SP0262
LD 817
Session - 128th Maine Legislature
C "A", Filing Number S-117, Sponsored by
LR 213
Item 2
Bill Tracking, Additional Documents Chamber Status

Amend the bill in section 1 in §4320-K in the first line (page 1, line 3 in L.D.) by striking out the following: " screening magnetic resonance imaging scan" and inserting the following: ' additional screening of dense breast tissue'

Amend the bill in section 1 in §4320-K by striking out all of subsection 2 (page 1, lines 12 to 14 in L.D.) and inserting the following:

2 Required coverage.   A carrier offering a health plan in this State shall provide coverage for an ultrasound evaluation, a magnetic resonance imaging scan, 3-dimensional mammography or additional testing of an entire breast or breasts after a baseline mammogram examination if:
A The mammogram results demonstrate dense breast tissue;
B The mammogram results are abnormal within any degree of breast density; or
C The enrollee has additional risk factors for breast cancer, including but not limited to family history of breast cancer, prior personal history of breast cancer, positive genetic testing, dense breast tissue or other indications as determined by the enrollee's health care provider.

The coverage required in this section may be subject to utilization review by the carrier, including periodic review of the medical necessity of the additional screening and diagnostic testing.

Sec. 2. Application. The requirements of this Act apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2019. For purposes of this Act, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.

Sec. 3. Exemption from review. Notwithstanding the Maine Revised Statutes, Title 24-A, section 2752, this Act is enacted without review and evaluation by the Department of Professional and Financial Regulation, Bureau of Insurance.’

summary

This amendment is the minority report of the committee. The amendment requires health insurance carriers to provide coverage for an ultrasound evaluation, a magnetic resonance imaging scan, 3-dimensional mammography or additional testing of an entire breast or breasts after a baseline mammogram examination if the mammogram results demonstrate dense breast tissue or are abnormal within any degree of breast density or if the person has certain risk factors for breast cancer. The bill limits coverage to a magnetic resonance imaging scan. The requirements apply to all individual and group policies and contracts issued or renewed on or after January 1, 2019. The amendment also adds language exempting the bill from the provisions of the Maine Revised Statutes, Title 24-A, section 2752.


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