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HB 137 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to coverage for mammograms and 2
supplemental breast cancer screenings; creating s. 3
409.9064, F.S.; providing definitions; requiring the 4
Agency for Health Care Administration to provide 5
coverage for yearly mammograms and yearly supplemental 6
breast cancer screenings for certain women under the 7
Medicaid program under certain circumstances; 8
requiring the agency to seek federal approval under a 9
specified circumstance; amending ss. 627.6418, 10
627.6613, and 641.31095, F.S.; defining the term 11
"supplemental breast cancer screening"; revising 12
coverages for mammograms under certain individual 13
accident and health insurance policies, group, 14
blanket, and franchise accident and health insurance 15
policies, and health maintenance contracts, 16
respectively; requiring coverages for supplemental 17
breast cancer screenings under such policies and 18
contracts under certain circumstances; providing 19
applicability; providing an effective date. 20
21
Be It Enacted by the Legislature of the State of Florida: 22
23
Section 1. Section 409.9064, Florida Statutes, is created 24
to read: 25
HB 137 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
409.9064 Coverage for mammograms and supplemental breast 26
cancer screenings.— 27
(1) As used in this section, the term: 28
(a) "Mammogram" means an image of a radiologic examination 29
used to detect unsuspected breast cancer at an early stage in an 30
asymptomatic woman and includes the X-ray picture of the breast 31
using equipment that is dedicated specifically for mammography, 32
including, but not limited to, the X-ray tube, filter, 33
compression device, screens, film, and cassettes. The radiologic 34
examination must include two views of each breast. The term also 35
includes images from digital breast tomosynthesis and the 36
professional interpretation of images from any mammography 37
equipment, but does not include any diagnostic mammography 38
image. 39
(b) "Supplemental breast cancer screening" means a 40
clinically appropriate examination, in addition to a mammogram, 41
deemed medically necessary by a treating health care provider 42
for breast cancer screening in accordance with applicable 43
American College of Radiology guidelines, including, but not 44
limited to, magnetic resonance imaging, ultrasound, and 45
molecular breast imaging. 46
(2) Subject to the availability of funds and subject to 47
any limitations or directions provided in the General 48
Appropriations Act, the agency must provide the following 49
coverage each year for a Medicaid recipient who is a woman 50
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
between 25 and 40 years of age, inclusive: 51
(a) One mammogram to detect the presence of breast cancer. 52
(b) One supplemental breast cancer screening to detect the 53
presence of breast cancer if: 54
1. The woman's mammogram demonstrates, based on the breast 55
imaging reporting and data system established by the American 56
College of Radiology, that the woman has dense breast tissue; or 57
2. The woman is at an increased risk of breast cancer due 58
to: 59
a. A personal or family history of breast cancer; 60
b. A personal history of biopsy-proven benign breast 61
disease; 62
c. Ancestry; 63
d. Genetic predisposition; 64
e. Not having given birth before the age of 30; or 65
f. Other reasons as determined by the woman's physician. 66
(3) The agency shall seek federal approval, if needed, for 67
the implementation of this section. 68
Section 2. Section 627.6418, Florida Statutes, is amended, 69
to read: 70
627.6418 Coverage for mammograms and supplemental breast 71
cancer screenings.— 72
(1) As used in this section, the term "supplemental breast 73
cancer screening" means a clinically appropriate examination, in 74
addition to a mammogram, deemed medically necessary by a 75
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
treating physician for breast cancer screening in accordance 76
with applicable American College of Radiology guidelines, 77
including, but not limited to, magnetic resonance imaging, 78
ultrasound, and molecular breast imaging. 79
(2)(1) An accident or health insurance policy issued, 80
amended, delivered, or renewed in this state on or after July 1, 81
2026, must provide coverage for at least the following for any 82
woman between 25 and 40 years of age, inclusive: 83
(a) One A baseline mammogram each year, including a 84
digital breast tomosynthesis for any woman who is 35 years of 85
age or older, but younger than 40 years of age. 86
(b) A mammogram every 2 years for any woman who is 40 87
years of age or older, but younger than 50 years of age, or more 88
frequently based on the patient's physician's recommendation. 89
(c) A mammogram every year for any woman who is 50 years 90
of age or older. 91
(b)(d) One supplemental breast cancer screening each or 92
more mammograms a year, based upon a physician's recommendation, 93
if the for any woman who is at risk for breast cancer because of 94
dense breast tissue as the woman's mammogram demonstrates, based 95
on the breast imaging reporting and data system established by 96
the American College of Radiology; because of a personal or 97
family history of breast cancer;, because of having a personal 98
history of biopsy-proven benign breast disease; because of 99
ancestry; because of genetic predisposition;, because of having 100
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a mother, sister, or daughter who has or has had breast cancer, 101
or because the a woman has not given birth before the age of 30; 102
or because of other reasons as determined by the woman's 103
physician. 104
(3)(2) Except as provided in paragraph (1)(b), for 105
mammograms done more frequently than every 2 years for women 40 106
years of age or older but younger than 50 years of age, The 107
coverage required by subsection (2) (1) applies, with or without 108
a physician prescription, if the insured obtains a mammogram or, 109
if applicable, a supplemental breast cancer screening in an 110
office, facility, or health testing service that uses 111
radiological equipment registered with the Department of Health 112
for breast cancer screening. The coverage is subject to the 113
deductible and coinsurance provisions applicable to outpatient 114
visits, and is also subject to all other terms and conditions 115
applicable to other benefits. This section does not affect any 116
requirements or prohibitions relating to who may perform, 117
analyze, or interpret a mammogram or the persons to whom the 118
results of a mammogram may be furnished or released. 119
(4)(3) This section does not apply to disability income, 120
specified disease, or hospital indemnity policies. 121
(5)(4) Every insurer subject to the requirements of this 122
section shall make available to the policyholder as part of the 123
application, for an appropriate additional premium, the coverage 124
required in this section without such coverage being subject to 125
HB 137 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
the deductible or coinsurance provisions of the policy. 126
Section 3. Section 627.6613, Florida Statutes, is amended 127
to read: 128
627.6613 Coverage for mammograms and supplemental breast 129
cancer screenings.— 130
(1) As used in this section, the term "supplemental breast 131
cancer screening" means a clinically appropriate examination, in 132
addition to a mammogram, deemed medically necessary by a 133
treating physician for breast cancer screening in accordance 134
with applicable American College of Radiology guidelines, 135
including, but not limited to, magnetic resonance imaging, 136
ultrasound, and molecular breast imaging. 137
(2)(1) A group, blanket, or franchise accident or health 138
insurance policy issued, amended, delivered, or renewed in this 139
state on or after July 1, 2026, must provide coverage for at 140
least the following for any woman between 25 and 40 years of 141
age, inclusive: 142
(a) One A baseline mammogram each year, including a 143
digital breast tomosynthesis for any woman who is 35 years of 144
age or older, but younger than 40 years of age. 145
(b) A mammogram every 2 years for any woman who is 40 146
years of age or older, but younger than 50 years of age, or more 147
frequently based on the patient's physician's recommendation. 148
(c) A mammogram every year for any woman who is 50 years 149
of age or older. 150
HB 137 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
(b)(d) One supplemental breast cancer screening each or 151
more mammograms a year, based upon a physician's recommendation, 152
if the for any woman who is at risk for breast cancer because of 153
dense breast tissue as the woman's mammogram demonstrates, based 154
on the breast imaging reporting and data system established by 155
the American College of Radiology; because of a personal or 156
family history of breast cancer;, because of having a personal 157
history of biopsy-proven benign breast disease; because of 158
ancestry; because of genetic predisposition;, because of having 159
a mother, sister, or daughter who has or has had breast cancer, 160
or because the a woman has not given birth before the age of 30; 161
or because of other reasons as determined by the woman's 162
physician. 163
(3)(2) Except as provided in paragraph (1)(b), for 164
mammograms done more frequently than every 2 years for women 40 165
years of age or older but younger than 50 years of age, The 166
coverage required by subsection (2) (1) applies, with or without 167
a physician prescription, if the insured obtains a mammogram or, 168
if applicable, a supplemental breast cancer screening in an 169
office, facility, or health testing service that uses 170
radiological equipment registered with the Department of Health 171
for breast cancer screening. The coverage is subject to the 172
deductible and coinsurance provisions applicable to outpatient 173
visits, and is also subject to all other terms and conditions 174
applicable to other benefits. This section does not affect any 175
HB 137 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
requirements or prohibitions relating to who may perform, 176
analyze, or interpret a mammogram or the persons to whom the 177
results of a mammogram may be furnished or released. 178
(4)(3) Every insurer referred to in subsection (2) (1) 179
shall make available to the policyholder as part of the 180
application, for an appropriate additional premium, the coverage 181
required in this section without such coverage being subject to 182
the deductible or coinsurance provisions of the policy. 183
Section 4. Section 641.31095, Florida Statutes, is amended 184
to read: 185
641.31095 Coverage for mammograms and supplemental breast 186
cancer screenings.— 187
(1) As used in this section, the term "supplemental breast 188
cancer screening" means a clinically appropriate examination, in 189
addition to a mammogram, deemed medically necessary by a 190
treating physician for breast cancer screening in accordance 191
with applicable American College of Radiology guidelines, 192
including, but not limited to, magnetic resonance imaging, 193
ultrasound, and molecular breast imaging. 194
(2)(1) Every health maintenance contract issued or renewed 195
on or after July 1, 2026, must January 1, 1996, shall provide 196
coverage for at least the following for any woman between 25 and 197
40 years of age, inclusive: 198
(a) One A baseline mammogram each year, including a 199
digital breast tomosynthesis for any woman who is 35 years of 200
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age or older, but younger than 40 years of age. 201
(b) A mammogram every 2 years for any woman who is 40 202
years of age or older, but younger than 50 years of age, or more 203
frequently based on the patient's physician's recommendations. 204
(c) A mammogram every year for any woman who is 50 years 205
of age or older. 206
(b)(d) One supplemental breast cancer screening each or 207
more mammograms a year, based upon a physician's recommendation, 208
if the for any woman who is at risk for breast cancer because of 209
dense breast tissue as the woman's mammogram demonstrates, based 210
on the breast imaging reporting and data system established by 211
the American College of Radiology; because of a personal or 212
family history of breast cancer;, because of having a personal 213
history of biopsy-proven benign breast disease; because of 214
ancestry; because of genetic predisposition;, because of having 215
a mother, sister, or daughter who has had breast cancer, or 216
because the a woman has not given birth before the age of 30; or 217
because of other reasons as determined by the woman's physician. 218
(3)(2) The coverage required by this section is subject to 219
the deductible and copayment provisions applicable to outpatient 220
visits, and is also subject to all other terms and conditions 221
applicable to other benefits. A health maintenance organization 222
shall make available to the subscriber as part of the 223
application, for an appropriate additional premium, the coverage 224
required in this section without such coverage being subject to 225
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any deductible or copayment provisions in the contract. 226
Section 5. This act shall take effect July 1, 2026. 227