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Bill Summary · HB 297

HB 297 — Breast Cancer Prevention Imaging Parity

Status: Passed 2nd Reading (in 2025); introduced in 2025
Subjects: Cancer; Diseases & Health Disorders; Health Services; Insurance; Public Health

Purpose / Intent

HB 297 is designed to ensure parity in health insurance coverage and patient cost-sharing for supplemental and diagnostic breast imaging (e.g., breast MRI and ultrasound) so that patients do not face higher out‑of‑pocket costs for medically necessary or risk‑based imaging than they do for routine screening mammography. The bill also reaffirms coverage for cervical cancer screening consistent with major clinical guidance.

Key provisions

  • Definitions: Clarifies terms used in the statute, including:
    • “Low‑dose mammography” (screening mammography),
    • “Diagnostic examination” (imaging determined by a treating provider to be medically necessary to evaluate an abnormality), and
    • “Supplemental examination” (imaging used to screen when no abnormality is seen but the patient meets high‑risk criteria).
  • Cost‑sharing parity: Requires that for any health benefit plan that covers diagnostic or supplemental breast imaging, the cost‑sharing (deductible, coinsurance, copayments, and related limits) for those diagnostic/supplemental services must be no less favorable than the cost‑sharing that applies to routine low‑dose screening mammography.
  • Covered services: Specifies that covered modalities include diagnostic and screening mammography, breast ultrasound, and breast MRI.
  • Frequency and eligibility for screening mammography:
    • Baseline mammogram for individuals aged 35–39 (one baseline),
    • Every other year for ages 40–49 (or more often if physician recommends),
    • Annually for age 50 and older,
    • One or more mammograms per year for individuals at increased risk (criteria listed).
  • Supplemental imaging eligibility: Covers supplemental screening MRI/ultrasound for individuals at increased risk based on personal or family history or per current USPSTF recommendations.
  • Diagnostic imaging: Coverage when an abnormality is seen/suspected on screening or detected by other means; coverage only when determined medically necessary by treating provider.
  • Provider reimbursement limitation: Insurers are not required to reimburse non‑contracted providers at rates higher than those paid to contracted network providers for the listed breast imaging services.
  • Accreditation requirements: Reimbursement for mammography and relevant laboratory tests is limited to facilities/labs that meet state accreditation standards.
  • Cervical cancer screening: Maintains coverage aligned to American Cancer Society/ACOG or state guidance (exam, lab fee, physician interpretation).
  • HSA safeguard: If applying a provision would make the insured ineligible for a tax‑preferred health savings account (IRC §223), that provision applies only to the extent it does not cause ineligibility.

Who is affected

  • Individuals and families with health insurance in the state — especially those at higher risk for breast cancer or who have abnormal screening results.
  • Health insurers and health benefit plans that issue coverage in the state (policy and plan adjustments may be required).
  • Radiology and breast imaging providers, hospitals, and accredited laboratories (accreditation and billing practices reinforced).
  • Treating clinicians who determine medical necessity for diagnostic/supplemental imaging.

Fiscal and procedural notes

  • The bill revises and recodifies existing provisions of state insurance law related to mammography and screening.
  • Procedural status (as provided): Passed second reading and moved forward in the legislative process in 2025; further committee and floor action may follow depending on chamber rules and scheduling.
  • Implementation will require insurers and providers to align plan terms, prior‑authorization and billing practices, and to ensure accreditation compliance.

If you want, I can:
- Draft a one‑page one‑sentence summary suitable for a briefing memo.
- Compare this bill to your state’s current law (to identify specific changes).
- List likely operational impacts for insurers and providers (prior auth, forms, coding, patient notices).

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

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