Current through 2024 Legislative Session Act Chapter 510
Section 532 - [Effective Until 1/1/2025] Supplemental and diagnostic breast examinations(a) As used in this section: (1) "Breast magnetic resonance imaging" or "breast MRI" means a diagnostic tool, including standard and abbreviated breast MRI, that uses radio waves and magnets to produce detailed images of structures within the breast. A breast MRI may be used as a screening tool when clinically indicated, including after indeterminant results from a mammogram that requires additional evaluation and for those at high risk for breast cancer.(2) "Breast ultrasound" means a noninvasive diagnostic tool that uses high-frequency sound waves and their echoes to produce detailed images of structures within the breast. A breast ultrasound may be used as a screening tool when clinically indicated, including after indeterminant results from a mammogram that requires additional evaluation and for those at high risk for breast cancer.(3) "Carrier" means any entity that provides health insurance under § 505(3) of this title.(4) "Cost-sharing requirement" means a deductible, coinsurance, or copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment, or similar out-of-pocket expense.(5) "Diagnostic breast examination" means a medically necessary and clinically appropriate examination of the breast, including such examination using breast MRI, breast ultrasound, or mammogram, that is used for either of the following:a. To evaluate an abnormality seen or suspected from a screening examination for breast cancer.b. To evaluate an abnormality detected by another means of examination.(6) "Mammogram" means a diagnostic or screening mammography exam using a low-dose X-ray to produce an image of the breast.(7) "Supplemental breast screening examination" means a medically necessary and clinically appropriate examination of the breast, including such examination using breast MRI, breast ultrasound, or mammogram, that is used for either of the following: a. To screen for breast cancer when there is no abnormality seen or suspected in the breast.b. Based on personal or family medical history or additional factors that may increase the individual's risk of breast cancer.(b) All carriers shall provide coverage for diagnostic breast examinations and supplemental breast screening examinations. The terms of such coverage, including cost-sharing requirements, shall be no less favorable than the cost-sharing requirements applicable to screening mammography for breast cancer.Added by Laws 2023 , ch. 121, s 4, eff. 9/24/2023.Section 5 of the 2023 enacting legislation provides that this Act takes effect 60 days after its enactment and applies to all policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2024.This section is set out more than once due to postponed, multiple, or conflicting amendments.