Washington State

House of Representatives

Office of Program Research

BILL

ANALYSIS

Health Care & Wellness Committee

SB 5912

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Background:

Mammograms are screening tests used for early breast cancer detection and for breast evaluation. Breast density is a measure used to describe the proportion of the area of breast and connective, or fibroglandular, tissue to the area of fat. Breast and connective tissue is denser, meaning it blocks the passage of x-rays to a greater extent than fatty tissue. Dense tissue appears white or light gray on a mammogram. Lumps, both benign and cancerous, also appear white. Thus, mammograms may be less accurate in patients with dense breasts, since it is more difficult to interpret or detect abnormalities.

Digital breast tomosynthesis, also called three-dimensional mammography, is an emerging imaging technique that attempts to improve the visibility of cancers and facilitate the differentiation between malignant and non-malignant features. Small cancers, which may be obscured by normal fibroglandular tissue in standard two-dimensional projection imaging, may be more readily detected using digital breast tomosynthesis, particularly in women with radiologically dense breasts.

Under the Affordable Care Act, health benefit plans must provide coverage for preventive or wellness services that have a rating of A or B in the current recommendations of the United States Preventive Services Task Force (USPSTF). The USPSTF recommends, at a B grade, screening mammography for women every two years for women aged 50 - 74 years. The USPSTF's January 2016 recommendations for breast cancer screening for digital breast tomosynthesis concluded that the current evidence is insufficient to balance the benefits and harms of the service.

The Office of the Insurance Commissioner requires that health carriers provide coverage for screening or diagnostic mammography services upon the recommendation of the patient's physician or advanced registered nurse practitioner. The Health Care Authority requires identical coverage for all public employee health plans.

Summary of Bill:

The Office of the Insurance Commissioner is directed to clarify that existing mandates for mammography includes coverage for tomosynthesis for all disability, group disability, health maintenance organizations, and health service contractor plans. The Health Care Authority is directed to clarify that the current mandate for mammography includes coverage tomosynthesis for public employee plans.