2024 -- S 2070

========

LC003434

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

____________

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Senators Zurier, Sosnowski, Miller, Gallo, DiMario, and Lauria

     Date Introduced: January 12, 2024

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance

Policies" is hereby amended by adding thereto the following section:

     27-18-42.1. Diagnostic and supplemental breast examination.

     (a) As used in this section, the following words shall have the following meanings:

     (1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any

maximum limitation on the application of such a deductible, coinsurance, copayment or similar

out-of-pocket expense.

     (2) "Diagnostic breast examinations" means a medically necessary and appropriate

examination of the breast, including an examination using diagnostic mammography, breast

magnetic resonance imaging, or breast ultrasound, that is:

     (i) Used to evaluate an abnormality seen or suspected from a screening examination for

breast cancer; or

     (ii) Used to evaluate an abnormality detected by another means of examination.

     (3) "Supplemental breast examinations" means a medically necessary and appropriate

examination of the breast, including an examination using breast magnetic resonance imaging, or

breast ultrasound, that is:

     (i) Used to screen for breast cancer when there is no abnormality seen or suspected; and

     (ii) Based on personal or family medical history, or additional factors that may increase the

individual’s risk of breast cancer.

     (b) In the case that a group health plan, or a health insurance issuer offering group or

individual health insurance coverage, that provides benefits with respect to screening, supplemental

and diagnostic breast examinations furnished to an individual enrolled under such plan or such

coverage, the plan or coverage shall not impose any cost-sharing requirements.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-34.2. Diagnostic and supplemental breast examination.

     (a) As used in this section, the following words shall have the following meanings:

     (1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any

maximum limitation on the application of such a deductible, coinsurance, copayment or similar

out-of-pocket expense.

     (2) "Diagnostic breast examinations" means a medically necessary and appropriate

examination of the breast, including an examination using diagnostic mammography, breast

magnetic resonance imaging, or breast ultrasound, that is:

     (i) Used to evaluate an abnormality seen or suspected from a screening examination for

breast cancer; or

     (ii) Used to evaluate an abnormality detected by another means of examination.

     (3) "Supplemental breast examinations" means a medically necessary and appropriate

examination of the breast, including an examination using breast magnetic resonance imaging, or

breast ultrasound, that is:

     (i) Used to screen for breast cancer when there is no abnormality seen or suspected; and

     (ii) Based on personal or family medical history, or additional factors that may increase the

individual’s risk of breast cancer.

     (b) In the case that a group health plan, or a health insurance issuer offering group or

individual health insurance coverage, that provides benefits with respect to screening, supplemental

and diagnostic breast examinations furnished to an individual enrolled under such plan or such

coverage, the plan or coverage shall not impose any cost-sharing requirements.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-17.2. Diagnostic and supplemental breast examination.

     (a) As used in this section, the following words shall have the following meanings:

     (1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any

maximum limitation on the application of such a deductible, coinsurance, copayment or similar

out-of-pocket expense.

LC003434 - Page 2 of 5

     (2) "Diagnostic breast examinations" means a medically necessary and appropriate

examination of the breast, including an examination using diagnostic mammography, breast

magnetic resonance imaging, or breast ultrasound, that is:

     (i) Used to evaluate an abnormality seen or suspected from a screening examination for

breast cancer; or

     (ii) Used to evaluate an abnormality detected by another means of examination.

     (3) "Supplemental breast examinations" means a medically necessary and appropriate

examination of the breast, including an examination using breast magnetic resonance imaging, or

breast ultrasound, that is:

     (i) Used to screen for breast cancer when there is no abnormality seen or suspected; and

     (ii) Based on personal or family medical history, or additional factors that may increase the

individual’s risk of breast cancer.

     (b) In the case that a group health plan, or a health insurance issuer offering group or

individual health insurance coverage, that provides benefits with respect to screening, supplemental

and diagnostic breast examinations furnished to an individual enrolled under such plan or such

coverage, the plan or coverage shall not impose any cost-sharing requirements.

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-30.2. Diagnostic and supplemental breast examination.

     (a) As used in this section, the following words shall have the following meanings:

     (1) "Cost-sharing requirements" means a deductible, coinsurance, copayment and any

maximum limitation on the application of such a deductible, coinsurance, copayment or similar

out-of-pocket expense.

     (2) "Diagnostic breast examinations" means a medically necessary and appropriate

examination of the breast, including an examination using diagnostic mammography, breast

magnetic resonance imaging, or breast ultrasound, that is:

     (i) Used to evaluate an abnormality seen or suspected from a screening examination for

breast cancer; or

     (ii) Used to evaluate an abnormality detected by another means of examination.

     (3) "Supplemental breast examinations" means a medically necessary and appropriate

examination of the breast, including an examination using breast magnetic resonance imaging, or

breast ultrasound, that is:

     (i) Used to screen for breast cancer when there is no abnormality seen or suspected; and

     (ii) Based on personal or family medical history, or additional factors that may increase the

LC003434 - Page 3 of 5

individual’s risk of breast cancer.

     (b) In the case that a group health plan, or a health insurance issuer offering group or

individual health insurance coverage, that provides benefits with respect to screening, supplemental

and diagnostic breast examinations furnished to an individual enrolled under such plan or such

coverage, the plan or coverage shall not impose any cost-sharing requirements.

     SECTION 5. This act shall take effect upon passage.

========

LC003434

========

LC003434 - Page 4 of 5

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would prohibit an insurance company from imposing any cost-sharing

requirements for any diagnostic or supplemental breast examinations.

     This act would take effect upon passage.

========

LC003434

========

LC003434 - Page 5 of 5