Washington State
House of Representatives
Office of Program Research
BILL
ANALYSIS
Health Care & Wellness Committee
HB 1261
Brief Description: Concerning cost sharing for diagnostic and supplemental breast examinations.
Sponsors: Representatives Walen, Ryu, Reeves, Reed, Simmons, Davis, Ormsby, Fosse, Doglio, Santos and Pollet.
Brief Summary of Bill
  • Prohibits health carriers from imposing cost sharing on diagnostic and supplemental breast examinations.
Hearing Date: 1/18/23
Staff: Kim Weidenaar (786-7120).
Background:

Mammograms are screening tests used for early breast cancer detection and for breast evaluation.  State law requires that all disability, group disability, health maintenance organizations, and health service contractor (collectively known as health carriers) plans provide coverage for screening or diagnostic mammography services upon the recommendation of the patient's physician or advanced registered nurse practitioner.
 
Under the Affordable Care Act, health benefit plans must provide, at a minimum, coverage with no cost sharing, 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 currently recommends, at a B grade, biennial screening mammography for women aged 50 to 74 years.
Summary of Bill:

For non-grandfathered health plans issued or renewed on or after January 1, 2024, that include coverage of supplemental and diagnostic breast examinations, health carriers may not impose cost sharing on these examinations.  For health plans that are offered as a qualifying health plan for a health savings account, the health carrier must establish the plan's cost sharing for coverage of these examinations at the minimum level necessary to preserve the enrollee's ability to claim tax exempt contributions from their health savings account under federal laws and regulations.  
 
A "diagnostic breast examination" is a medically necessary and appropriate examination of the breast, including an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is used to evaluate an abnormality that is seen or suspected from a screening examination or detected by another means.   A "supplemental breast examination" is a medically necessary and appropriate examination of the breast, including an examination using breast magnetic resonance imaging or breast ultrasound, that is used to screen for breast cancer when there is no abnormality seen or suspected and based on personal or family medical history or additional risk factors.
Appropriation: None.
Fiscal Note: Requested on January 13, 2023.
Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.