WeVote
Log In

Bill

Bill

HB 560

An Act amending the act of December 17, 1959 (P.L.1913, No.694), known as the Equal Pay Law, providing for pay ranges.

2025-2026 Regular Session Introduced by Johanny Cepeda-Freytiz and 12 co-sponsors

Requires health plans to have cost-sharing for diagnostic or supplemental breast imaging no less favorable than for screening mammography.

Referred to Labor & Industry
0
WeVote Research Nonpartisan
Bill Summary · HB 560

Summary — HB 560: Diagnostic Imaging Parity

Status: Reported Favorably (Reptd Fav)
Title: Diagnostic Imaging Parity
Primary subject areas: Breast cancer screening and diagnostic imaging; health insurance coverage; public health; women’s health

Note: HB 560 text provided corresponds to the Diagnostic Imaging Parity bill as enacted in North Carolina (recodifies and consolidates prior law). This summary covers the bill’s purpose, primary provisions, who is affected, and timing.

Main purpose

Require health benefit plans to provide parity in coverage and cost‑sharing between screening mammography and medically necessary diagnostic or supplemental breast imaging (e.g., diagnostic mammography, breast MRI, breast ultrasound). The goal is to ensure patients undergoing follow‑up or higher‑level imaging after an abnormal screening (or because of clinical risk factors or dense breast tissue) face no less favorable cost‑sharing than for routine screening.

Key provisions and changes

  • Definitions established for terms including:
    • Breast magnetic resonance imaging (breast MRI)
    • Breast ultrasound
    • Low‑dose (screening) mammography
    • Diagnostic examination for breast cancer
    • Screening and supplemental examinations
    • Cost‑sharing requirement (deductible, coinsurance, copayment, etc.)
  • Cost‑sharing parity:
    • Any insurer plan that covers diagnostic or supplemental breast imaging must apply cost‑sharing that is no less favorable than the cost‑sharing for screening mammography.
  • Screening mammography coverage schedule (minimums):
    • Baseline mammogram for ages 35–39.
    • Mammogram every other year for ages 40–49 (or more frequently if physician recommends).
    • Annual mammogram for age 50 and older.
    • One or more mammograms per year as recommended by a physician for individuals at increased risk (personal history of breast cancer, biopsy‑proven benign breast disease, a first‑degree relative with breast cancer, or not having given birth before age 30).
  • Diagnostic and supplemental imaging:
    • Coverage must include medically necessary diagnostic low‑dose mammography, breast MRI, and breast ultrasound when determined necessary by the treating provider (e.g., follow‑up to abnormal screening, detected abnormality, high risk, or dense breast tissue).
  • Provider/facility standards:
    • Reimbursement for mammography requires the facility to meet mammography accreditation standards established by the North Carolina Medical Care Commission.
    • Laboratory reimbursements for cervical cancer screening require labs to meet Medical Care Commission accreditation standards.
  • Cervical cancer screening:
    • The act reaffirms coverage for cervical cancer screening (Pap, liquid‑based cytology, HPV testing) consistent with FDA‑approved methods and national/State guidelines (American Cancer Society or NC Advisory Committee).
  • Statutory housekeeping:
    • Recodifies G.S. 58‑51‑57 as G.S. 58‑3‑271 and repeals certain outdated sections (G.S. 58‑65‑92 and G.S. 58‑67‑76).
    • Requires State Health Plan compliance (G.S. 135‑48.51 updated to reference the new section).

Who is affected

  • Health insurers and issuers of health benefit plans in the state that offer mammography and breast imaging services.
  • Covered individuals (policyholders and enrollees), including those undergoing diagnostic follow‑up after abnormal screening, individuals at increased breast cancer risk, and people with dense breast tissue.
  • State Health Plan (explicitly required to follow the law).
  • Accredited imaging facilities and laboratories (reimbursement conditioned on accreditation).

Implementation / effective date

  • The bill becomes effective October 1, 2023 and applies to insurance contracts issued, renewed, or amended on or after that date (per the bill language).

Potential impacts

  • For patients: reduced financial barriers for diagnostic and supplemental breast imaging—fewer out‑of‑pocket disparities between screening and follow‑up diagnostic procedures.
  • For insurers: potential increase in utilization of diagnostic imaging and adjustments to plan cost‑sharing structures to maintain parity; administrative updates to coverage policies.
  • For providers/facilities: must maintain required accreditation to ensure reimbursement; potential increase in diagnostic imaging volume.

Additional notes

  • The bill ties parity specifically to cost‑sharing (not necessarily mandating coverage of every specific service); it requires parity where diagnostic/supplemental imaging is already covered.
  • The statute cross‑references existing screening guidelines and accreditation requirements to define quality and reimbursement conditions.

If you want, I can:
- Extract and display the specific statutory text changes (recodified language).
- Provide a short explainer aimed at patients outlining how the law affects out‑of‑pocket costs in typical follow‑up scenarios.

Compiled from official sources — confirm details with the bill’s official record.

Sign in to ask a question.