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, Price, G. Smith, S. Smith, Cirelli, Hollister, Reidelbach, Aslanides, Boccieri, Book, Buehrer, Callender, Carano, Carmichael, Cates, Chandler, Collier, Daniels, DeGeeter, Distel, Domenick, C. Evans, D. Evans, Faber, Gilb, Hagan, Hartnett, Hoops, Koziura, Martin, Mason, Oelslager, Olman, Otterman, Schaffer, Seaver, Setzer, Sferra, Skindell, Slaby, D. Stewart, Strahorn, Sykes, Taylor, Ujvagi, Widener, Widowfield, Willamowski, Wilson, Woodard, Yates

To amend sections 1751.62, 3923.52, 3923.53, and

1

3923.54 of the Revised Code to cap the benefits

2

health care plans provide for the expense of

3

screening mammographies, an examination that the

4

plans are required to cover, at 130% of the

5

Medicare reimbursement rate.

6

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

Section 1. That sections 1751.62, 3923.52, 3923.53, and	7
3923.54 of the Revised Code be amended to read as follows:	8

Sec. 1751.62.  (A) As used in this section, "screening:

9

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

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

(2) "Medicare reimbursement rate" means the reimbursement	22
rate paid in Ohio under the medicare program for screening	23
mammography that does not include digitalization or computer aided	24
detection, regardless of whether the actual benefit includes	25
digitalization or computer aided detection.	26

(B) Every individual or group health insuring corporation	27
policy, contract, or agreement providing basic health care	28
services that is delivered, issued for delivery, or renewed in	29
this state shall provide benefits for the expenses of both of the	30
following:	31

(1) Screening mammography to detect the presence of breast	32
cancer in adult women;	33

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

34

(C) The benefits provided under division (B)(1) of this	35
section shall cover expenses in accordance with all of the	36
following:	37

(1) If a woman is at least thirty-five years of age but under	38
forty years of age, one screening mammography;	39

(2) If a woman is at least forty years of age but under fifty	40
years of age, either of the following:	41

(a) One screening mammography every two years;

42

(b) If a licensed physician has determined that the woman has	43
risk factors to breast cancer, one screening mammography every	44
year.	45

(3) If a woman is at least fifty years of age but under	46
sixty-five years of age, one screening mammography every year.	47

(D)(1) The benefitsSubject to divisions (D)(2) and (3) of	48
this section, if a provider, hospital, or other health care	49
facility provides a service that is a component of the screening	50
mammography benefit in division (B)(1) of this section and submits	51
a separate claim for that component, a separate payment shall be	52
made to the provider, hospital, or other health care facility in	53
an amount that corresponds to the ratio paid by medicare in this	54
state for that component.	55

(2) Regardless of whether separate payments are made for the	56
benefit provided under division (B)(1) of this section, the total	57
benefit for a screening mammography shall not exceed eighty-five	58
dollars per year unless a lower amount is established pursuant to	59
a provider contractone hundred thirty per cent of the medicare	60
reimbursement rate in this state for screening mammography. If	61
there is more than one medicare reimbursement rate in this state	62
for screening mammography or a component of a screening	63
mammography, the reimbursement limit shall be one hundred thirty	64
per cent of the lowest medicare reimbursement rate in this state.	65

(2)(3) The benefit paid in accordance with division (D)(1) of	66
this section shall constitute full payment. No institutional or	67
professionalprovider, hospital, or other health care provider	68
facility shall seek or receive remuneration in excess of the	69
payment made in accordance with division (D)(1) of this section,	70
except for approved deductibles and copayments.	71

(E) The benefits provided under division (B)(1) of this	72
section shall be provided only for screening mammographies that	73
are performed in a health care facility or mobile mammography	74
screening unit that is accredited under the American college of	75
radiology mammography accreditation program or in a hospital as	76
defined in section 3727.01 of the Revised Code.	77

(F) The benefits provided under divisions (B)(1) and (2) of	78
this section shall be provided according to the terms of the	79
subscriber contract.	80

(G) The benefits provided under division (B)(2) of this	81
section shall be provided only for cytologic screenings that are	82
processed and interpreted in a laboratory certified by the college	83
of American pathologists or in a hospital as defined in section	84
3727.01 of the Revised Code.	85

Sec. 3923.52.  (A) As used in this section and section	86
3923.53 of the Revised Code, "screening mammography" means a	87
radiologic examination utilized to detect unsuspected breast	88
cancer at an early stage in asymptomatic women and includes the	89
x-ray examination of the breast using equipment that is dedicated	90
specifically for mammography, including, but not limited to, the	91
x-ray tube, filter, compression device, screens, film, and	92
cassettes, and that has an average radiation exposure delivery of	93
less than one rad mid-breast. "Screening mammography" includes two	94
views for each breast. The term also includes the professional	95
interpretation of the film.	96

"Screening mammography" does not include diagnostic	97
mammography.	98

(B) Every policy of individual or group sickness and accident	99
insurance that is delivered, issued for delivery, or renewed in	100
this state shall offer to provide benefits for the expenses of	101
both of the following:	102

(1) Screening mammography to detect the presence of breast	103
cancer in adult women;	104

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

105

(C) The benefits provided under division (B)(1) of this	106
section shall cover expenses in accordance with all of the	107
following:	108

(1) If a woman is at least thirty-five years of age but under	109
forty years of age, one screening mammography;	110

(2) If a woman is at least forty years of age but under fifty	111
years of age, either of the following:	112

(a) One screening mammography every two years;

113

(b) If a licensed physician has determined that the woman has	114
risk factors to breast cancer, one screening mammography every	115
year.	116

(3) If a woman is at least fifty years of age but under	117
sixty-five years of age, one screening mammography every year.	118

(D)(1) The benefitsAs used in this division, "medicare	119
reimbursement rate" means the reimbursement rate paid in this	120
state under the medicare program for screening mammography that	121
does not include digitization or computer-aided detection,	122
regardless of whether the actual benefit includes digitization or	123
computer-aided detection.	124

(1) Subject to divisions (D)(2) and (3) of this section, if a	125
provider, hospital, or other health care facility provides a	126
service that is a component of the screening mammography benefit	127
in division (B)(1) of this section and submits a separate claim	128
for that component, a separate payment shall be made to the	129
provider, hospital, or other health care facility in an amount	130
that corresponds to the ratio paid by medicare in this state for	131
that component.	132

(2) Regardless of whether separate payments are made for the	133
benefit provided under division (B)(1) of this section, the total	134
benefit for a screening mammography shall not exceed eighty-five	135
dollars per year unless a lower amount is established pursuant to	136
a provider contractone hundred thirty per cent of the medicare	137
reimbursement rate in this state for screening mammography. If	138
there is more than one medicare reimbursement rate in this state	139
for screening mammography or a component of a screening	140
mammography, the reimbursement limit shall be one hundred thirty	141
per cent of the lowest medicare reimbursement rate in this state.	142

(2)(3) The benefit paid in accordance with division (D)(1) of	143
this section shall constitute full payment. No institutional or	144
professionalprovider, hospital, or other health care provider	145
facility shall seek or receive compensation in excess of the	146
payment made in accordance with division (D)(1) of this section,	147
except for approved deductibles and copayments.	148

(E) The benefits provided under division (B)(1) of this	149
section shall be provided only for screening mammographies that	150
are performed in a facility or mobile mammography screening unit	151
that is accredited under the American college of radiology	152
mammography accreditation program or in a hospital as defined in	153
section 3727.01 of the Revised Code.	154

(F) The benefits provided under division (B)(2) of this	155
section shall be provided only for cytologic screenings that are	156
processed and interpreted in a laboratory certified by the college	157
of American pathologists or in a hospital as defined in section	158
3727.01 of the Revised Code.	159

(G) This section does not apply to any policy that provides	160
coverage for specific diseases or accidents only, or to any	161
hospital indemnity, medicare supplement, or other policy that	162
offers only supplemental benefits.	163

Sec. 3923.53.  (A) Every public employee benefit plan that is	164
established or modified in this state shall provide benefits for	165
the expenses of both of the following:	166

(1) Screening mammography to detect the presence of breast	167
cancer in adult women;	168

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

169

(B) The benefits provided under division (A)(1) of this	170
section shall cover expenses in accordance with all of the	171
following:	172

(1) If a woman is at least thirty-five years of age but under	173
forty years of age, one screening mammography;	174

(2) If a woman is at least forty years of age but under fifty	175
years of age, either of the following:	176

(a) One screening mammography every two years;

177

(b) If a licensed physician has determined that the woman has	178
risk factors to breast cancer, one screening mammography every	179
year.	180

(3) If a woman is at least fifty years of age but under	181
sixty-five years of age, one screening mammography every year.	182

(C)(1) The benefitsAs used in this division, "medicare	183
reimbursement rate" means the reimbursement rate paid in this	184
state under the medicare program for screening mammography that	185
does not include digitization or computer-aided detection,	186
regardless of whether the actual benefit includes digitization or	187
computer-aided detection.	188

(1) Subject to divisions (C)(2) and (3) of this section, if a	189
provider, hospital, or other health care facility provides a	190
service that is a component of the screening mammography benefit	191
in division (B)(1) of this section and submits a separate claim	192
for that component, a separate payment shall be made to the	193
provider, hospital, or other health care facility in an amount	194
that corresponds to the ratio paid by medicare in this state for	195
that component.	196

(2) Regardless of whether separate payments are made for the	197
benefit provided under division (A)(1) of this section, the total	198
benefit for a screening mammography shall not exceed eighty-five	199
dollars per year unless a lower amount is established pursuant to	200
a provider contractone hundred thirty per cent of the medicare	201
reimbursement rate in this state for screening mammography. If	202
there is more than one medicare reimbursement rate in this state	203
for screening mammography or a component of a screening	204
mammography, the reimbursement limit shall be one hundred thirty	205
per cent of the lowest medicare reimbursement rate in this state.	206

(2)(3) The benefit paid in accordance with division (C)(1) of	207
this section shall constitute full payment. No institutional or	208
professionalprovider, hospital, or other health care provider	209
facility shall seek or receive compensation in excess of the	210
payment made in accordance with division (C)(1) of this section,	211
except for approved deductibles and copayments.	212

(D) The benefits provided under division (A)(1) of this	213
section shall be provided only for screening mammographies that	214
are performed in a facility or mobile mammography screening unit	215
that is accredited under the American college of radiology	216
mammography accreditation program or in a hospital as defined in	217
section 3727.01 of the Revised Code.	218

(E) The benefits provided under division (A)(2) of this	219
section shall be provided only for cytologic screenings that are	220
processed and interpreted in a laboratory certified by the college	221
of American pathologists or in a hospital as defined in section	222
3727.01 of the Revised Code.	223

Sec. 3923.54.  (A) As used in this section, "screening	224
mammography" means a radiologic examination utilized to detect	225
unsuspected breast cancer at an early stage in asymptomatic women	226
and includes the x-ray examination of the breast using equipment	227
that is dedicated specifically for mammography including, but not	228
limited to, the x-ray tube, filter, compression device, screens,	229
film, and cassettes, and that has an average radiation exposure	230
delivery of less than one rad mid-breast. "Screening mammography"	231
includes two views for each breast. The term also includes the	232
professional interpretation of the film.	233

"Screening mammography" does not include diagnostic	234
mammography.	235

(B) Each employer in this state that provides, in whole or in	236
part, health care benefits for its employees under a policy of	237
sickness and accident insurance issued in accordance with Chapter	238
3923. of the Revised Code shall also provide to its employees	239
benefits for the expenses of both of the following:	240

(1) Screening mammography to detect the presence of breast	241
cancer in adult women;	242

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

243

(C) An employer may comply with division (B) of this section	244
in any of the following ways:	245

(1) By providing the benefits under a health insuring	246
corporation contract issued in accordance with Chapter 1751. of	247
the Revised Code or a policy of sickness and accident insurance	248
issued in accordance with Chapter 3923. of the Revised Code;	249

(2) By reimbursing the employee for the direct health care	250
provider charges associated with receipt of the covered service;	251

(3) By making any other arrangement that provides the	252
benefits described in division (B) of this section.	253

(D) The benefits provided under division (B)(1) of this	254
section shall cover expenses in accordance with all of the	255
following:	256

(1) If a woman is at least thirty-five years of age but under	257
forty years of age, one screening mammography;	258

(2) If a woman is at least forty years of age but under fifty	259
years of age, either of the following:	260

(a) One screening mammography every two years;

261

(b) If a licensed physician has determined that the woman has	262
risk factors to breast cancer, one screening mammography every	263
year.	264

(3) If a woman is at least fifty years of age but under	265
sixty-five years of age, one screening mammography every year.	266

(E)(1) The benefitsAs used in this division, "medicare	267
reimbursement rate" means the reimbursement rate paid in this	268
state under the medicare program for screening mammography that	269
does not include digitization or computer-aided detection,	270
regardless of whether the actual benefit includes digitization or	271
computer-aided detection.	272

(1) Subject to divisions (E)(2) and (3) of this section, if a	273
provider, hospital, or other health care facility provides a	274
service that is a component of the screening mammography benefit	275
in division (B)(1) of this section and submits a separate claim	276
for that component, a separate payment shall be made to the	277
provider, hospital, or other health care facility in an amount	278
that corresponds to the ratio paid by medicare in this state for	279
that component.	280

(2) Regardless of whether separate payments are made for the	281
benefit provided under division (B)(1) of this section, the total	282
benefit for a screening mammography need not exceed eighty-five	283
dollars per yearone hundred thirty per cent of the medicare	284
reimbursement rate in this state for screening mammography. If	285
there is more than one medicare reimbursement rate in this state	286
for screening mammography or a component of a screening	287
mammography, the reimbursement limit shall be one hundred thirty	288
per cent of the lowest medicare reimbursement rate in this state.	289

(2)(3) The benefit paid in accordance with division (E)(1) of	290
this section shall constitute full payment. No institutional or	291
professionalprovider, hospital, or other health care provider	292
facility shall seek or receive compensation in excess of the	293
payment made in accordance with division (E)(1) of this section,	294
except for approved deductibles and copayments.	295

(F) The benefits provided under division (B)(1) of this	296
section shall be provided only for screening mammographies that	297
are performed in a facility or mobile mammography screening unit	298
that is accredited under the American college of radiology	299
mammography accreditation program or in a hospital as defined in	300
section 3727.01 of the Revised Code.	301

(G) The benefits provided under division (B)(2) of this	302
section shall be provided only for cytologic screenings that are	303
processed and interpreted in a laboratory certified by the college	304
of American pathologists or in a hospital as defined in section	305
3727.01 of the Revised Code.	306

Section 2. That existing sections 1751.62, 3923.52, 3923.53,	307
and 3923.54 of the Revised Code are hereby repealed.	308