REPRESENTATIVES Schmidt, Schneider, Hughes, Clancy, Raga, Schlichter, Webster, T. Patton, Grendell, Flowers, Barrett, J. Stewart, Miller, Allen, DeBose, McGregor, Latta, S. Patton, Key, Kearns, Brown, Jerse, Beatty, Harwood, Kilbane, Walcher

To amend sections 1751.62, 3923.52, 3923.53, and

1

3923.54 of the Revised Code to raise the cap on

2

the amount of benefits health care plans may

3

provide for the expense of screening

4

mammographies, an examination that the plans are

5

required to cover, and to provide for the annual

6

adjustment of this cap to reflect inflation.

7

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 1751.62, 3923.52, 3923.53, and	8
3923.54 of the Revised Code be amended to read as follows:	9

Sec. 1751.62.  (A) As used in this section, "screening	10
mammography" means a radiologic examination utilized to detect	11
unsuspected breast cancer at an early stage in an asymptomatic	12
woman and includes the x-ray examination of the breast using	13
equipment that is dedicated specifically for mammography,	14
including, but not limited to, the x-ray tube, filter, compression	15
device, screens, film, and cassettes, and that has an average	16
radiation exposure delivery of less than one rad mid-breast.	17
"Screening mammography" includes two views for each breast. The	18
term also includes the professional interpretation of the film.	19

"Screening mammography" does not include diagnostic	20
mammography.	21

(B) Every individual or group health insuring corporation	22
policy, contract, or agreement providing basic health care	23
services that is delivered, issued for delivery, or renewed in	24
this state shall provide benefits for the expenses of both of the	25
following:	26

(1) Screening mammography to detect the presence of breast	27
cancer in adult women;	28

(2) Cytologic screening for the presence of cervical cancer.

29

(C) The benefits provided under division (B)(1) of this	30
section shall cover expenses in accordance with all of the	31
following:	32

(1) If a woman is at least thirty-five years of age but under	33
forty years of age, one screening mammography;	34

(2) If a woman is at least forty years of age but under fifty	35
years of age, either of the following:	36

(a) One screening mammography every two years;

37

(b) If a licensed physician has determined that the woman has	38
risk factors to breast cancer, one screening mammography every	39
year.	40

(3) If a woman is at least fifty years of age but under	41
sixty-five years of age, one screening mammography every year.	42

(D)(1) The benefits provided under division (B)(1) of this	43
section shall not exceed eighty-fiveone hundred five dollars per	44
year unless a lower amount is established pursuant to a provider	45
contract. The limit on the amount of benefits that may be provided	46
for the expense of screening mammographies shall be adjusted	47
annually to reflect the rate of inflation for medical services in	48
the previous calendar year.	49

(2) The benefit paid in accordance with division (D)(1) of	50
this section shall constitute full payment. No institutional or	51
professional health care provider shall seek or receive	52
remuneration in excess of the payment made in accordance with	53
division (D)(1) of this section, except for approved copayments.	54

(E) The benefits provided under division (B)(1) of this	55
section shall be provided only for screening mammographies that	56
are performed in a health care facility or mobile mammography	57
screening unit that is accredited under the American college of	58
radiology mammography accreditation program or in a hospital as	59
defined in section 3727.01 of the Revised Code.	60

(F) The benefits provided under divisions (B)(1) and (2) of	61
this section shall be provided according to the terms of the	62
subscriber contract.	63

(G) The benefits provided under division (B)(2) of this	64
section shall be provided only for cytologic screenings that are	65
processed and interpreted in a laboratory certified by the college	66
of American pathologists or in a hospital as defined in section	67
3727.01 of the Revised Code.	68

Sec. 3923.52.  (A) As used in this section and section	69
3923.53 of the Revised Code, "screening mammography" means a	70
radiologic examination utilized to detect unsuspected breast	71
cancer at an early stage in asymptomatic women and includes the	72
x-ray examination of the breast using equipment that is dedicated	73
specifically for mammography, including, but not limited to, the	74
x-ray tube, filter, compression device, screens, film, and	75
cassettes, and that has an average radiation exposure delivery of	76
less than one rad mid-breast. "Screening mammography" includes two	77
views for each breast. The term also includes the professional	78
interpretation of the film.	79

"Screening mammography" does not include diagnostic	80
mammography.	81

(B) Every policy of individual or group sickness and accident	82
insurance that is delivered, issued for delivery, or renewed in	83
this state shall offer to provide benefits for the expenses of	84
both of the following:	85

(1) Screening mammography to detect the presence of breast	86
cancer in adult women;	87

(2) Cytologic screening for the presence of cervical cancer.

88

(C) The benefits provided under division (B)(1) of this	89
section shall cover expenses in accordance with all of the	90
following:	91

(1) If a woman is at least thirty-five years of age but under	92
forty years of age, one screening mammography;	93

(2) If a woman is at least forty years of age but under fifty	94
years of age, either of the following:	95

(a) One screening mammography every two years;

96

(b) If a licensed physician has determined that the woman has	97
risk factors to breast cancer, one screening mammography every	98
year.	99

(3) If a woman is at least fifty years of age but under	100
sixty-five years of age, one screening mammography every year.	101

(D)(1) The benefits provided under division (B)(1) of this	102
section shall not exceed eighty-fiveone hundred five dollars per	103
year unless a lower amount is established pursuant to a provider	104
contract. The limit on the amount of benefits that may be provided	105
for the expense of screening mammographies shall be adjusted	106
annually to reflect the rate of inflation for medical services in	107
the previous calendar year.	108

(2) The benefit paid in accordance with division (D)(1) of	109
this section shall constitute full payment. No institutional or	110
professional health care provider shall seek or receive	111
compensation in excess of the payment made in accordance with	112
division (D)(1) of this section, except for approved deductibles	113
and copayments.	114

(E) The benefits provided under division (B)(1) of this	115
section shall be provided only for screening mammographies that	116
are performed in a facility or mobile mammography screening unit	117
that is accredited under the American college of radiology	118
mammography accreditation program or in a hospital as defined in	119
section 3727.01 of the Revised Code.	120

(F) The benefits provided under division (B)(2) of this	121
section shall be provided only for cytologic screenings that are	122
processed and interpreted in a laboratory certified by the college	123
of American pathologists or in a hospital as defined in section	124
3727.01 of the Revised Code.	125

(G) This section does not apply to any policy that provides	126
coverage for specific diseases or accidents only, or to any	127
hospital indemnity, medicare supplement, or other policy that	128
offers only supplemental benefits.	129

Sec. 3923.53.  (A) Every public employee benefit plan that is	130
established or modified in this state shall provide benefits for	131
the expenses of both of the following:	132

(1) Screening mammography to detect the presence of breast	133
cancer in adult women;	134

(2) Cytologic screening for the presence of cervical cancer.

135

(B) The benefits provided under division (A)(1) of this	136
section shall cover expenses in accordance with all of the	137
following:	138

(1) If a woman is at least thirty-five years of age but under	139
forty years of age, one screening mammography;	140

(2) If a woman is at least forty years of age but under fifty	141
years of age, either of the following:	142

(a) One screening mammography every two years;

143

(b) If a licensed physician has determined that the woman has	144
risk factors to breast cancer, one screening mammography every	145
year.	146

(3) If a woman is at least fifty years of age but under	147
sixty-five years of age, one screening mammography every year.	148

(C)(1) The benefits provided under division (A)(1) of this	149
section shall not exceed eighty-fiveone hundred five dollars per	150
year unless a lower amount is established pursuant to a provider	151
contract. The limit on the amount of benefits that may be provided	152
for the expense of screening mammographies shall be adjusted	153
annually to reflect the rate of inflation for medical services in	154
the previous calendar year.	155

(2) The benefit paid in accordance with division (C)(1) of	156
this section shall constitute full payment. No institutional or	157
professional health care provider shall seek or receive	158
compensation in excess of the payment made in accordance with	159
division (C)(1) of this section, except for approved deductibles	160
and copayments.	161

(D) The benefits provided under division (A)(1) of this	162
section shall be provided only for screening mammographies that	163
are performed in a facility or mobile mammography screening unit	164
that is accredited under the American college of radiology	165
mammography accreditation program or in a hospital as defined in	166
section 3727.01 of the Revised Code.	167

(E) The benefits provided under division (A)(2) of this	168
section shall be provided only for cytologic screenings that are	169
processed and interpreted in a laboratory certified by the college	170
of American pathologists or in a hospital as defined in section	171
3727.01 of the Revised Code.	172

Sec. 3923.54.  (A) As used in this section, "screening	173
mammography" means a radiologic examination utilized to detect	174
unsuspected breast cancer at an early stage in asymptomatic women	175
and includes the x-ray examination of the breast using equipment	176
that is dedicated specifically for mammography including, but not	177
limited to, the x-ray tube, filter, compression device, screens,	178
film, and cassettes, and that has an average radiation exposure	179
delivery of less than one rad mid-breast. "Screening mammography"	180
includes two views for each breast. The term also includes the	181
professional interpretation of the film.	182

"Screening mammography" does not include diagnostic	183
mammography.	184

(B) Each employer in this state that provides, in whole or in	185
part, health care benefits for its employees under a policy of	186
sickness and accident insurance issued in accordance with Chapter	187
3923. of the Revised Code shall also provide to its employees	188
benefits for the expenses of both of the following:	189

(1) Screening mammography to detect the presence of breast	190
cancer in adult women;	191

(2) Cytologic screening for the presence of cervical cancer.

192

(C) An employer may comply with division (B) of this section	193
in any of the following ways:	194

(1) By providing the benefits under a health insuring	195
corporation contract issued in accordance with Chapter 1751. of	196
the Revised Code or a policy of sickness and accident insurance	197
issued in accordance with Chapter 3923. of the Revised Code;	198

(2) By reimbursing the employee for the direct health care	199
provider charges associated with receipt of the covered service;	200

(3) By making any other arrangement that provides the	201
benefits described in division (B) of this section.	202

(D) The benefits provided under division (B)(1) of this	203
section shall cover expenses in accordance with all of the	204
following:	205

(1) If a woman is at least thirty-five years of age but under	206
forty years of age, one screening mammography;	207

(2) If a woman is at least forty years of age but under fifty	208
years of age, either of the following:	209

(a) One screening mammography every two years;

210

(b) If a licensed physician has determined that the woman has	211
risk factors to breast cancer, one screening mammography every	212
year.	213

(3) If a woman is at least fifty years of age but under	214
sixty-five years of age, one screening mammography every year.	215

(E)(1) The benefits provided under division (B)(1) of this	216
section need not exceed eighty-fiveone hundred five dollars per	217
year. The limit on the amount of benefits that may be provided for	218
the expense of screening mammographies shall be adjusted annually	219
to reflect the rate of inflation for medical services in the	220
previous calendar year.	221

(2) The benefit paid in accordance with division (E)(1) of	222
this section shall constitute full payment. No institutional or	223
professional health care provider shall seek or receive	224
compensation in excess of the payment made in accordance with	225
division (E)(1) of this section, except for approved deductibles	226
and copayments.	227

(F) The benefits provided under division (B)(1) of this	228
section shall be provided only for screening mammographies that	229
are performed in a facility or mobile mammography screening unit	230
that is accredited under the American college of radiology	231
mammography accreditation program or in a hospital as defined in	232
section 3727.01 of the Revised Code.	233

(G) The benefits provided under division (B)(2) of this	234
section shall be provided only for cytologic screenings that are	235
processed and interpreted in a laboratory certified by the college	236
of American pathologists or in a hospital as defined in section	237
3727.01 of the Revised Code.	238

Section 2. That existing sections 1751.62, 3923.52, 3923.53,	239
and 3923.54 of the Revised Code are hereby repealed.	240