis (dbt) and pap smears -- Coverage mandated.

     (a)(1) Every individual or group hospital or medical expense insurance policy or

individual or group hospital or medical services plan contract delivered, issued for delivery, or

renewed in this state shall provide coverage for mammograms, and digital breast tomosynthesis

(dbt) screenings, and pap smears, in accordance with guidelines established by the American

Cancer Society.

     (2) Notwithstanding the provisions of this chapter, every individual or group hospital or

medical insurance policy or individual or group hospital or medical services plan contract

delivered, issued for delivery, or renewed in this state shall pay for two (2) screening

mammograms per year when recommended by a physician for women who have been treated for

breast cancer within the last five (5) years or are at high risk of developing breast cancer due to

genetic predisposition (BRCA gene mutation or multiple first degree relatives) or high risk lesion

on prior biopsy (lobular carcinoma in situ) or atypical ductal hyperplasia.

     (b) This section shall not apply to insurance coverage providing benefits for: (1) hospital

confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare

supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily

injury or death by accident or both; and (9) other limited benefit policies.

     SECTION 5. Section 27-19-20 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-20. Mammograms and pap smears -- Coverage mandated Mammograms,

digital breast tomosynthesis (dbt) and pap smears -- Coverage mandated.

     (a) Subscribers to any nonprofit hospital service plan shall be afforded coverage under

the plan for mammograms, and digital breast tomosynthesis (dbt) screenings, and pap smears, in

accordance with guidelines established by the American Cancer Society.

     (b) Notwithstanding the provisions of this chapter, subscribers to any nonprofit hospital

service plan shall be afforded coverage for two (2) screening mammograms per year when

recommended by a physician for women who have been treated for breast cancer within the last

five (5) years or who are at high risk of developing breast cancer due to genetic predisposition

(BRCA gene mutation or multiple first degree relatives) or high risk lesion on prior biopsy

(lobular carcinoma in situ) or atypical ductal hyperplasia.

     SECTION 6. Section 27-20-17 of the General Laws in Chapter 27-20 entitled "Nonprofit

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Medical Service Corporations" is hereby amended to read as follows:

     27-20-17. Mammograms and pap smears -- Coverage mandated Mammograms,

digital breast tomosynthesis (dbt) and pap smears -- Coverage mandated.

     (a) Subscribers to any nonprofit medical service plan shall be afforded coverage under

the plan for mammograms, and digital breast tomosynthesis (dbt) screenings, and pap smears, in

accordance with guidelines established by the American Cancer Society.

     (b) Notwithstanding the provisions of this chapter, subscribers to any nonprofit medical

service plan shall be afforded coverage for two (2) paid screening mammograms per year when

recommended by a physician for women who have been treated for breast cancer within the last

five (5) years or who are at high risk of developing breast cancer due to genetic predisposition

(BRCA gene mutation or multiple first degree relatives) or high risk lesion on prior biopsy

(lobular carcinoma in situ) or atypical ductal hyperplasia.

     SECTION 7. Section 27-41-30 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-30. Mammograms and pap smears -- Coverage mandated Mammograms,

digital breast tomosynthesis (dbt) and pap smears -- Coverage mandated.

     (a) Subscribers to any health maintenance organization plan shall be afforded coverage

under that plan for mammograms, and digital breast tomosynthesis (dbt) screenings, and pap

smears, in accordance with guidelines established by the American Cancer Society.

     (b) Notwithstanding the provisions of this chapter, subscribers to any health maintenance

organization plan shall be afforded coverage for two (2) paid screening mammograms per year

when recommended by a physician for women who have been treated for breast cancer within the

last five (5) years or who are at high risk of developing breast cancer due to genetic

predisposition (BRCA gene mutation or multiple first degree relatives) or high risk lesion on prior

biopsy (lobular carcinoma in situ) or atypical ductal hyperplasia.

     SECTION 8. Section 42-62-26 of the General Laws in Chapter 42-62 entitled

"Catastrophic Health Insurance Plan Act" is hereby amended to read as follows:

     42-62-26. Mammograms and pap smears -- Coverage mandated Mammograms,

digital breast tomosynthesis (dbt) and pap smears -- Coverage mandated.

     Any insurer, as defined in this chapter, shall afford health insurance coverage for

mammograms, and digital breast tomosynthesis (dbt) screenings, and Pap smears, in accordance

with guidelines established by the American Cancer Society.

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     SECTION 9. This act shall take effect upon passage.

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LC001987

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- THE BREAST CANCER ACT

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     This act would amend the current law so that digital breast tomosynthesis (dbt)

screenings are available wherever mammograms are conducted and to provide insurance

coverage for such screenings.

     This act would take effect upon passage.

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