HB3673 Summary

• Expands mammography coverage under the Illinois Insurance Code and Medicaid to include screening MRI when medically necessary, in addition to baseline mammograms, annual mammograms, ultrasound screening for dense breast tissue, and physical breast exams.

• Requires all insurance policies covering mastectomies to also cover breast reconstruction, prosthetic devices, and treatment for complications including lymphedema, with coverage determined in consultation with the patient and physician.

• Establishes a grant program for breast cancer imaging and diagnostic equipment in rural and medically underserved areas, targeting disproportionate share hospitals, rural mammography facilities, federally qualified health centers, and rural health clinics.

• Requires Illinois Department of Healthcare and Family Services to ensure Medicaid networks include access to at least one breast imaging Center of Excellence and reimburse breast cancer treatment providers at no less than 95% of Medicare rates beginning January 1, 2017.

• Mandates the Department establish quality standards for mammography and breast cancer treatment, implement reminder systems for age-appropriate screening, and develop breast cancer patient navigation services starting with pilot programs in multiple regions.