OLR Bill Analysis

sSB 458

AN ACT REQUIRING COMMUNICATION OF MAMMOGRAPHIC BREAST DENSITY INFORMATION TO PATIENTS.

SUMMARY:

This bill requires all mammography reports (i. e. , written results of a mammogram) given to a patient on and after October 1, 2009 to include information about breast density based on the American College of Radiology's Breast Imaging Reporting and Data System (BIRADS). When applicable, the report must 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.

EFFECTIVE DATE: October 1, 2009

BACKGROUND

Federal Requirements for Mammography Report

The federal Mammography Quality Standards Act requires a mammography facility to provide a mammogram report containing the imaging results to the patient and patient's health care provider within 30 days of the exam. The physician's report is clinical in nature, but the patient's report must be in plain, easy-to-understand language. If the result is “suspicious” or “highly suggestive of malignancy,” the facility must make reasonable attempts to communicate with the patient and health care provider as soon as possible (42 USC 263b(f)(1)(G)(ii) and 21 CFR 900. 12(c)(2),(3)).

BIRADS

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 BIRADS, which is used to standardize mammography reporting. There are two BIRADS scales: one characterizes breast density and the other characterizes a radiologist's reading of what he or she sees on a mammogram. The breast density scale ranges from 1 (no areas with tissue that could obscure cancer) to 4 (tissue that can obscure cancer in more than 75% of the breast).

Related Law Mandating Insurance Coverage

By law, individual and group health insurance policies must provide coverage for at least (1) one baseline mammogram for a woman age 35 through age 39 and (2) one annual mammogram for a woman age 40 or older.

The policies also must cover a comprehensive ultrasound screening of an entire breast or breasts if (1) a mammogram shows heterogeneous or dense breast tissue based on BIRADS or (2) a woman is considered at an increased breast cancer risk because of family history, her prior breast cancer history, positive genetic testing, or other indications her physician or advanced practice registered nurse determines.

The law specifies that the required mammogram and ultrasound benefits are subject to policy provisions applicable to other covered services.

Applicability of State Insurance Benefit Laws

Due to federal law (ERISA), state insurance benefit mandates do not apply to self-insured benefit plans.

COMMITTEE ACTION

Insurance and Real Estate Committee

Joint Favorable Substitute

Yea

19

Nay

0

(02/10/2009)