United States 116th Congress Status: Died Bipartisan · 30 D · 7 R cosponsors

HR 2428 — Access to Breast Cancer Diagnosis Act of 2019

Last action — Referred to the Subcommittee on Health.

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. Died in session

This bill died with 116th Congress. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Summary

Access to Breast Cancer Diagnosis Act of 2019 This bill prohibits private health insurance plans from imposing higher cost-sharing requirements on breast cancer diagnostic examinations than initial breast cancer screening examinations. Diagnostic examinations are generally required after an initial screening detects an abnormality and typically require additional mammogram images (e.g., x-rays).

Bill Text

Sections of law this bill changes

2 sections in 2 laws

From the bill's own amending language, matched to the official United States Code (current through Public Law 119-124).

Public health service · 42 U.S.C. ch. 6A 1 section
  • § 300gg-19a Patient protections Amends

    42 U.S.C. § 300gg-19a

    The law today

    (a) Choice of health care professional If a group health plan, or a health insurance issuer offering group or individual health insurance coverage, requires or provides for designation by a participant, beneficiary, or enrollee of a participating primary care provider, then the plan or issuer shall permit each participant, beneficiary, and enrollee to designate any participating primary care provider who is available to accept such individual. (b) Coverage of emergency services (1) In general If a group health plan, or a health insurance issuer offering group or individual health insurance issuer,1 provides or covers any benefits with respect to services in an emergency department of a hospital, the plan or issuer shall cover emergency services (as defined in paragraph (2)(B))— (A) without the need for any prior authorization determination; (B) whether the health care provider furnishing such services is a participating provider with respect to such services; (C) in a manner so that, if such services are provided to a participant, beneficiary, or enrollee— (i) by a nonparticipating health care provider with or without prior authorization; or (ii) (I) such services will be provided without imposing any requirement under the plan for prior authorization of services or any limitation on coverage where the provider of services does not have a contractual relationship with the plan for the providing of services that is more restrictive than the requirements or limitations that apply to emergency department services received from providers who do have such a contractual relationship with the plan; and (II) if such services are provided out-of-network, the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such services were provided in-network; 2 (D) without regard to any other term or condition of such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under section 2701 3 of this Act, section 1181 of title 29, or section 9801 of title 26, and other than applicable cost-sharing). (2) Definitions In this subsection: (A) Emergency medical condition The term “emergency medical condition” means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in a condition described in clause (i), (ii), or (iii) of section 1395dd(e)(1)(A) of this title. (B) Emergency services The term “emergency services” means, with respect to an emergency medical condition— (i) a medical screening examination (as required under section 1395dd of this title) that is within the capability of the emergency department of a hospital, including ancillary services routinely available to the emergency department to evaluate such emergency medical condition, and (ii) within the capabilities of the staff and facilities available at the hospital, such further medical examination and treatment as are required under section 1395dd of this title to stabilize the patient. (C) Stabilize The term “to stabilize”, with respect to an emergency medical condition (as defined in subparagraph (A)), has the meaning give 4 in section 1395dd(e)(3) of this title. (c) Access to pediatric care (1) Pediatric care In the case of a person who has a child who is a participant, beneficiary, or enrollee under a group health plan, or health insurance coverage offered by a health insurance issuer in the group or individual market, if the plan or issuer requires or provides for the designation of a participating primary care provider for the child, the plan or issuer shall permit such person to designate a physician (allopathic or osteopathic) who specializes in pediatrics as the child’s primary care provider if such provider participates in the network of t...

    24 other bills also change this section · Follow it → Official text at uscode.house.gov ↗

Quality, affordable health care for all americans · 42 U.S.C. ch. 157 1 section
  • § 18011 Preservation of right to maintain existing coverage Amends

    42 U.S.C. § 18011 — at 18011(a)(4)(A)

    The law today

    (a) No changes to existing coverage (1) In general Nothing in this Act (or an amendment made by this Act) shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on March 23, 2010. (2) Continuation of coverage Except as provided in paragraph (3), with respect to a group health plan or health insurance coverage in which an individual was enrolled on March 23, 2010, this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply to such plan or coverage, regardless of whether the individual renews such coverage after March 23, 2010. (3) Application of certain provisions The provisions of sections 2715 [42 U.S.C. 300gg–15] and 2718 [42 U.S.C. 300gg–18] of the Public Health Service Act (as added by subtitle A) shall apply to grandfathered health plans for plan years beginning on or after March 23, 2010. (4) Application of certain provisions (A) In general The following provisions of the Public Health Service Act [42 U.S.C. 201 et seq.] (as added by this title) 1 shall apply to grandfathered health plans for plan years beginning with the first plan year to which such provisions would otherwise apply: (i) Section 2708 [42 U.S.C. 300gg–7] (relating to excessive waiting periods). (ii) Those provisions of section 2711 [42 U.S.C. 300gg–11] relating to lifetime limits. (iii) Section 2712 [42 U.S.C. 300gg–12] (relating to rescissions). (iv) Section 2714 [42 U.S.C. 300gg–14] (relating to extension of dependent coverage). (B) Provisions applicable only to group health plans (i) Provisions described Those provisions of section 2711 [42 U.S.C. 300gg–11] relating to annual limits and the provisions of section 2704 [42 U.S.C. 300gg–3] (relating to pre-existing condition exclusions) of the Public Health Service Act (as added by this subtitle) shall apply to grandfathered health plans that are group health plans for plan years beginning with the first plan year to which such provisions otherwise apply. (ii) Adult child coverage For plan years beginning before January 1, 2014, the provisions of section 2714 of the Public Health Service Act [42 U.S.C. 300gg–14] (as added by this subtitle) shall apply in the case of an adult child with respect to a grandfathered health plan that is a group health plan only if such adult child is not eligible to enroll in an eligible employer-sponsored health plan (as defined in section 5000A(f)(2) of title 26) other than such grandfathered health plan. (5) Application of additional provisions Sections 300gg–111, 300gg–112, and 300gg–117 of this title shall apply to grandfathered health plans for plan years beginning on or after January 1, 2022. (b) Allowance for family members to join current coverage With respect to a group health plan or health insurance coverage in which an individual was enrolled on March 23, 2010, and which is renewed after such date, family members of such individual shall be permitted to enroll in such plan or coverage if such enrollment is permitted under the terms of the plan in effect as of March 23, 2010. (c) Allowance for new employees to join current plan A group health plan that provides coverage on March 23, 2010, may provide for the enrolling of new employees (and their families) in such plan, and this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply with respect to such plan and such new employees (and their families). (d) Effect on collective bargaining agreements In the case of health insurance coverage maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers that was ratified before March 23, 2010, the provisions of this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply until the date on which the last of the collective bargaining agreements relating to the coverage terminates. Any coverage amendment made pursuan...

    36 other bills also change this section · Follow it → Official text at uscode.house.gov ↗

How this bill changes current law

3 changes Share ↗

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill amends the Public Health Service Act to require parity in cost-sharing and treatment limitations between diagnostic and screening examinations for breast cancer.

  • 42 U.S.C. 300gg-19a

    ``(e) Diagnostic and Screening Examinations for Breast Cancer Parity.-- ... (1) In general.--In the case of a group health plan, or a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to a diagnostic examination for breast cancer furnished to an individual enrolled under such plan or such coverage, such plan or such coverage shall ensure that-- (A) the cost-sharing requirements applicable to such examination for such individual are no less favorable than such requirements applicable to a screening examination for breast cancer for such individual; and (B) the treatment limitations applicable to such diagnostic examination for breast cancer for such individual are no less favorable than such limitations applicable to a screening examinations for breast cancer for such individual. ``

    This addition mandates that group health plans and insurers provide the same cost-sharing and treatment limitations for diagnostic breast cancer examinations as they do for screening examinations.

  • 42 U.S.C. 18011(a)(4)(A)

    ``title'' → ``title, or as added after the date of the enactment of this Act)''

    This change clarifies the reference to titles for grandfathered health plans, ensuring it includes subsequent amendments.

  • 42 U.S.C. 18011(a)(4)(A)

    ``(v) Section 2719A(e) (relating to parity for diagnostic and screening examinations for breast cancer).''

    This addition incorporates the new parity requirement for diagnostic and screening examinations for breast cancer as applicable provisions for grandfathered health plans.

Action History

  1. Referred to the Subcommittee on Health.

  2. Introduced in House

  3. Introduced in House

  4. Referred to the House Committee on Energy and Commerce.

Sponsors

Sponsorship breakdown

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1 sponsors · 36 co-sponsors · 510 not signed on

Sponsors (1)

Co-sponsors (36)

Not signed on (510)

510 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
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Frequently asked questions

What does HR 2428 do?
Access to Breast Cancer Diagnosis Act of 2019 This bill prohibits private health insurance plans from imposing higher cost-sharing requirements on breast cancer diagnostic examinations than initial breast cancer screening examinations. Diagnostic examinations are generally required after an initial screening detects an abnormality and typically require additional mammogram images (e.g., x-rays).
Who sponsors HR 2428?
HR 2428 is sponsored by King, Peter T. (Republican), Wasserman Schultz, Debbie (Democratic), Fitzpatrick, Brian K. (Republican), Allred, Colin Z. (Democratic), McMorris Rodgers, Cathy (Republican), Castro, Joaquin (Democratic), Norton, Eleanor Holmes (Democratic), Wild, Susan (Democratic), Clarke, Yvette D. (Democratic), Jackson Lee, Sheila (Democratic), Kim, Andy (Democratic), Kuster, Ann M. (Democratic), Green, Al (Democratic), Porter, Katie (Democratic), Cartwright, Matt (Democratic), Blunt Rochester, Lisa (Democratic), Davis, Susan A. (Democratic), Himes, James A. (Democratic), Cohen, Steve (Democratic), Tipton, Scott R. (Republican), Trone, David J. (Democratic), Axne, Cynthia (Democratic), Evans, Dwight (Democratic), Chu, Judy (Democratic), Levin, Andy (Democratic), Barragán, Nanette Diaz (Democratic), Frankel, Lois (Democratic), Cole, Tom (Republican), Van Drew, Jefferson (Republican), Rouda, Harley (Democratic), Johnson, Eddie Bernice (Democratic), Underwood, Lauren (Democratic), Houlahan, Chrissy (Democratic), Doggett, Lloyd (Democratic), Lucas, Frank D. (Republican), Napolitano, Grace F. (Democratic), and Dingell, Debbie (Democratic).
What is the current status of HR 2428?
This bill died with 116th Congress. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track HR 2428?
Track HR 2428 free on One Click Politics — get push/email alerts when it moves.

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