Breast and Cervical Cancer Related Legislation
Statistics on breast and cervical cancer
are alarming at both national and state levels:
- The National Cancer Society estimates
that by the end of 2001, 192,000 women will be diagnosed with breast
cancer and 40,600 will die of the disease.
- Oklahomas cervical cancer death
rate is the 10th highest in the nation.
- Oklahoma is also among the states with
the highest numbers of newly diagnosed cases of cervical cancer annually.
- As Oklahomas population ages in
the next 5 years, it is estimated that 2,800 women will have breast
cancer and another 2,000 women will have pre-cancerous conditions
of the cervix or cervical cancer.
- Early detection can reduce breast cancer
deaths by 30% and can reduce cervical cancer deaths by 95%.
The Legislature first addressed breast cancer as an issue in SB 612
(1988), by providing that all individual and group health insurance
policies providing coverage on an expense incurred basis, and all individual
and group service or indemnity type contracts issued by a nonprofit
corporation and all self-insurers which provide coverage for a female
forty-five (45) years old or older shall include coverage for an annual
screening by low-dose mammography for the presence of occult breast
The Legislature amended the section again in 1989 as follows:
lowered the age from 45 to 35
clarified language related to an annual low-dose screening by mammography;
established a reimbursement amount of no more than $75.00
removed language specifying that the procedure be not less favorable
than for other radiological examination and subject to the same dollar
limits, deductibles and co-insurance factors
specified coverage as being for one low-dose mammography screening
for women 35-39 years of age and an annual low-dose mammography screening
for females 40 and older
required that any entity advertising mammography services include
the total cost of the procedure in its advertising
The Legislature overrode then Governor Henry Bellmons veto of
SB 772 (1994) deleted the requirement for
self-insurers. Companies who self insure are exempted
from state mandates by the federal Employee Retirement Insurance Security
Act (ERISA). The bill further prohibited subjecting the patient
to any policy deductible, co-payment or co-insurance.
This past session, the Oklahoma Legislature enacted SB 711, SB 741 and
HB 1570, related to breast and cervical cancer:
SB 711 (Dickerson/Askins)
Effective July 1, 2001, the Act:
modifies mandated insurance coverage for mammography screenings for
women of specified ages
- specifies that
the State and Education Employees Group Insurance Board is included
in the mandate
increases the reimbursement amount from $75 to up to $115 to bring
this amount in line with present day costs for a mammography screening
- Prohibits conditioning of payment for
coverage on receiving the screening at a specified time
- Provides for coverage for an annual
low-dose mammography screening at no charge for women 40 years of
age and older
- Provides for coverage for one low-dose
mammography screening within a 5-year period for women 35 39
years of age
- SB 741 (Dunlap/Askins)
The Act expands the state Medicaid program to include services for
eligible individuals who are in need of breast or cervical cancer
treatment. The Act further provides for presumptive eligibility
for applicants and continuation of assistance throughout the period
required for treatment of the individuals breast or cervical
cancer. The Act requires implementation of the Centers for Disease
Control-sponsored program by July 1, 2002, contingent upon funds availability.
- Background: SB 741 is
related to the federal PL 106-354 (2000) which provides treatment
for women diagnosed with either breast or cervical cancer, or pre-cancerous
conditions of either the breast or cervix, who are without insurance,
who meet state income guidelines, and who have been screened by the
state breast and cervical cancer early detection program. In
Oklahoma, the program is administered by the Chronic Disease Service
within the State Department of Health. The program targets women
50-64 years of age, who are uninsured or underinsured, who meet age
and income eligibility requirements, and who have never or who have
rarely been screened for either breast or cervical cancer.
HB 1570 relates to appropriations
to various state agencies and modifications to budget limits. The
bill contained a $500,000.00 appropriation to the State Health Department
for additional breast and cervical cancer detection screenings. OSDH
will use the funding to maintain dysplasia clinics and to continue providing
diagnostic services for women with abnormal pap smears, a federal requirement.
The additional funding to expand Medicaid
pursuant to SB 741 was not provided, but is expected to be addressed
during the next legislative session. Such additional funding will
enable the state to receive an enhanced match equal to the Federal Medical
Assistance Percentage used in the States Childrens Health
Insurance Program, which is currently 80-20, and to hopefully expand
services to include women 40-49 years of age. Presently, the state
receives $1.5 Million federal dollars for the $510,000 in state dollars,
a 3 to 1 match.
What It Means
Under SB 711, specified insurers must now cover low-dose mammography
screenings for women, aged 35 years and older, at no charge to the patient,
- For women aged 35-39 years - one time
during a 5-year period
- For women aged 40 years and older -
This means providers shall not charge co-pays,
deductibles or co-insurance amounts in connection with the screenings. This
provision also applies to the State and Education Employees Group Insurance
Board (OSEEGIB). Companies that self-insure are exempt from the
state mandate by the federal ERISA law.
As a condition of contracting under Medicare, providers shall not require
a patient to pay any additional amounts over and above what Medicare
contracts with the provider to pay.
Women should be aware that allowable rates for mammography screenings
at hospitals are different from rates at free standing clinics.
Questions regarding billing for a mammography screening should be directed
to an insurance plans benefits coordinator.
Contact For More Information:
The Oklahoma State Senate, Senate Staff
Senator Stratton Taylor, President Pro Tempore