Breast Cancer Prevention Imaging Parity.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 2
HOUSE BILL 297
Committee Substitute Favorable 4/3/25

Short Title: Breast Cancer Prevention Imaging Parity. (Public)
Sponsors:
Referred to:
March 6, 2025
*H297-v-2*
A BILL TO BE ENTITLED 1
AN ACT TO PROVIDE HE ALTH COVERAGE PARITY FOR SUPPLEMENTAL AN D 2
DIAGNOSTIC BREAST IMAGING. 3
The General Assembly of North Carolina enacts: 4
5
PART I. HEALTH INSUR ANCE REGULATION CHAN GES TO CREATE PARITY 6
FOR SUPPLEMENTAL AND DIAGNOSTIC BREAST IMAGING 7
SECTION 1.1.(a) G.S. 58-51-57 is recodified as G.S. 58-3-271. 8
SECTION 1.1.(b) G.S. 58-65-92 is repealed. 9
SECTION 1.1.(c) G.S. 58-67-76 is repealed. 10
SECTION 1.2. G.S. 58-3-271, as enacted by Section 1.1(a) of this act, reads as 11
rewritten: 12
"§ 58-3-271. Coverage for diagnostic, screening, and supplemental examinations for 13
breast cancer, including mammograms and other imaging, and cervical cancer 14
screening. 15
(a) The following definitions apply in this section: 16
(1) Breast magnetic resonance imaging. – A diagnostic tool that uses a powerful 17
magnetic field, radio waves, and a computer to produce detailed pictures of 18
the structures within the breast. 19
(2) Breast ultrasound. – A noninvasive diagnostic tool that uses high -frequency 20
sound waves to produce detailed images of the breast. 21
(3) Cost-sharing. – A deductible, coinsurance, copayment, and any maximum 22
limitation on the application of a deductible, coinsurance, copayment, or 23
similar out-of-pocket expense. 24
(4) Diagnostic examination for breast cancer. – An examination for breast cancer 25
that is determined by the healthcare provider treating the patient to be 26
medically necessary and appropriate and that may include breast magnetic 27
resonance imaging, breast ultrasound, and diagnostic low -dose 28
mammography to evaluate the abnormality in the breast that meets one of the 29
following criteria: 30
a. Is seen or suspected from a screening examination for breast cancer. 31
b. Is detected by another means of examination. 32
(5) High-deductible health plan. – As defined under the Internal Revenue Code. 33
(6) Low-dose mammography. – A radiologic procedure for the early detection of 34
breast cancer using equipment dedicated specifically for mammography, 35
including a physician's interpretation of the results of the procedure. 36
General Assembly Of North Carolina Session 2025
Page 2 House Bill 297-Second Edition
(7) Screening examination for breast cancer. – Low-dose mammography, or an 1
equivalent procedure, that is used to determine if there is abnorm ality in the 2
breast. 3
(8) Screening of early detection of cervical cancer. – Examinations and laboratory 4
tests used to detect cervical cancer, including conventional PAP smear 5
screening, liquid-based cytology, and human papilloma virus (HPV) detection 6
methods for women with equivocal findings on cervical cytologic analysis 7
that are subject to the approval of and have been approved by the United States 8
Food and Drug Administration. 9
(9) Section 223. – Section 223 of the Internal Revenue Code or its equivalent. 10
(10) Supplemental examination for breast cancer . – An examination for breast 11
cancer that is determined by the healthcare provider treating the patient to be 12
medically necessary and appropriate and that may include breast magnetic 13
resonance imaging or breast ultrasound to screen for cancer when there is no 14
abnormality seen or suspected if the patient meets either of the following 15
criteria: 16
a. The patient is at increased risk for breast cancer based on the patient's 17
personal medical history or family medical history of breast cancer. 18
b. The patient has a breast cancer risk profile that qualifies the patient 19
based on current recommendations of the United S tates Preventive 20
Services Task Force, also known as USPSTF. 21
(a)(a1) Every policy or contract of accident or health insurance, and every preferred provider 22
benefit plan under G.S. 58-50-56, that is issued, renewed, or amended on or after January 1, 1992, 23
health benefit plan offered by an insurer in this State shall provide coverage for examinations 24
and laboratory tests for the screening for the early detection of cervical cancer and for low-dose 25
screening mammography. The same deductibles, coinsurance, and other limitations as apply to 26
similar services covered under the policy, contract, or plan shall apply to coverage for 27
examinations and laboratory tests for the screening for the early detection of cervical cancer and 28
low-dose screening mammography. 29
(a1) As used in this section, "examinations and laboratory tests for the screening for the 30
early detection of cervical cancer" means conventional PAP smear scree ning, liquid -based 31
cytology, and human papilloma virus (HPV) detection methods for women with equivocal 32
findings on cervical cytologic analysis that are subject to the approval of and have been approved 33
by the United States Food and Drug Administration. 34
(b) As used in this section, "low -dose screening mammography" means a radiologic 35
procedure for the early detection of breast cancer provided to an asymptomatic woman using 36
equipment dedicated specifically for mammography, including a physician's interpretation of the 37
results of the procedure. 38
(b1) Every health benefit plan offered by an insurer that provides benefits for a diagnostic 39
or supplemental examination for breast cancer shall ensure that the cost -sharing requirements 40
applicable to a diagnostic or supplemental examination for breast cancer are no less favorable 41
than the cost-sharing requirements applicable to low-dose screening mammography for breast 42
cancer. 43
(b2) An insurer shall not be required to reimburse a healthcare provider that is not a 44
contracted provider in the provider network of a health benefit plan offered by the insurer any 45
reimbursement rate more than the rate paid to a provider that has contracted with the insurer to 46
participate in the provider network of the health benefit plan for any of the following services: 47
(1) Diagnostic, screening, or supplemental examination for breast cancer. 48
(2) Low-dose mammography. 49
(3) Breast ultrasound. 50
(4) Breast magnetic resonance imaging. 51
General Assembly Of North Carolina Session 2025
House Bill 297-Second Edition Page 3
(c) Coverage for low-dose screening mammography shall be provided as follows: 1
(1) One or more mammograms a year, as recommended by a physician, for any 2
woman who is at risk for breast can cer. For purposes of this subdivision, a 3
woman is at risk for breast cancer if any one or more of the following is true: 4
a. The woman has a personal history of breast cancer;cancer. 5
b. The woman has a personal history of biopsy -proven benign breast 6
disease;disease. 7
c. The woman's mother, sister, or daughter has or has had breast cancer; 8
orcancer. 9
d. The woman has not given birth prior to the age of 30;30. 10
(2) One baseline mammogram for any woman 35 through 39 years of age, 11
inclusive;inclusive. 12
(3) A mammogram every other year for any woman 40 through 49 years of age, 13
inclusive, or more frequently upon recommendation of a physician; 14
andphysician. 15
(4) A mammogram every year for any woman 50 years of age or older. 16
(d) Reimbursement for a mammogram authorized un der this section shall be made only 17
if the facility in which the mammogram was performed meets mammography accreditation 18
standards established by the North Carolina Medical Care Commission. 19
(e) Coverage for the screening for the early detection of cervical cancer shall be in 20
accordance with the most recently published American Cancer Society American College of 21
Obstetricians and Gynecologists' guidelines or guidelines adopted by the North Carolina 22
Advisory Committee on Cancer Coordination and Control. Coverage shall include the 23
examination, the laboratory fee, and the physician's interpretation of the laboratory results. 24
Reimbursements for laboratory fees shall be made only if the laboratory meets accreditation 25
standards adopted by the North Carolina Medical Care Commission. 26
(f) If the application of any provision of this section would render the insured ineligible 27
for a health savings account under section 223 , then that provision shall apply only for 28
high-deductible health plans with respect to the ded uctible of that plan after the insured has 29
satisfied the minimum deductible under section 223, except with respect to items or services that 30
are prevent ative care . For items or services that are preventative care under section 223, all 31
provisions of this section shall apply regardless of whether or not the minimum deductible under 32
section 223 has been satisfied." 33
SECTION 1.3. G.S. 135-48.51 reads as rewritten: 34
"§ 135-48.51. Coverage and operational mandates related to Chapter 58 of the General 35
Statutes. 36
The following provisions of Chapter 58 of the General Statutes apply to the State Health Plan: 37
… 38
(9a) G.S. 58-3-271, Coverage for diagnostic, screening, and supplemental 39
examinations for breast cancer, including mammograms and other imaging, 40
and cervical cancer screening. 41
…." 42
SECTION 1.4. Except as otherwise provided, this Part becomes effective October 43
1, 2025, and applies to insurance contracts issued, renewed, or amended on or after that date. 44
45
PART II. HEALTHCARE PROVIDER BILLING REG ULATION CHANGES TO 46
CREATE PARITY FOR SU PPLEMENTAL AND DIAGN OSTIC BREAST CANCER 47
IMAGING 48
SECTION 2.1.(a) G.S. 90-701 is recodified as G.S. 90-705. 49
SECTION 2.1.(b) Article 41 of Chapter 90 of the General Statutes, as amended by 50
subsection (a) of this section, reads as rewritten: 51
General Assembly Of North Carolina Session 2025
Page 4 House Bill 297-Second Edition
"Article 41. 1
"Pathology Services Billing.Transparency in Healthcare Provider Billing Practices. 2
"§ 90-702. Definitions. 3
The following definitions shall apply in this Article: 4
(1) Breast cancer prevention service. – All services listed under 5
G.S. 58-3-271(b2). 6
(2) Cost-sharing. – As defined in G.S. 58-3-271. 7
(3) Reserved for future codification purposes. 8
(4) Health benefit plan. – As defined in G.S. 58-3-167. 9
(5) Healthcare provider. – A health services facility or a person who is licensed, 10
registered, or certified under Chapter 90 or Chapter 90B of the General 11
Statutes, or under the laws of another state, to provide healthcare services in 12
the ordinary care of business or practice, or as a profession, or in an approved 13
education or training program. 14
(6) Health services facility. – As defined in G.S. 131E-214.25 15
(7) Reserved for future codification purposes. 16
(8) Insurer. – As defined in G.S. 58-3-167. 17
"§ 90-704. Billing for certain breast cancer prevention services. 18
(a) A healthcare provider who has not contracted with an insurer to participate in the 19
provider network of a health benefit plan shall accept as reimbursement for any breast cancer 20
prevention service provided to an individual insured under a health benefit plan the amount of 21
reimbursement provided by that insurer , including any cost-sharing required to be paid by the 22
patient. 23
(b) No healthcare provider may bill a patient covered under a health benefit plan or 24
request additional reimbursement from the insurer for any amount above the amount required to 25
be accepted under subsection (a) of this section. 26
…." 27
SECTION 2.2. This Part is effective October 1, 2025, and applies to services 28
provided on or after that date. 29
30
PART III. EFFECTIVE DATE 31
SECTION 3.1. Except as otherwise provided, this act is effective when it becomes 32
law. 33