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A1945
ASSEMBLY, No. 1945
STATE OF NEW JERSEY
222nd LEGISLATURE
�
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Assemblywoman ANNETTE QUIJANO
District 20 (Union)
Co-Sponsored by:
Assemblywoman Haider
SYNOPSIS
���� Requires health care professionals to order
bi-lateral ultrasounds concurrently when ordering mammograms; requires insurers
to cover concurrent mammograms and bi-lateral ultrasounds.
CURRENT VERSION OF TEXT
���� Introduced Pending Technical Review by Legislative
Counsel.
��
An Act
concerning mammograms and other diagnostic
testing for breast cancer, amending P.L.1991, c.279 and P.L.2004, c.86, and
supplementing Title 26 of the Revised Statues.
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� Section 1 of P.L.1991,
c.279 (C.17:48-6g) is amended to read as follows:
���� 1.��� a. �No group or
individual hospital service corporation contract providing hospital or medical
expense benefits shall be delivered, issued, executed, or renewed in this State
or approved for issuance or renewal in this State by the Commissioner of
Banking and Insurance, on or after the effective date of this act, unless the
contract provides benefits to any subscriber or other person covered thereunder
for expenses incurred in conducting:
���� (1)� one baseline mammogram
examination for women who are 40 years of age; a mammogram examination every
year for women age 40 and over; and, in the case of a woman who is under 40
years of age and has a family history of breast cancer or other breast cancer risk
factors, a mammogram examination at such age and intervals as deemed medically
necessary by the woman's health care provider;
[
and
]
���� (2)� an ultrasound evaluation,
a magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination, if the mammogram demonstrates extremely dense breast tissue, if
the mammogram is abnormal within any degree of breast density including not
dense, moderately dense, heterogeneously dense, or extremely dense breast
tissue, or if the patient has additional risk factors for breast cancer
including but not limited to family history of breast cancer, prior personal
history of breast cancer, positive genetic testing, extremely dense breast
tissue based on the Breast Imaging Reporting and Data System established by the
American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the hospital
service corporation of the medical necessity of the additional screening and diagnostic
testing
; and
����
(3)� an ultrasound
evaluation, a magnetic resonance imaging scan, a three-dimensional mammography,
or other additional testing of an entire breast or breasts concurrently ordered
with a mammogram examination by a health care provider pursuant to section 10
of P.L. , c.��� (C.�������� ) (pending before the
Legislature as this bill)
.
���� b.��� These benefits shall be
provided to the same extent as for any other sickness under the contract.
���� c.��� The provisions of this
section shall apply to all contracts in which the hospital service corporation
has reserved the right to change the premium.
(cf: P.L.2013, c.196, s.1)
���� 2.��� Section 2 of P.L.1991,
c.279 (C.17:48A-7f) is amended to read as follows:.
���� 2.��� a. �No group or
individual medical service corporation contract providing hospital or medical
expense benefits shall be delivered, issued, executed, or renewed in this State
or approved for issuance or renewal in this State by the Commissioner of
Banking and Insurance, on or after the effective date of this act, unless the
contract provides benefits to any subscriber or other person covered thereunder
for expenses incurred in conducting:
���� (1)� one baseline mammogram
examination for women who are 40 years of age; a mammogram examination every
year for women age 40 and over; and, in the case of a woman who is under 40
years of age and has a family history of breast cancer or other breast cancer risk
factors, a mammogram examination at such age and intervals as deemed medically
necessary by the woman's health care provider;
[
and
]
���� (2)� an ultrasound evaluation,
a magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination, if the mammogram demonstrates extremely dense breast tissue, if
the mammogram is abnormal within any degree of breast density including not
dense, moderately dense, heterogeneously dense, or extremely dense breast
tissue, or if the patient has additional risk factors for breast cancer
including but not limited to family history of breast cancer, prior personal
history of breast cancer, positive genetic testing, extremely dense breast
tissue based on the Breast Imaging Reporting and Data System established by the
American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the medical
service corporation of the medical necessity of the additional screening and diagnostic
testing
; and
����
(3)� an ultrasound
evaluation, a magnetic resonance imaging scan, a three-dimensional mammography,
or other additional testing of an entire breast or breasts conducted pursuant
to paragraph concurrently ordered with a mammogram examination by a health care
provider pursuant to section 10 of P.L.���� , c.��� (C.�������� ) (pending
before the Legislature as this bill)
.
���� b.��� These benefits shall be
provided to the same extent as for any other sickness under the contract.
���� c.��� The provisions of this
section shall apply to all contracts in which the medical service corporation
has reserved the right to change the premium.
(cf: P.L.2013, c.196, s.2)
���� 3.��� Section 3 of P.L.1991,
c.279 (C.17:48E-35.4) is amended to read as follows:
���� 3.��� a. �No group or
individual health service corporation contract providing hospital or medical
expense benefits shall be delivered, issued, executed, or renewed in this State
or approved for issuance or renewal in this State by the Commissioner of
Banking and Insurance, on or after the effective date of this act, unless the
contract provides benefits to any subscriber or other person covered thereunder
for expenses incurred in conducting:
���� (1)� one baseline mammogram
examination for women who are 40 years of age; a mammogram examination every
year for women age 40 and over; and, in the case of a woman who is under 40
years of age and has a family history of breast cancer or other breast cancer risk
factors, a mammogram examination at such age and intervals as deemed medically
necessary by the woman's health care provider;
[
and
]
���� (2)� an ultrasound evaluation,
a magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination, if the mammogram demonstrates extremely dense breast tissue, if
the mammogram is abnormal within any degree of breast density including not
dense, moderately dense, heterogeneously dense, or extremely dense breast
tissue, or if the patient has additional risk factors for breast cancer
including but not limited to family history of breast cancer, prior personal
history of breast cancer, positive genetic testing, extremely dense breast
tissue based on the Breast Imaging Reporting and Data System established by the
American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the health
service corporation of the medical necessity of the additional screening and
diagnostic testing
; and
����
(3)� an ultrasound
evaluation, a magnetic resonance imaging scan, a three-dimensional mammography,
or other additional testing of an entire breast or breasts concurrently ordered
with a mammogram examination by a health care provider pursuant to section 10
of P.L. , c.��� (C.�������� ) (pending before the
Legislature as this bill)
.
���� b.� These benefits shall be
provided to the same extent as for any other sickness under the contract.
���� c.� The provisions of this
section shall apply to all contracts in which the health service corporation
has reserved the right to change the premium.
(cf: P.L.2013, c.196, s.3)
���� 4.��� Section 4 of P.L.1991,
c.279, s.4 (C.17B:26-2.1) is amended to read as follows:
���� 4.��� a. �No individual health
insurance policy providing hospital or medical expense benefits shall be
delivered, issued, executed, or renewed in this State or approved for issuance
or renewal in this State by the Commissioner of Banking and Insurance, on or
after the effective date of this act, unless the policy provides benefits to
any named insured or other person covered thereunder for expenses incurred in
conducting:
���� (1)� one baseline mammogram
examination for women who are 40 years of age; a mammogram examination every
year for women age 40 and over; and, in the case of a woman who is under 40
years of age and has a family history of breast cancer or other breast cancer risk
factors, a mammogram examination at such age and intervals as deemed medically
necessary by the woman's health care provider;
[
and
]
���� (2)� an ultrasound evaluation,
a magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination, if the mammogram demonstrates extremely dense breast tissue, if
the mammogram is abnormal within any degree of breast density including not
dense, moderately dense, heterogeneously dense, or extremely dense breast
tissue, or if the patient has additional risk factors for breast cancer
including but not limited to family history of breast cancer, prior personal
history of breast cancer, positive genetic testing, extremely dense breast
tissue based on the Breast Imaging Reporting and Data System established by the
American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the insurer of
the medical necessity of the additional screening and diagnostic testing
;
and
����
(3)� an ultrasound
evaluation, a magnetic resonance imaging scan, a three-dimensional mammography,
or other additional testing of an entire breast or breasts concurrently ordered
with a mammogram examination by a health care provider pursuant to section 10
of P.L. , c.��� (C.�������� ) (pending before the
Legislature as this bill)
.
���� b.��� These benefits shall be
provided to the same extent as for any other sickness under the policy.�
���� c.� The provisions of this
section shall apply to all policies in which the insurer has reserved the right
to change the premium.
(cf: P.L.2013, c.196, s.4)
���� 5.��� Section 5 of P.L.1991,
c.279 (C.17B:27-46.1f) is amended to read as follows:.
���� 5. �a. �No group health
insurance policy providing hospital or medical expense benefits shall be
delivered, issued, executed, or renewed in this State or approved for issuance
or renewal in this State by the Commissioner of Banking and Insurance, on or
after the effective date of this act, unless the policy provides benefits to
any named insured or other person covered thereunder for expenses incurred in
conducting:
���� (1) one baseline mammogram
examination for women who are 40 years of age; a mammogram examination every
year for women age 40 and over; and, in the case of a woman who is under 40
years of age and has a family history of breast cancer or other breast cancer risk
factors, a mammogram examination at such age and intervals as deemed medically
necessary by the woman's health care provider;
[
and
]
���� (2) an ultrasound evaluation,
a magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination, if the mammogram demonstrates extremely dense breast tissue, if
the mammogram is abnormal within any degree of breast density including not
dense, moderately dense, heterogeneously dense, or extremely dense breast
tissue, or if the patient has additional risk factors for breast cancer
including but not limited to family history of breast cancer, prior personal
history of breast cancer, positive genetic testing, extremely dense breast
tissue based on the Breast Imaging Reporting and Data System established by the
American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the insurer of
the medical necessity of the additional screening and diagnostic testing
;
and
����
(3) an ultrasound
evaluation, a magnetic resonance imaging scan, a three-dimensional mammography,
or other additional testing of an entire breast or breasts concurrently ordered
with a mammogram examination by a health care provider pursuant to section 10
of P.L. , c.��� (C.�������� ) (pending before the
Legislature as this bill)
.
���� b.� These benefits shall be
provided to the same extent as for any other sickness under the policy.
���� c.� The provisions of this
section shall apply to all policies in which the insurer has reserved the right
to change the premium.
(cf: P.L.2013, c.196, s.5)
���� 6.��� Section 7 of P.L.2004,
c.86 (C.17B:27A-7.10) is amended to read as follow:
���� 7.��� a. �Every individual
health benefits plan that is delivered, issued, executed, or renewed in this
State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) or approved for
issuance or renewal in this State, on or after the effective date of this act,
shall provide benefits to any person covered thereunder for expenses incurred
in conducting:
���� (1)� one baseline mammogram
examination for women who are 40 years of age; a mammogram examination every
year for women age 40 and over; and, in the case of a woman who is under 40
years of age and has a family history of breast cancer or other breast cancer risk
factors, a mammogram examination at such age and intervals as deemed medically
necessary by the woman's health care provider;
[
and
]
���� (2)� an ultrasound evaluation,
a magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination, if the mammogram demonstrates extremely dense breast tissue, if
the mammogram is abnormal within any degree of breast density including not
dense, moderately dense, heterogeneously dense, or extremely dense breast
tissue, or if the patient has additional risk factors for breast cancer
including but not limited to family history of breast cancer, prior personal
history of breast cancer, positive genetic testing, extremely dense breast
tissue based on the Breast Imaging Reporting and Data System established by the
American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the carrier of
the medical necessity of the additional screening and diagnostic testing
;
and
.
����
(3) an ultrasound
evaluation, a magnetic resonance imaging scan, a three-dimensional mammography,
or other additional testing of an entire breast or breasts concurrently ordered
with a mammogram examination by a health care provider pursuant to section 10
of P.L. , c.��� (C.�������� ) (pending before the
Legislature as this bill)
.
���� b.� The benefits shall be
provided to the same extent as for any other medical condition under the health
benefits plan.
���� c.� The provisions of this
section shall apply to all health benefit plans in which the carrier has
reserved the right to change the premium.
(cf: P.L.2013, c.196, s.6)
���� 7.��� Section 8 of L.2004,
c.86 (C.17B:27A-19.13) is amended to read as follows:
���� 8.��� a. �Every small employer
health benefits plan that is delivered, issued, executed, or renewed in this
State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) or approved for
issuance or renewal in this State, on or after the effective date of this act,
shall provide benefits to any person covered thereunder for expenses incurred
in conducting:
���� (1) one baseline mammogram
examination for women who are 40 years of age; a mammogram examination every
year for women age 40 and over; and, in the case of a woman who is under 40
years of age and has a family history of breast cancer or other breast cancer risk
factors, a mammogram examination at such age and intervals as deemed medically
necessary by the woman's health care provider;
[
and
]
���� (2) an ultrasound evaluation,
a magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination, if the mammogram demonstrates extremely dense breast tissue, if
the mammogram is abnormal within any degree of breast density including not
dense, moderately dense, heterogeneously dense, or extremely dense breast
tissue, or if the patient has additional risk factors for breast cancer
including but not limited to family history of breast cancer, prior personal
history of breast cancer, positive genetic testing, extremely dense breast
tissue based on the Breast Imaging Reporting and Data System established by the
American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the carrier of
the medical necessity of the additional screening and diagnostic testing
;
and
����
(3) an ultrasound
evaluation, a magnetic resonance imaging scan, a three-dimensional mammography,
or other additional testing of an entire breast or breasts concurrently ordered
with a mammogram examination by a health care provider pursuant to section 10
of P.L. , c.��� (C.�������� ) (pending before the
Legislature as this bill)
.
���� b.� The benefits shall be
provided to the same extent as for any other medical condition under the health
benefits plan.
���� c.� The provisions of this
section shall apply to all health benefit plans in which the carrier has
reserved the right to change the premium.
(cf: P.L.2013, c.196, s.7)
���� 8.��� Section 6 of L.1991,
c.279 (C.26:2J-4.4) is amended to read as follows:
���� 6.��� a. �Notwithstanding any
provision of law to the contrary, a certificate of authority to establish and
operate a health maintenance organization in this State shall not be issued or
continued by the Commissioner of Banking and Insurance on or after the effective
date of this act unless the health maintenance organization provides health
care services to any enrollee for the conduct of:
���� (1)� one baseline mammogram
examination for women who are 40 years of age; a mammogram examination every
year for women age 40 and over; and, in the case of a woman who is under 40
years of age and has a family history of breast cancer or other breast cancer risk
factors, a mammogram examination at such age and intervals as deemed medically
necessary by the woman's health care provider;
[
and
]
���� (2) an ultrasound evaluation,
a magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination, if the mammogram demonstrates extremely dense breast tissue, if
the mammogram is abnormal within any degree of breast density including not
dense, moderately dense, heterogeneously dense, or extremely dense breast
tissue, or if the patient has additional risk factors for breast cancer
including but not limited to family history of breast cancer, prior personal
history of breast cancer, positive genetic testing, extremely dense breast
tissue based on the Breast Imaging Reporting and Data System established by the
American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the health
maintenance organization of the medical necessity of the additional screening
and diagnostic testing
; and
����
(3) an ultrasound
evaluation, a magnetic resonance imaging scan, a three-dimensional mammography,
or other additional testing of an entire breast or breasts concurrently ordered
with a mammogram examination by a health care provider pursuant to section 10
of P.L. , c.��� (C.�������� ) (pending before the
Legislature as this bill)
.
���� b.��� These health care
services shall be provided to the same extent as for any other sickness under
the enrollee agreement.
���� c.� The provisions of this
section shall apply to all enrollee agreements in which the health maintenance
organization has reserved the right to change the schedule of charges.
(cf: P.L.2013, c.196, s.8)
���� 9.��� Section 9 of P.L.2004,
c.86 (C.52:14-17.29i) is amended to read as follows:
���� 9.��� a. �The State Health
Benefits Commission shall provide benefits to each person covered under the
State Health Benefits Program for expenses incurred in conducting:
���� (1)� one baseline mammogram
examination for women who are 40 years of age; a mammogram examination every
year for women age 40 and over; and, in the case of a woman who is under 40
years of age and has a family history of breast cancer or other breast cancer risk
factors, a mammogram examination at such age and intervals as deemed medically
necessary by the woman's health care provider;
[
and
]
���� (2)� an ultrasound evaluation,
a magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination, if the mammogram demonstrates extremely dense breast tissue, if
the mammogram is abnormal within any degree of breast density including not
dense, moderately dense, heterogeneously dense, or extremely dense breast
tissue, or if the patient has additional risk factors for breast cancer
including but not limited to family history of breast cancer, prior personal
history of breast cancer, positive genetic testing, extremely dense breast
tissue based on the Breast Imaging Reporting and Data System established by the
American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the carrier of
the medical necessity of the additional screening and diagnostic testing
;
and
����
(3) an ultrasound
evaluation, a magnetic resonance imaging scan, a three-dimensional mammography,
or other additional testing of an entire breast or breasts concurrently ordered
with a mammogram examination by a health care provider pursuant to section 10
of P.L. , c.��� (C.�������� ) (pending before the
Legislature as this bill)
.
���� b.� The benefits shall be
provided to the same extent as for any other medical condition under the
contract.
(cf: P.L.2013, c.196, s.9)
���� 10.� (New section)� Any health
care provider engaged in the diagnosis or treatment of breast cancer shall
concurrently order an ultrasound evaluation, a magnetic resonance imaging scan,
a three-dimensional mammography, or other additional testing of an entire
breast or breasts when ordering a mammogram examination if a woman has
additional risk factors for breast cancer or other indications as determined by
the provider.
���� 11. The Commissioner of
Health, pursuant to the "Administrative Procedure Act," P.L.1968,
c.410 (C.52:14B-1 et seq.), shall adopt such rules and regulations as are
necessary to effectuate the purposes of section 10 of P.L.���� , c.��� (C.�����
) (pending before the Legislature as this bill).
���� 12.� This act shall take
effect on the first day of the fourth month next following the date of
enactment.� Sections 1 through 9 of this act shall apply to all contracts and
policies that are delivered, issued, executed, or renewed in this State, or
approved for issuance or renewal in this State by the Commissioner of Banking
and Insurance on or after the effective date.� The Commissioner of Health may
take such anticipatory administrative action in advance thereof as shall be
necessary for the implementation of section 10 of this act.
STATEMENT
���� This bill requires any health
care provider engaged in the diagnosis or treatment of breast cancer to
concurrently order an ultrasound evaluation, a magnetic resonance imaging scan,
three-dimensional mammography, or other additional testing of an entire breast
or breasts when ordering a mammogram examination if a woman has additional risk
factors for breast cancer or other indications as determined by the provider.
���� The bill also requires health
insurers to cover the ultrasound evaluation, a magnetic resonance imaging scan,
three-dimensional mammography, or other additional testing of an entire breast
or breasts when concurrently ordered with a mammogram examination.
���� The bill provides that the
health benefits coverage requirements apply to: health, hospital, and medical
service corporations; commercial, individual, and group health insurers; health
maintenance organizations; and health benefits plans issued pursuant to the New
Jersey Individual Health Coverage and Small Employer Health Benefits Programs.�
The bill provides the coverage requirements also apply to the State Health
Benefits Program, which by law requires similar health benefits coverage under
the School Employees� Health Benefits Program.