[First Reprint]

ASSEMBLY, No. 2022

STATE OF NEW JERSEY

215th LEGISLATURE

 

PRE-FILED FOR INTRODUCTION IN THE 2012 SESSION

 


 

Sponsored by:

Assemblyman  TROY SINGLETON

District 7 (Burlington)

Assemblyman  DANIEL R. BENSON

District 14 (Mercer and Middlesex)

Assemblyman  GORDON M. JOHNSON

District 37 (Bergen)

Assemblywoman  PAMELA R. LAMPITT

District 6 (Burlington and Camden)

Assemblywoman  ANNETTE QUIJANO

District 20 (Union)

Assemblywoman  VALERIE VAINIERI HUTTLE

District 37 (Bergen)

 

Co-Sponsored by:

Assemblywoman Jimenez, Assemblyman Eustace, Assemblywoman Wagner, Assemblymen Amodeo, C.A.Brown, Assemblywoman Caride, Assemblymen Cryan, Caputo, DeAngelo, Chivukula, P.Barnes, III, Assemblywomen Jasey, Schepisi, Sumter, Riley, Assemblyman Giblin, Assemblywomen Angelini, Mosquera, Stender, Tucker, Assemblyman Ramos, Assemblywoman Casagrande and Assemblyman Prieto

 

 

 

 

SYNOPSIS

     Requires insurers to cover comprehensive ultrasound breast screening or other screening if a mammogram demonstrates certain dense breast tissue and requires certain mammogram reports to contain information on breast density.

 

CURRENT VERSION OF TEXT

     As reported by the Assembly Health and Senior Services Committee on March 7, 2013, with amendments.


An Act concerning mammograms, amending P.L.1991, c.279 and P.L.2004, c.86, and supplementing Title 26 of the Revised Statutes.

 

     Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

     1.    Section 1 of P.L.1991, c.279 (C.17:48-6g) is amended to read as follows:

     1.    a.  No group or individual hospital service corporation contract providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in conducting:

     (1)   one baseline mammogram examination for women who are at least 35 but less than 40 years of age; a mammogram examination every year for women age 40 and over; and, in the case of a woman who is under 40 years of age and has a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age and intervals as deemed medically necessary by the woman's health care provider; and

     (2)   comprehensive ultrasound screening 1, or other screening deemed medically necessary by the woman’s health care provider,1 of an entire breast or breasts 1, after a baseline mammogram examination,1 if 1[a] the1 mammogram demonstrates 1[heterogeneous] heterogeneously1 or 1extremely1 dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or if 1[a] the1 woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing, or other indications as determined by 1[a] the1 woman's 1[physician or advanced practice nurse] health care provider.  The coverage required under this paragraph may be subject to utilization review, including periodic review, by the hospital service corporation of the medical necessity of the comprehensive ultrasound screenings or other screenings if the provider has been determined by the hospital service corporation to have overutilized the coverage required under this paragraph1.

     b.    These benefits shall be provided to the same extent as for any other sickness under the contract.

     c.     The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.

(cf:  P.L.2004, c.86, s.1)

 

     2.    Section 2 of P.L.1991, c.279 (C.17:48A-7f) is amended to read as follows:

     2.    a.  No group or individual medical service corporation contract providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in conducting:

     (1)   one baseline mammogram examination for women who are at least 35 but less than 40 years of age; a mammogram examination every year for women age 40 and over; and, in the case of a woman who is under 40 years of age and has a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age and intervals as deemed medically necessary by the woman's health care provider; and

     (2)   comprehensive ultrasound screening 1, or other screening deemed medically necessary by the woman’s health care provider,1 of an entire breast or breasts 1, after a baseline mammogram examination,1 if 1[a] the1 mammogram demonstrates 1[heterogeneous] heterogeneously1 or 1extremely1 dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or if 1[a] the1 woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing, or other indications as determined by 1[a] the1 woman's 1[physician or advanced practice nurse] health care provider.  The coverage required under this paragraph may be subject to utilization review, including periodic review, by the medical service corporation of the medical necessity of the comprehensive ultrasound screenings or other screenings if the provider has been determined by the medical service corporation to have overutilized the coverage required under this paragraph1.

     b.    These benefits shall be provided to the same extent as for any other sickness under the contract.

     c.     The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.

(cf:  P.L.2004, c.86, s.2)

 

     3.    Section 3 of P.L.1991, c.279 (C.17:48E-35.4) is amended to read as follows:

     3.    a.  No group or individual health service corporation contract providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in conducting:

     (1)   one baseline mammogram examination for women who are at least 35 but less than 40 years of age; a mammogram examination every year for women age 40 and over; and, in the case of a woman who is under 40 years of age and has a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age and intervals as deemed medically necessary by the woman's health care provider; and

     (2)   comprehensive ultrasound screening 1, or other screening deemed medically necessary by the woman’s health care provider,1 of an entire breast or breasts 1, after a baseline mammogram examination,1 if 1[a] the1 mammogram demonstrates 1[heterogeneous] heterogeneously1 or 1extremely1 dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or if 1[a] the1 woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing, or other indications as determined by 1[a] the1 woman's 1[physician or advanced practice nurse] health care provider.  The coverage required under this paragraph may be subject to utilization review, including periodic review, by the health service corporation of the medical necessity of the comprehensive ultrasound screenings or other screenings if the provider has been determined by the health service corporation to have overutilized the coverage required under this paragraph1.

     b.    These benefits shall be provided to the same extent as for any other sickness under the contract.

     c.     The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium. 

(cf:  P.L.2004, c.86, s.3)

 

     4.    Section 4 of P.L.1991, c.279 (C.17B:26-2.1e) is amended to read as follows:

     4.    a.  No individual health insurance policy providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, unless the policy provides benefits to any named insured or other person covered thereunder for expenses incurred in conducting:

     (1)   one baseline mammogram examination for women who are at least 35 but less than 40 years of age; a mammogram examination every year for women age 40 and over; and, in the case of a woman who is under 40 years of age and has a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age and intervals as deemed medically necessary by the woman's health care provider; and

     (2)   comprehensive ultrasound screening 1, or other screening deemed medically necessary by the woman’s health care provider,1 of an entire breast or breasts 1, after a baseline mammogram examination,1 if 1[a] the1 mammogram demonstrates 1[heterogeneous] heterogeneously1 or 1extremely1 dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or if 1[a] the1 woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing, or other indications as determined by 1[a] the1 woman's 1[physician or advanced practice nurse] health care provider.  The coverage required under this paragraph may be subject to utilization review, including periodic review, by the insurer of the medical necessity of the comprehensive ultrasound screenings or other screenings if the provider has been determined by the insurer to have overutilized the coverage required under this paragraph1.

     b.    These benefits shall be provided to the same extent as for any other sickness under the policy. 

     c.     The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.

(cf:  P.L.2004, c.86, s.4)

 

     5.    Section 5 of P.L.1991, c.279 (C.17B:27-46.1f) is amended to read as follows:

     5.    a.  No group health insurance policy providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, unless the policy provides benefits to any named insured or other person covered thereunder for expenses incurred in conducting:

     (1)   one baseline mammogram examination for women who are at least 35 but less than 40 years of age; a mammogram examination every year for women age 40 and over; and, in the case of a woman who is under 40 years of age and has a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age and intervals as deemed medically necessary by the woman's health care provider; and

     (2)   comprehensive ultrasound screening 1, or other screening deemed medically necessary by the woman’s health care provider,1 of an entire breast or breasts 1, after a baseline mammogram examination,1 if 1[a] the1 mammogram demonstrates 1[heterogeneous] heterogeneously1 or 1extremely1 dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or if 1[a] the1 woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing, or other indications as determined by 1[a] the1 woman's 1[physician or advanced practice nurse] health care provider.  The coverage required under this paragraph may be subject to utilization review, including periodic review, by the insurer of the medical necessity of the comprehensive ultrasound screenings or other screenings if the provider has been determined by the insurer to have overutilized the coverage required under this paragraph1.

     b.    These benefits shall be provided to the same extent as for any other sickness under the policy.

     c.     The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.

(cf:  P.L.2004, c.86, s.5)

 

     6.    Section 7 of P.L.2004, c.86 (C.17B:27A-7.10) is amended to read as follows:

     7.    a.  Every individual health benefits plan that is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) or approved for issuance or renewal in this State, on or after the effective date of this act, shall provide benefits to any woman covered thereunder for expenses incurred in conducting:

     (1)   one baseline mammogram examination for women who are at least 35 but less than 40 years of age; a mammogram examination every year for women age 40 and over; and, in the case of a woman who is under 40 years of age and has a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age and intervals as deemed medically necessary by the woman's health care provider; and

     (2)   comprehensive ultrasound screening 1, or other screening deemed medically necessary by the woman’s health care provider,1 of an entire breast or breasts 1, after a baseline mammogram examination,1 if 1[a] the1 mammogram demonstrates 1[heterogeneous] heterogeneously1 or 1extremely1 dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or if 1[a] the1 woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing, or other indications as determined by 1[a] the1 woman's 1[physician or advanced practice nurse] health care provider.  The coverage required under this paragraph may be subject to utilization review, including periodic review, by the carrier of the medical necessity of the comprehensive ultrasound screenings or other screenings if the provider has been determined by the carrier to have overutilized the coverage required under this paragraph1.

     b.    The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.

     c.     The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.

(cf:  P.L.2004, c.86, s.7)

 

     7.    Section 8 of P.L.2004, c.86 (C.17B:27A-19.13) is amended to read as follows:

     8.    a.  Every small employer health benefits plan that is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) or approved for issuance or renewal in this State, on or after the effective date of this act, shall provide benefits to any woman covered thereunder for expenses incurred in conducting:

     (1)   one baseline mammogram examination for women who are at least 35 but less than 40 years of age; a mammogram examination every year for women age 40 and over; and, in the case of a woman who is under 40 years of age and has a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age and intervals as deemed medically necessary by the woman's health care provider; and

     (2)   comprehensive ultrasound screening 1, or other screening deemed medically necessary by the woman’s health care provider,1 of an entire breast or breasts 1, after a baseline mammogram examination,1 if 1[a] the1 mammogram demonstrates 1[heterogeneous] heterogeneously1 or 1extremely1 dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or if 1[a] the1 woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing, or other indications as determined by 1[a] the1 woman's 1[physician or advanced practice nurse] health care provider.  The coverage required under this paragraph may be subject to utilization review, including periodic review, by the carrier of the medical necessity of the comprehensive ultrasound screenings or other screenings if the provider has been determined by the carrier to have overutilized the coverage required under this paragraph1.

     b.    The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.

     c.     The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.

(cf:  P.L.2004, c.86, s.8)

 

     8.    Section 6 of P.L.1991, c.279 (C.26:2J-4.4) is amended to read as follows:

     6.    a.  Notwithstanding any provision of law to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued by the Commissioner of Banking and Insurance on or after the effective date of this act unless the health maintenance organization provides health care services to any enrollee for the conduct of:

     (1)   one baseline mammogram examination for women who are at least 35 but less than 40 years of age; a mammogram examination every year for women age 40 and over; and, in the case of a woman who is under 40 years of age and has a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age and intervals as deemed medically necessary by the woman's health care provider; and

     (2)   comprehensive ultrasound screening 1, or other screening deemed medically necessary by the woman’s health care provider,1 of an entire breast or breasts 1, after a baseline mammogram examination,1 if 1[a] the1 mammogram demonstrates 1[heterogeneous] heterogeneously1 or 1extremely1 dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or if 1[a] the1 woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing, or other indications as determined by 1[a] the1 woman's 1[physician or advanced practice nurse] health care provider.  The coverage required under this paragraph may be subject to utilization review, including periodic review, by the health maintenance organization of the medical necessity of the comprehensive ultrasound screenings or other screenings if the provider has been determined by the health maintenance organization to have overutilized the coverage required under this paragraph1.

     b.    These health care services shall be provided to the same extent as for any other sickness under the enrollee agreement.

     c.     The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.

(cf:  P.L.2012, c.17, s.263)

 

     9.    Section 9 of P.L.2004, c.86 (C.52:14-17.29i) is amended to read as follows:

     9.    a.  The State Health Benefits Commission shall provide benefits to each person covered under the State Health Benefits Program for expenses incurred in conducting:

     (1)   one baseline mammogram examination for women who are at least 35 but less than 40 years of age; a mammogram examination every year for women age 40 and over; and, in the case of a woman who is under 40 years of age and has a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age and intervals as deemed medically necessary by the woman's health care provider; and

     (2)   comprehensive ultrasound screening 1, or other screening deemed medically necessary by the woman’s health care provider,1 of an entire breast or breasts 1, after a baseline mammogram examination,1 if 1[a] the1 mammogram demonstrates 1[heterogeneous] heterogeneously1 or 1extremely1 dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or if 1[a] the1 woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing, or other indications as determined by 1[a] the1 woman's 1[physician or advanced practice nurse] health care provider.  The coverage required under this paragraph may be subject to utilization review, including periodic review, by the carrier of the medical necessity of the comprehensive ultrasound screenings or other screenings if the provider has been determined by the carrier to have overutilized the coverage required under this paragraph1.

     b.    The benefits shall be provided to the same extent as for any other medical condition under the contract.

(cf:  P.L.2004, c.86, s.9)

 

     10.  (New section)  1[Each mammography report provided to a patient shall include information about breast density, based on the Breast Imaging Reporting and Data System established by the American College of Radiology.  When applicable, the report shall include the following notice:  "If your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, which can include a breast ultrasound screening or a breast MRI examination, or both, depending on your individual risk factors.  A report of your mammography results, which contains information about your breast density, has been sent to your physician's office, and you should contact your physician if you have any questions or concerns about this report."]  A facility that provides a mammography report pursuant to the federal Mammography Quality Standards Act, 42 U.S.C. s.263b, shall, if a patient's mammogram demonstrates extremely dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology, include the following information, at a minimum, in the mammography report sent to the patient and the patient's physician: “Your mammogram shows that your breast tissue is dense as determined by the Breast Imaging Reporting and Data System established by the American College of Radiology.  Dense breast tissue is very common and is not abnormal.  However, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with a risk factor for breast cancer.  This information about the result of your mammogram is given to you to raise your awareness.  Use this information to talk to your health care provider about your own risks for breast cancer.  At that time, ask your health care provider if more screening tests might be useful, based on your risk.  A report of your results was sent to your physician.”1

 

     11.  The Commissioner of Health, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt such rules and regulations as are necessary to effectuate the purposes of section 10 of P.L.    , c.   (C.      ) (pending before the Legislature as this bill).

 

     12.  This act shall take effect on the first day of the fourth month next following the date of enactment.  Sections 1 through 9 of this act shall apply to all contracts and policies that are delivered, issued, executed, or renewed or approved for issuance or renewal in this State on or after the effective date.  The 1Commissioner of Banking and Insurance and the1 Commissioner of Health may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of 1[section 10 of]1 this act.