Chapter 29. Cancer Prevention.
Subchapter I. Screening for Women.
§ 31–2901. Definitions.
For the purposes of this subchapter, the term:
(1) “Baseline mammogram” means a screening mammogram that is used as a comparison for future examinations.
(2) “Screening mammogram” means a low dose x-ray used to visualize the internal structure of the breast.
(3) “Cytologic screening” means a pap test to detect cervical cancer through the simple microscopic examination of cells scraped from the surface of the cervix.
(4) “Health benefit plan” means any accident and health insurance policy or certificate, hospital and medical services corporation contract, health maintenance organization subscriber contract, plan provided by a multiple employer welfare arrangement, or plan provided by another benefit arrangement. The term “health benefit plan” does not mean accident only, credit, or disability insurance; coverage of Medicare services or federal employee health plans, pursuant to contracts with the United States government; Medicare supplemental or long-term care insurance; dental only or vision only insurance; specified disease insurance; hospital confinement indemnity coverage; limited benefit health coverage; coverage issued as a supplement to liability insurance, insurance arising out of a workers’ compensation or similar law; automobile medical payment insurance; medical expense and loss of income benefits; or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance.
§ 31–2902. Payable benefits.
(a) Any individual or group health benefit plan, including Medicaid, shall provide health insurance benefits to cover:
(1) A baseline mammogram for women, including a 3-D mammogram;
(2) An annual screening mammogram for women, including a 3-D mammogram; and
(3) Adjuvant breast cancer screening, including magnetic resonance imaging, ultrasound screening, or molecular breast imaging of the breast, if:
(A) A mammogram demonstrates a Class C or Class D breast density classification; or
(B) A woman is believed to be at an increased risk for cancer due to family history or prior personal history of breast cancer, positive genetic testing, or other indications of an increased risk for cancer as determined by a woman's physician or advanced practice registered nurse.
(b) Any individual or group health benefit plan, including Medicaid, shall provide health insurance benefits to cover:
(1) Annual cervical cytologic screening for women; and
(2) Cervical cytologic screening for women upon certification by an attending physician that the test is medically necessary.
(c) Benefits provided in accordance with this section shall not be subject to an annual or coinsurance deductible.
(d) Benefits provided in accordance with this section shall not be subject to a co-payment except when an enrollee or subscriber elects to have a baseline mammogram, annual screening mammogram, annual cervical cytologic screening, and a cervical cytologic screening certified by an attending physician as being necessary, performed by an out-of-network provider in a preferred provider plan.
(e) Co-payments and coinsurance may be applicable to the enrollee’s or subscriber’s office visit.
(f) Subsections (d) and (e) of this section shall apply:
(1) To any insurance policy or subscriber contract delivered or issued for delivery in the District more than 120 days after April 5, 2005; and
(2) To any insurance policy or subscriber contract renewed, amended, or reissued 120 days after April 5, 2005.
(g) For the purposes of this section, the term "breast density classification" means the 4 levels of breast density identified in the Breast Imaging Reporting and Data System established by the American College of Radiology, which are:
(1) Class A, indicating fatty breast tissue;
(2) Class B, indicating scattered fibroglandular breast tissue;
(3) Class C, indicating heterogeneously dense breast tissue with fibrous and glandular tissue that are evenly distributed throughout the breast; and
(4) Class D, indicating extremely dense breast tissue.
§ 31–2903. Applicability.
The requirements of this subchapter shall apply:
(1) To any health benefit plan delivered or issued for delivery in the District more than 120 days after March 7, 1991; and
(2) To any health benefit plan renewed, amended, or reissued 120 days after March 7, 1991.
Subchapter II. Colorectal Cancer Screening Insurance.
§ 31–2931. Coverage.
(a) Every individual and group health insurance policy or service, including Medicaid, shall provide coverage for colorectal cancer screening for policyholders residing in the District of Columbia.
(b) The screening shall be in compliance with American Cancer Society colorectal cancer screening guidelines.
(c) As American Cancer Society colorectal cancer screening guidelines are updated, every individual and group health insurance policy of service, including Medicaid, shall update their colorectal cancer screening benefits to comply with the American Cancer Society guidelines.
Subchapter III. Prostate Cancer Screening Insurance.
§ 31–2951. Definitions.
For the purposes of this subchapter, the term:
(1) “Commissioner” means the Commissioner of the Department of Insurance and Securities Regulation.
(2) “Health benefits plan” means any accident and health insurance policy or certificate, hospital and medical services corporation contract, health maintenance organization subscriber contract, plan provided by a multiple employer welfare arrangement, or plan provided by another benefit arrangement. The term “health benefit plan” does not mean accident only, credit, or disability insurance; coverage of Medicare services or federal employee health plans, pursuant to contracts with the United States government; Medicare supplemental or long-term care insurance; dental only or vision only insurance; specified disease insurance; hospital confinement indemnity coverage; limited benefit health coverage; coverage issued as a supplement to liability insurance, insurance arising out of a workers’ compensation or similar law; automobile medical payment insurance; medical expense and loss of income benefits; or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance.
(3) “Health insurer” means any person that provides one or more health benefit plans or insurance in the District of Columbia, including an insurer, a hospital and medical services corporation, a fraternal benefit society, a health maintenance organization, a multiple employer welfare arrangement, or any other person providing a plan of health insurance subject to the authority of the Commissioner.
§ 31–2952. Coverage for prostate cancer screening.
(a) Each individual and group health benefits plan issued or renewed in the District of Columbia shall provide coverage for prostate cancer screening in accordance with the latest screening guidelines issued by the American Cancer Society for the ages, family histories, and frequencies referenced in such guidelines.
(b) The coverage provided under this section shall not be more restrictive than or separate from coverage provided from any other illness, condition, or disorder for purposes of determining deductibles, benefit year or lifetime durational limits, benefit year or lifetime dollar limits, lifetime episodes or treatment limits, copayment and coinsurance factors, and benefit year maximum for deductibles and copayments and coinsurance factors.
§ 31–2953. Applicability.
This subchapter shall apply to all individual and group health benefits plans issued or renewed on or after 120 days after March 25, 2003.
§ 31–2954. Regulations.
The Commissioner may issue rules and regulations necessary to implement the provisions of this subchapter.
