Health Reform Provision Prevents Insurers From Denying Breast Screening Coverage

Dom Nicastro, April 13, 2010

Government and private insurers can't reduce coverage for mammography screenings that fall outside the controversial U.S. Preventive Services Task Force (USPSTF) mammography guidelines, according to a provision in the new health reform law.

The Patient Protection and Affordable Care Act calls the USPSTF recommendations the most current recommendations regarding breast cancer screening, mammography, and prevention.

However, Congress included an insurance coverage protection for patients whose screenings and other actions counter the USPSTF recommendations. Congress wrote in the law:

"Nothing in this subsection (2713) shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to deny coverage for services that are not recommended by such Task Force."

Mammography industry insiders called this a victory over the recommendations, which at least one expert tabbed as "atrocious" and a two-decade step backward for women's healthcare.

The USPSTF guidelines, released in November, suggested that women should not be required to start breast cancer screenings at 40. Instead, the task force said women should decide whether to get screened at 40 only after discussing the pros and cons with their physician. Routine screening should start at 50, according to the USPSTF.

The Annals of Internal Medicine, the journal that published the new recommendations, backed the changes in a February 2010 editorial, saying women need to understand the benefits and harms that come with screening.

USPSTF supporters say screening changes are needed because too many women are being over-treated for breast cancer, many of whom still die despite diligent screening. Breast experts counter that these changes put many more women at risk unnecessarily.

The ACR Breast Imaging Commission is now backing a new Congressional bill that would permanently protect mammography reimbursement, says Rebecca Spangler, director of congressional affairs and government relations and economic policy departments for ACR in Washington, D.C.

"It's not time to let down your guard," says Spangler. "I think we just have to stay vigilant. The immediate risk was averted, but it's something that I think everyone needs to stay on top of."

Dom Nicastro Dom Nicastro is a contributing writer. He edits the Medical Records Briefings newsletter and manages the HIPAA Update Blog.
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