Bills › 88th General Assembly
Relating to insurance coverage for diagnostic breast cancer examinations, and including applicability provisions
Sponsored by the Senate Human Resources Committee
Topics:Health care
Same legislation: SSB 3162
Where it is now
- Done: IntroducedFebruary 12, 2020
- Done: SubcommitteeFebruary 13, 2020
- Done: Senate committeeFebruary 19, 2020
- Stopped: Passes the SenateDied when the General Assembly ended
- Next: House committee
- Next: Passes the House
- Next: To the Governor
- Next: Signed into law
Died when the session ended The 2020 session adjourned on June 14, 2020, the General Assembly’s last regular session. Bills that didn’t pass both chambers died. What’s a funnel?
What’s in it
AI summary Health insurance plans in Iowa must now cover diagnostic breast cancer exams, such as ultrasounds or MRIs, if a doctor says they are necessary to check an abnormality. These plans cannot charge patients more for these diagnostic tests than they do for regular screening mammograms. This rule applies to most health insurance providers but excludes certain types of specialized health plans.1
Read the official explanation
This bill relates to insurance coverage for diagnostic breast cancer examinations. The bill requires a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses to provide coverage for diagnostic breast cancer examinations. “Diagnostic breast cancer examination” is defined in the bill as an examination of an abnormality, deemed medically necessary by a covered person’s health care professional, for the detection of breast cancer. The examination may be conducted using a diagnostic mammogram, breast magnetic resonance imaging, or breast ultrasound. “Abnormality”, “diagnostic mammogram”, “breast magnetic resonance imaging”, and “breast ultrasound” are also defined in the bill. The policy, contract, or plan cannot require cost-sharing greater than the cost-sharing that the policy, contract, or plan requires for a screening mammogram. “Cost-sharing” and “screening mammogram” are defined in the bill. The bill applies to third-party payment providers enumerated in the bill. The bill specifies the types of specialized health-related insurance which are not subject to the coverage requirements of the bill. The commissioner of insurance is required to adopt rules to administer the requirements of the bill. The bill applies to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021.
Senate subcommittee
Named February 13, 2020 (as SSB 3162). On February 18, 2020 it recommended passage.
Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part
Fiscal note
Cost: up to $129,000 Compare with other bills
AI summary This bill requires health insurance plans to cover the costs of diagnostic breast cancer examinations instead of making members pay copayments or deductibles. This change is estimated to cost the State of Iowa Plan approximately $122,000 in fiscal year 2021 and $129,000 in fiscal year 2022. The exact cost to other insurance plans is unknown, but it is expected to be above $100,000 annually.3
Read the fiscal note
Description
Senate File 2342 requires a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses to provide coverage for diagnostic breast cancer examinations, which are defined as medically necessary examinations of an abnormality for the purpose of detecting breast cancer. The requirement would become effective on January 1, 2021.
Background
Under Wellmark’s current plan designs for State of Iowa, there is typically no cost to Plan members for copayments, coinsurance, and deductibles for preventive/screening mammograms, ultrasounds, and magnetic resonance imaging (MRI) procedures. However, if the screening, ultrasound, or MRI procedure is diagnostic in nature, the Plan member assumes a cost-sharing liability in the form of copayments, coinsurance, and deductibles. Under the Bill, this cost-sharing arrangement would apply to breast cancer examinations as well, and the cost-sharing would be shifted from the State of Iowa Plan member to the Plan.
Assumptions
- Mammograms will account for most preventive imaging services as described in the Bill.
- Under Wellmark’s plan designs, diagnostic services, including examinations, are paid through a cost-sharing arrangement using copayments, coinsurance, and/or deductibles.
- The cost that is currently paid by members for breast cancer examinations will shift to the State of Iowa Plan beginning in FY 2021.
- The cost of these services and the utilization of these services are projected to increase by 5.3% annually.
Fiscal Impact
The fiscal impact of SF 2342 for shifting the share of costs associated with diagnostic breast cancer examinations from Plan members to the Plan is approximately $122,000 in FY 2021 and $129,000 in FY 2022. This amount represents less than 0.1% of the total amount paid by the State of Iowa Plan for medical and pharmaceutical expenses.
Cost-Sharing Changes Under SF 2342 for Diagnostic Breast Cancer ExaminationsFiscal Year Plan Share Member Liability Services Performed 2018 544,256$ 131,125$ 4,330 Current Law 2019 530,120 110,029 4,131 2020 558,550 115,930 4,353 SF 2342 2021 710,228 0 4,586 2022 876,414 0 4,832 The exact fiscal impact to other plans administered by other carriers is unknown, but is expected to be above $100,000 annually.
Source
- Wellmark
- Diagnostic Imaging, Insurance · February 27, 2020 · $129,000
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