S.Amdt. 3675

SA 3675. Mrs. BRITT (for herself and Mrs. Shaheen) submitted an
amendment intended to be proposed by her to the bill S. 2296, to
authorize appropriations for fiscal year 2026 for military activities
of the Department of Defense, for military construction, and for
defense activities of the Department of Energy, to prescribe military
personnel strengths for such fiscal year, and for other purposes; which
was ordered to lie on the table; as follows:

At the appropriate place, insert the following:

SEC. __. REQUIRING DIAGNOSTIC AND SUPPLEMENTAL BREAST
EXAMINATIONS TO BE COVERED WITH NO COST-SHARING
REQUIREMENTS.

(a) In General.--Subpart II of part A of title XXVII of the
Public Health Service Act (42 U.S.C. 300gg-11 et seq.) is
amended by adding at the end the following new section:

``SEC. 2730. DIAGNOSTIC AND SUPPLEMENTAL BREAST EXAMINATIONS.

``(a) In General.--In the case of a group health plan, or a
health insurance issuer offering group or individual health
insurance coverage, that provides benefits with respect to
diagnostic and supplemental breast examinations furnished to
an individual enrolled under such plan or such coverage, such
plan or coverage shall not impose any cost-sharing
requirements for these benefits.
``(b) Construction.--Nothing in this section shall be
construed--
``(1) to prohibit a group health plan or health insurance
issuer from requiring timely prior authorization or imposing
other appropriate utilization controls in approving coverage
for any diagnostic and supplemental breast examination; or
``(2) to supersede a State law that provides greater
protections with respect to the coverage of diagnostic and
supplemental breast examinations than is provided under this
section.
``(c) Definitions.--In this section:

[[Page S5469]]

``(1) Cost-sharing requirements.--The term `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 examination.--The term `diagnostic
breast examination' means a medically necessary and
appropriate (in accordance with National Comprehensive Cancer
Network Guidelines) examination of the breast (including, but
not limited to such an examination using diagnostic
mammography, breast magnetic resonance imaging, or breast
ultrasound) that is--
``(A) used to evaluate an abnormality seen or suspected
from a screening examination for breast cancer; or
``(B) used to evaluate an abnormality detected by another
means of examination.
``(3) Supplemental breast examinations.--The term
`supplemental breast examination' means a medically necessary
and appropriate (in accordance with National Comprehensive
Cancer Network Guidelines) examination of the breast
(including, but not limited to such an examination using
breast magnetic resonance imaging or breast ultrasound) that
is--
``(A) used to screen for breast cancer when there is no
abnormality seen or suspected; and
``(B) furnished based on personal or family medical history
or additional factors that may increase the individual's risk
of breast cancer.''.
(b) Application to Grandfathered Health Plans.--Section
1251(a)(4)(A) of the Patient Protection and Affordable Care
Act (42 U.S.C. 18011(a)(4)(A)) is amended--
(1) by striking ``title'' and inserting ``title, or as
added after the date of the enactment of this Act''; and
(2) by adding at the end the following new clause:
``(v) Section 2730 (relating to coverage for diagnostic and
supplemental breast examinations).''.
(c) Application to High Deductible Health Plans With Health
Savings Account Eligibility.--Section 223(c)(2) of the
Internal Revenue Code of 1986 is amended by adding at the end
the following:
``(H) Safe harbor for absence of deductible for diagnostic
and supplemental breast examinations.--In the case of plan
years beginning on or after January 1, 2026, a plan shall not
fail to be treated as a high deductible health plan by reason
of failing to have a deductible for diagnostic and
supplemental breast examinations.''.
(d) Effective Date.--The amendments made by this section
shall apply with respect to plan years beginning on or after
January 1, 2026.
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