North Carolina SB 553: LME/MCO Enrollee Grievances & Appeals.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 1
SENATE BILL 553

Short Title: Save More Tatas Act. (Public)
Sponsors: Senators Batch, Mayfield, and Applewhite (Primary Sponsors).
Referred to: Rules and Operations of the Senate
March 26, 2025
*S553-v-1*
A BILL TO BE ENTITLED 1
AN ACT PROVIDING HEALTH COVERAGE PARITY FOR BREAST CANCER 2
DIAGNOSTIC IMAGING, MAKING TECHNICAL AND CONFORMING CHANGES TO 3
THE GENERAL STATUTES RELATED TO BREAST CANCER SCREENING, 4
APPROPRIATING FUNDS TO SUPPORT AVAILABILITY OF MAMMOGRAPHY 5
TECHNOLOGISTS IN RURAL AND UNDERSERVED AREAS OF THE STATE, AND 6
UPDATING MAMMOGRAPHIC BREAST DENSITY PATIENT NOTIFICATION 7
REQUIREMENTS. 8
The General Assembly of North Carolina enacts: 9
SECTION 1. G.S. 58-51-57 is recodified as G.S. 58-3-271. 10
SECTION 2.(a) G.S. 58-3-271, as created by Section 1 of this act, reads as rewritten: 11
"§ 58-3-271. Coverage for mammograms exams for breast cancer and cervical cancer 12
screening. 13
(a) Every policy or contract of accident or health insurance, and every preferred provider 14
health benefit plan under G.S. 58-50-56, that is issued, renewed, or amended on or after January 15
1, 1992, offered by an insurer shall provide coverage for examinations and laboratory tests for 16
the screening for the early detection of cervical cancer and for low-dose screening 17
mammography. The same deductibles, coinsurance, and other limitations as apply to similar 18
services covered under the policy, contract, or plan shall apply to coverage for examinations and 19
laboratory tests for the screening for the early detection of cervical cancer and low-dose screening 20
mammography. 21
(a1) As used in this section, "examinations The following definitions apply in this section: 22
(1) Cost-sharing requirement. – A deductible, coinsurance, copayment, and any 23
maximum limitation on the application of a deductible, coinsurance, 24
copayment, or similar out-of-pocket expense. 25
(2) Dense breast tissue. – Heterogeneously or extremely dense breast tissue as 26
defined by the Breast Imaging Reporting and Data System established by the 27
American College of Radiology. 28
(3) Diagnostic examination for breast cancer. – An examination for breast cancer 29
that is determined by the healthcare provider treating the patient to be 30
medically necessary and appropriate, in accordance with applicable American 31
College of Radiology guidelines. A diagnostic exam for breast cancer may 32
include a diagnostic low-dose mammography, breast magnetic resonance 33
imaging, or breast ultrasound to evaluate an abnormality in the breast that 34
meets one of the following criteria: 35

General Assembly Of North Carolina Session 2025
Page 2 Senate Bill 553-First Edition
a. The abnormality is seen or suspected from a screening examination for 1
breast cancer. 2
b. The abnormality is detected by a means of examination other than a 3
screening examination for breast cancer. 4
(4) Low-dose mammography. – A radiologic procedure for the early detection of 5
breast cancer using equipment dedicated specifically for mammography, 6
including a physician's interpretation of the results of the procedure. 7
(5) Magnetic resonance imaging. – Medical imaging that uses nuclear magnetic 8
resonance. 9
(6) Screening of early detection of cervical cancer. – Examinations and laboratory 10
tests for the screening for the early detection of used to detect cervical cancer" 11
means cancer, including conventional PAP smear screening, liquid-based 12
cytology, and human papilloma virus (HPV) detection methods for women 13
with equivocal findings on cervical cytologic analysis that are subject to the 14
approval of and have been approved by the United States Food and Drug 15
Administration. 16
(7) Supplemental examination for breast cancer. – An examination for breast 17
cancer that is determined by the healthcare provider treating the patient to be 18
medically necessary and appropriate, in accordance with applicable American 19
College of Radiology guidelines. A supplemental examination for breast 20
cancer may include breast magnetic resonance imaging, breast ultrasound, 21
diagnostic low-dose mammography, and digital breast tomosynthesis to 22
evaluate a potential abnormality in the breast in an individual who meets both 23
of the following criteria: 24
a. The individual has a personal or family medical history of breast 25
cancer. 26
b. The individual has dense breast tissue. 27
(b) As used in this section, "low-dose screening mammography" means a radiologic 28
procedure for the early detection of breast cancer provided to an asymptomatic woman using 29
equipment dedicated specifically for mammography, including a physician's interpretation of the 30
results of the procedure. 31
(c) Coverage for low-dose screening mammography and breast ultrasound shall be 32
provided as follows: 33
(1) One or more mammograms a year, as recommended by a physician, for any 34
woman who is at risk for breast cancer. For purpos