North Carolina HB 297: Breast Cancer Prevention Imaging Parity.

Bill Text

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 HEALTH COVERAGE PARITY FOR SUPPLEMENTAL AND 2
DIAGNOSTIC BREAST IMAGING. 3
The General Assembly of North Carolina enacts: 4
5
PART I. HEALTH INSURANCE REGULATION CHANGES 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SECTION 1.1.(b) G.S. 58-65-92 is repealed. 9
SECTION 1.1.(c) G.S. 58-67-76 is repealed. 10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 abnormality 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 States 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 screening, 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