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--- version:Edition 1+++ version:Filed@@ -1,26 +1,24 @@GENERAL ASSEMBLY OF NORTH CAROLINASESSION 2025-H 1-HOUSE BILL 297+H D+HOUSE BILL DRH40155-MR-16AShort Title: Breast Cancer Prevention Imaging Parity. (Public)-Sponsors: Representatives Belk, Carney, White, and Lambeth (Primary Sponsors).-For a complete list of sponsors, refer to the North Carolina General Assembly web site.-Referred to: Health, if favorable, Insurance, if favorable, Rules, Calendar, and Operations of-the House-March 6, 2025-*H297-v-1*+Sponsors: Representative Belk.+Referred to:++*DRH40155-MR-16A*A BILL TO BE ENTITLED 1-AN ACT TO PROVIDE HE ALTH COVERAGE PARITY FOR SUPPLEMENTAL AN D 2+AN ACT TO PROVIDE HEALTH COVERAGE PARITY FOR SUPPLEMENTAL AND 2DIAGNOSTIC BREAST IMAGING. 3The General Assembly of North Carolina enacts: 45-PART I. HEALTH INSUR ANCE REGULATION CHAN GES TO CREATE PARITY 6+PART I. HEALTH INSURANCE REGULATION CHANGES TO CREATE PARITY 6FOR SUPPLEMENTAL AND DIAGNOSTIC BREAST IMAGING 7SECTION 1.1.(a) G.S. 58-51-57 is recodified as G.S. 58-3-271. 8SECTION 1.1.(b) G.S. 58-65-92 is repealed. 9SECTION 1.1.(c) G.S. 58-67-76 is repealed. 10-SECTION 1.2. G.S. 58-3-271, as enacted by Section 1.1(a) of this act, reads as 11+SECTION 1.2. G.S. 58-3-271, as enacted by Section 1 .1(a) of this act, reads as 11rewritten: 12"§ 58-3-271. Coverage for diagnostic, screening, and supplemental examinations for 13breast cancer, including mammograms and other imaging, and cervical cancer 14@@ -43,146 +41,149 @@a. Is seen or suspected from a screening examination for breast cancer. 31b. Is detected by another means of examination. 32(5) High-deductible health plan. – As defined under the Internal Revenue Code. 33+(6) Low-dose mammography. – A radiologic procedure for the early detection of 34+breast cancer using equipment dedicated specifically for mammography, 35+including a physician's interpretation of the results of the procedure. 36+H.B. 297+Mar 5, 2025+HOUSE PRINCIPAL CLERKGeneral Assembly Of North Carolina Session 2025-Page 2 House Bill 297-First Edition-(6) Low-dose mammography. – A radiologic procedure for the early detection of 1-breast cancer using equipment dedicated specifically for mammography, 2-including a physician's interpretation of the results of the procedure. 3-(7) Screening examination for breast cancer. – Low-dose mammography, or an 4-equivalent procedure, that is used to determine if there is abnorm ality in the 5-breast. 6-(8) Screening of early detection of cervical cancer. – Examinations and laboratory 7-tests used to detect cervical cancer, including conventional PAP smear 8-screening, liquid-based cytology, and human papilloma virus (HPV) detection 9-methods for women with equivocal findings on cervical cytologic analysis 10-that are subject to the approval of and have been approved by the United States 11-Food and Drug Administration. 12-(9) Section 223. – Section 223 of the Internal Revenue Code or its equivalent. 13-(10) Supplemental examination for breast cancer . – An examination for breast 14-cancer that is determined by the healthcare provider treating the patient to be 15-medically necessary and appropriate and that may include breast magnetic 16-resonance imaging or breast ultrasound to screen for cancer if the patient 17-meets either of the following criteria: 18-a. The patient is at increased risk for breast cancer based on the patient's 19-personal medical history or family medical history of breast cancer. 20-b. The patient has a breast cancer risk profile that qualifies the patient 21-based on current recommendations of the United S tates Preventive 22-Services Task Force, also known as USPSTF. 23-(a)(a1) Every policy or contract of accident or health insurance, and every preferred provider 24-benefit plan under G.S. 58-50-56, that is issued, renewed, or amended on or after January 1, 1992, 25-health benefit plan offered by an insurer in this State shall provide coverage for examinations 26-and laboratory tests for the screening for the early detection of cervical cancer and for low -dose 27-screening mammography. The same deductibles, coinsurance, and other limitations as apply to 28-similar services covered under the policy, contract, or plan shall apply to coverage for 29-examinations and laboratory tests for the screening for the early detection of cervical cancer and 30-low-dose screening mammography. 31-(a1) As used in this section, "examinations and laboratory tests for the screening for the 32-early detection of cervical cancer" means conventional PAP smear screening, liquid -based 33-cytology, and human papilloma virus (HPV) detection methods for women with equivocal 34-findings on cervical cytologic analysis that are subject to the approval of and have been approved 35-by the United States Food and Drug Administration. 36-(b) As used in this section, "low -dose sc reening mammography" means a radiologic 37-procedure for the early detection of breast cancer provided to an asymptomatic woman using 38-equipment dedicated specifically for mammography, including a physician's interpretation of the 39-results of the procedure. 40-(b1) Every health benefit plan offered by an insurer that provides benefits for a diagnostic 41-or supplemental examination for breast cancer shall ensure that the cost -sharing requirements 42-applicable to a diagnostic or supplemental examination for breast cancer are no less favorable 43-than the cost-sharing requirements applicable to low-dose screening mammography for breast 44-cancer. 45-(b2) An insurer shall not be required to reimburse a healthcare provider that is not a 46-contracted provider in the provider network of a health benefit plan offered by the insurer any 47-reimbursement rate more than the rate paid to a provider that has contracted with the insurer to 48-participate in the provider network of the health benefit plan for any of the following services: 49-(1) Diagnostic, screening, or supplemental examination for breast cancer. 50-(2) Low-dose mammography. 51+Page 2 DRH40155-MR-16A+(7) Screening examination for breast cancer. – Low-dose mammography, or an 1+equivalent procedure, that is used to determine if there is abnorm ality in the 2+breast. 3+(8) Screening of early detection of cervical cancer. – Examinations and laboratory 4+tests used to detect cervical cancer, including conventional PAP smear 5+screening, liquid-based cytology, and human papilloma virus (HPV) detection 6+methods for women with equivocal findings on cervical cytologic analysis 7+that are subject to the approval of and have been approved by the United States 8+Food and Drug Administration. 9+(9) Section 223. – Section 223 of the Internal Revenue Code or its equivalent. 10+(10) Supplemental examination for breast cancer . – An examination for breast 11+cancer that is determined by the healthcare provider treating the patient to be 12+medically necessary and appropriate and that may include breast magnetic 13+resonance imaging or breast ultrasound to screen for cancer if the patient 14+meets either of the following criteria: 15+a. The patient is at increased risk for breast cancer based on the patient's 16+personal medical history or family medical history of breast cancer. 17+b. The patient has a breast cancer risk profile that qualifies the patient 18+based on current recommendations of the United S tates Preventive 19+Services Task Force, also known as USPSTF. 20+(a)(a1) Every policy or contract of accident or health insurance, and every preferred provider 21+benefit plan under G.S. 58-50-56, that is issued, renewed, or amended on or after January 1, 1992, 22+health benefit plan offered by an insurer in this State shall provide coverage for examinations 23+and laboratory tests for the screening for the early detection of cervical cancer and for low-dose 24+screening mammography. The same deductibles, coinsurance, and other limitations as apply to 25+similar services covered under the policy, contract, or plan shall apply to coverage for 26+examinations and laboratory tests for the screening for the early detection of cervical cancer and 27+low-dose screening mammography. 28+(a1) As used in this section, "examinations and laboratory tests for the screening for the 29+early detection of cervical cancer" means conventional PAP smear screening, liquid -based 30+cytology, and human papilloma virus (HPV) detection methods for women with equivocal 31+findings on cervical cytologic analysis that are subject to the approval of and have been approved 32+by the United States Food and Drug Administration. 33+(b) As used in this section, "low -dose screening mammography" means a radiologic 34+procedure for the early detection of breast cancer provided to an asymptomatic woman using 35+equipment dedicated specifically for mammography, including a physician's interpretation of the 36+results of the procedure. 37+(b1) Every health benefit plan offered by an insurer that provides benefits for a diagnostic 38+or supplemental examination for breast cancer shall ensure that the cost -sharing requirements 39+applicable to a diagnostic or supplemental examination for breast cancer are no less favorable 40+than the cost-sharing requirements applicable to low-dose screening mammography for breast 41+cancer. 42+(b2) An insurer shall not be required to reimburse a healthcare provider that is not a 43+contracted provider in the provider network of a health benefit plan offered by the insurer any 44+reimbursement rate more than the rate paid to a provider that has contracted with the insurer to 45+participate in the provider network of the health benefit plan for any of the following services: 46+(1) Diagnostic, screening, or supplemental examination for breast cancer. 47+(2) Low-dose mammography. 48+(3) Breast ultrasound. 49+(4) Breast magnetic resonance imaging. 50+(c) Coverage for low-dose screening mammography shall be provided as follows: 51General Assembly Of North Carolina Session 2025-House Bill 297-First Edition Page 3-(3) Breast ultrasound. 1-(4) Breast magnetic resonance imaging. 2-(c) Coverage for low-dose screening mammography shall be provided as follows: 3-(1) One or more mammograms a year, as recommended by a physician, for any 4-woman individual who is at risk for breast cancer. For purposes of this 5-subdivision, a woman an individual is at risk for bre ast cancer if any one or 6-more of the following is true: 7-a. The woman individual has a personal history of breast cancer;cancer. 8-b. The woman individual has a personal history of biopsy-proven benign 9-breast disease;disease. 10-c. The woman's individual's mother, sister, or daughter has or has had 11-breast cancer; orcancer. 12-d. The woman has not given birth prior to the age of 30;30. 13-(2) One baseline mammogram for any woman 35 through 39 years of age, 14-inclusive;inclusive. 15-(3) A mammogram every other year for a ny woman 40 through 49 years of age, 16-inclusive, or more frequently upon recommendation of a physician; 17-andphysician. 18-(4) A mammogram every year for any woman 50 years of age or older. 19-(d) Reimbursement for a mammogram authorized under this section shall be made only 20-if the facility in which the mammogram was performed meets mammography accreditation 21-standards established by the North Carolina Medical Care Commission. 22-(e) Coverage for the screening for the early detection of cervical cancer shall be in 23-accordance with the most recently published American Cancer Society guidelines or guidelines 24-adopted by the North Carolina Advisory Committee on Cancer Coordination and Control. 25-Coverage shall include the examination, the laboratory fee, and the physician's int erpretation of 26-the laboratory results. Reimbursements for laboratory fees shall be made only if the laboratory 27-meets accreditation standards adopted by the North Carolina Medical Care Commission. 28-(f) If the application of any provision of this section would render the insured ineligible 29-for a health savings account under section 223 , then that provision shall apply only for 30-high-deductible health plans with respect to the deductible of that plan after the insured has 31-satisfied the minimum deductible under section 223, except with respect to items or services that 32-are prevent ative care . For items or services that are preventative care under section 223, all 33-provisions of this section shall apply regardless of whether or not the minimum deductible under 34-section 223 has been satisfied." 35-SECTION 1.3. G.S. 135-48.51 reads as rewritten: 36-"§ 135-48.51. Coverage and operational mandates related to Chapter 58 of the General 37-Statutes. 38-The following provisions of Chapter 58 of the General Statutes apply to the State Health Plan: 39-… 40-(9a) G.S. 58-3-271, Coverage for diagnostic, screening, and supplemental 41-examinations for breast cancer, including mammograms and other imaging, 42-and cervical cancer screening. 43-…." 44-SECTION 1.4. Except as otherwise provided, this Part becomes effective October 45-1, 2025, and applies to insurance contracts issued, renewed, or amended on or after that date. 46- 47-PART II. HEALTHCARE PROVIDER BILLING REG ULATION CHANGES TO 48-CREATE PARITY FOR SU PPLEMENTAL AN D DIAGNOSTIC BREAST CANCER 49-IMAGING 50-SECTION 2.1.(a) G.S. 90-701 is recodified as G.S. 90-705. 51+DRH40155-MR-16A Page 3+(1) One or more mammograms a year, as recommended by a physician, for any 1+woman individual who is at risk for breast cancer. For purposes of this 2+subdivision, a woman an individual is at risk for breast cancer if any one or 3+more of the following is true: 4+a. The woman individual has a personal history of breast cancer;cancer. 5+b. The woman individual has a personal history of biopsy-proven benign 6+breast disease;disease. 7+c. The woman's individual's mother, sister, or daughter has or has had 8+breast cancer; orcancer. 9+d. The woman has not given birth prior to the age of 30;30. 10+(2) One baseline mammogram for any woman 35 through 39 years of age, 11+inclusive;inclusive. 12+(3) A mammogram every other year for any woman 40 through 49 years of age, 13+inclusive, or more frequently upon recommendation of a physician; 14+andphysician. 15+(4) A mammogram every year for any woman 50 years of age or older. 16+(d) Reimbursement for a mammogram authorized under this section shall be made only 17+if the facility in which the mammogram was performed meets mammography accreditation 18+standards established by the North Carolina Medical Care Commission. 19+(e) Coverage for the screening for the early detection of cervical cancer shall be in 20+accordance with the most recently published American Cancer Society guidelines or guidelines 21+adopted by the North Carolina Advisory Committee on Cancer Coordination and Control. 22+Coverage shall include the examination, the laboratory fee, and the physician 's interpretation of 23+the laboratory results. Reimbursements for laboratory fees shall be made only if the laboratory 24+meets accreditation standards adopted by the North Carolina Medical Care Commission. 25+(f) If the application of any provision of this section would render the insured ineligible 26+for a health savings account under section 223 , then that provision shall apply only for 27+high-deductible health plans with respect to the deductible of that plan after the insured has 28+satisfied the minimum deductible under section 223, except with respect to items or services that 29+are prevent ative care . For items or services that are preventative care under section 223, all 30+provisions of this section shall apply regardless of whether or not the minimum deductible under 31+section 223 has been satisfied." 32+SECTION 1.3. G.S. 135-48.51 reads as rewritten: 33+"§ 135-48.51. Coverage and operational mandates related to Chapter 58 of the General 34+Statutes. 35+The following provisions of Chapter 58 of the General Statutes apply to the State Health Plan: 36+… 37+(9a) G.S. 58-3-271, Coverage for diagnostic, screening, and supplemental 38+examinations for breast cancer, including mammograms and other imaging, 39+and cervical cancer screening. 40+…." 41+SECTION 1.4. Except as otherwise provided, this Part becomes effective October 42+1, 2025, and applies to insurance contracts issued, renewed, or amended on or after that date. 43+ 44+PART II. HEALTHCARE PROVIDER BILLING REGULATION CHANGES TO 45+CREATE PARITY FOR SUPPLEMENTAL AND DIAGNOSTIC BREAST CANCER 46+IMAGING 47+SECTION 2.1.(a) G.S. 90-701 is recodified as G.S. 90-705. 48+SECTION 2.1.(b) Article 41 of Chapter 90 of the General Statutes, as amended by 49+subsection (a) of this section, reads as rewritten: 50+"Article 41. 51General Assembly Of North Carolina Session 2025-Page 4 House Bill 297-First Edition-SECTION 2.1.(b) Article 41 of Chapter 90 of the General Statutes, as amended by 1-subsection (a) of this section, reads as rewritten: 2-"Article 41. 3-"Pathology Services Billing.Transparency in Healthcare Provider Billing Practices. 4-"§ 90-702. Definitions. 5-The following definitions shall apply in this Article: 6-(1) Breast cancer prevention service. – All services listed under 7-G.S. 58-3-271(b2). 8-(2) Cost-sharing. – As defined in G.S. 58-3-271. 9-(3) Reserved for future codification purposes. 10-(4) Health benefit plan. – As defined in G.S. 58-3-167. 11-(5) Healthcare provider. – A health services facility or a person who is licensed, 12-registered, or certified under Chapter 90 or Chapter 90B of the General 13-Statutes, or under the laws of another state, to provide healthcare services in 14-the ordinary care of business or practice, or as a profession, or in an approved 15-education or training program. 16-(6) Health services facility. – As defined in G.S. 131E-214.25 17-(7) Reserved for future codification purposes. 18-(8) Insurer. – As defined in G.S. 58-3-167. 19-"§ 90-704. Billing for certain breast cancer prevention services. 20-(a) A healthcare provider who has not contracted with an insurer to participate in the 21-provider network of a health benefit plan shall accept as reimbursement for any breast cancer 22-prevention service provided to an individual insured under a health benefit plan the amount of 23-reimbursement provided by that insurer , including any cost-sharing required to be paid by the 24-patient. 25-(b) No healthcare provider may bill a patient covered under a health benefit plan or 26-request additional reimbursement from the insurer for any amount above the amount required to 27-be accepted under subsection (a) of this section. 28-…." 29-SECTION 2.2. This Part is effective October 1, 2025, and applies to services 30-provided on or after that date. 31- 32-PART III. EFFECTIVE DATE 33-SECTION 3.1. Except as otherwise provided, this act is effective when it becomes 34-law. 35+Page 4 DRH40155-MR-16A+"Pathology Services Billing.Transparency in Healthcare Provider Billing Practices. 1+"§ 90-702. Definitions. 2+The following definitions shall apply in this Article: 3+(1) Breast cancer prevention service. – All services listed under 4+G.S. 58-3-271(b2). 5+(2) Cost-sharing. – As defined in G.S. 58-3-271. 6+(3) Reserved for future codification purposes. 7+(4) Health benefit plan. – As defined in G.S. 58-3-167. 8+(5) Healthcare provider. – A health services facility or a person who is licensed, 9+registered, or certified under Chapter 90 or Chapter 90B of the General 10+Statutes, or under the laws of another state, to provide healthcare services in 11+the ordinary care of business or practice, or as a profession, or in an approved 12+education or training program. 13+(6) Health services facility. – As defined in G.S. 131E-214.25 14+(7) Reserved for future codification purposes. 15+(8) Insurer. – As defined in G.S. 58-3-167. 16+"§ 90-704. Billing for certain breast cancer prevention services. 17+(a) A healthcare provider who has not contracted with an insurer to participate in the 18+provider network of a health benefit plan shall accept as reimbursement for any breast cancer 19+prevention service provided to an individual insured under a health benefit plan the amount of 20+reimbursement provided by that insurer , including any cost-sharing required to be paid by the 21+patient. 22+(b) No healthcare provider may bill a patient covered under a health benefit plan or 23+request additional reimbursement from the insurer for any amount above the amount required to 24+be accepted under subsection (a) of this section. 25+…." 26+SECTION 2.2. This Part is effective October 1, 2025, and applies to services 27+provided on or after that date. 28+ 29+PART III. EFFECTIVE DATE 30+SECTION 3.1. Except as otherwise provided, this act is effective when it becomes 31+law. 32
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