SENATE BILL REPORT
SB 5396
As of January 18, 2023
Title: An act relating to cost sharing for diagnostic and supplemental breast examinations.
Brief Description: Concerning cost sharing for diagnostic and supplemental breast examinations.
Sponsors: Senators Wilson, L., Boehnke, Frame, Hunt, Kauffman, Kuderer, Rivers, Rolfes, Shewmake, Valdez and Warnick.
Brief History:
Committee Activity: Health & Long Term Care: 1/20/23.
Brief Summary of Bill
  • Requires health carriers that provide coverage for supplemental and diagnostic breast exams to provide coverage without cost sharing.
SENATE COMMITTEE ON HEALTH & LONG TERM CARE
Staff: Greg Attanasio (786-7410)
Background:

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 recommends, at a B grade, screening mammography, with or without clinical breast examination, every one to two years for women age 40 years and older.
Summary of Bill:

Beginning January 1, 2024, for health plans that include coverage of supplemental breast examinations and diagnostic breast examinations, health carriers may not impose cost sharing for such examinations. 

 

"Diagnostic breast examination" means a medically necessary and appropriate examination, including an examination using diagnostic mammography, breast magnetic resonance imaging, or ultrasound, that is used to evaluate an abnormality seen or suspected from a screening examination for breast cancer, or detected by another means of examination.

 

 "Supplemental breast examination" means a medically necessary and appropriate examination, including an examination using breast magnetic resonance imaging or ultrasound, that is used to screen for breast cancer based an individual's personal or family medical history, or additional factors that may increase the individual's risk of breast cancer.
Appropriation: None.
Fiscal Note: Requested on January 14, 2023.
Creates Committee/Commission/Task Force that includes Legislative members: No.
Effective Date: Ninety days after adjournment of session in which bill is passed.