OLR Bill Analysis
SB 422 (as amended by Senate “A”)*
AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR BREAST CANCER SCREENING.
This bill changes when health insurance policies must provide coverage for a comprehensive ultrasound screening of an entire breast or breasts for a woman. Under current law, a policy must provide coverage if a physician recommends the screening for a woman classified as category 2, 3, 4, or 5 on the American College of Radiology's Breast Imaging Reporting and Database System (BI-RADS) mammogram reading scale. The bill instead requires coverage if (1) a mammogram shows heterogeneous or dense breast tissue based on BI-RADS or (2) a woman is considered at an increased breast cancer risk because of family history, her own prior breast cancer history, positive genetic testing, or other indications determined by her physician or advanced-practice registered nurse. As under current law, coverage is subject to any policy provisions applicable to other covered services.
The bill applies to individual and group health insurance policies that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; and (4) hospital or medical services, including those provided by HMOs. The bill also applies to individual policies that cover (1) accidents only and (2) limited benefits.
*Senate Amendment “A” allows an advanced-practice registered nurse to determine if a woman is at an increased risk of breast cancer.
EFFECTIVE DATE: October 1, 2006
BACKGROUND
BI-RADS Categories
The American College of Radiology collaborated with the National Cancer Institute, the Centers for Disease Control and Prevention, the American Medical Association, and others to develop BI-RADS, which is used to standardize mammography reporting. There are two BI-RADS scales: (1) one characterizes breast density and (2) the other characterizes a radiologist's reading of what he sees on a mammogram.
Density. The BI-RADs scale shown in Table 1 categorizes breast density.
TABLE 1
Category |
Breast Density |
1 |
Having no areas of tissue that could obscure cancer |
2 |
Having at least one area of tissue that could obscure cancer |
3 |
Having tissue that can obscure cancer in 50% to 75% of the breast |
4 |
Having tissue that can obscure cancer in greater than 75% of the breast |
Mammogram Reading. The BI-RADS scale shown in Table 2 categorizes specific findings and recommendations based on what a radiologist sees on a mammogram.
TABLE 2
Category |
Finding and Recommendation |
0 |
Need additional imaging evaluation |
1 |
Negative – continue annual mammogram screening |
2 |
Benign (non-cancerous) – continue with annual mammogram screening |
3 |
Probably benign – six-month follow-up mammogram |
4 |
Suspicious abnormality – biopsy should be considered |
5 |
Highly suggestive of malignancy – appropriate action should be taken (e. g. , biopsy) |
Related Law
Health insurance policies must provide coverage for mammograms at least equal to the following: one initial examination for women ages 35 to 39 and one examination every year for women age 40 and older. Coverage is subject to any policy provisions applicable to other covered services.
COMMITTEE ACTION
Insurance and Real Estate Committee
Joint Favorable
Yea |
15 |
Nay |
0 |
(03/09/2006) |
Planning and Development Committee
Joint Favorable
Yea |
15 |
Nay |
0 |
(04/11/2006) |