SenateS. 4566119th Congress
Increasing Access to Lung Cancer Screening Act
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[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4566 Introduced in Senate (IS)]
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119th CONGRESS
2d Session
S. 4566
To amend title XIX of the Social Security Act to require coverage under
State plans under the Medicaid program for annual lung cancer screening
with no cost sharing for individuals for whom screening is recommended
by U.S. Preventive Services Task Force guidelines, to expand coverage
under Medicaid of counseling and pharmacotherapy for cessation of
tobacco use, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 19, 2026
Mr. Durbin (for himself and Ms. Hirono) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to require coverage under
State plans under the Medicaid program for annual lung cancer screening
with no cost sharing for individuals for whom screening is recommended
by U.S. Preventive Services Task Force guidelines, to expand coverage
under Medicaid of counseling and pharmacotherapy for cessation of
tobacco use, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Increasing Access to Lung Cancer
Screening Act''.
SEC. 2. MEDICAID COVERAGE OF ANNUAL LUNG CANCER SCREENING WITH NO COST
SHARING FOR CERTAIN INDIVIDUALS.
(a) In General.--Section 1905(a)(4) of the Social Security Act (42
U.S.C. 1396d(a)(4)) is amended--
(1) by striking ``and'' before ``(D)'';
(2) by striking ``and'' before ``(E)'';
(3) by striking ``and'' before ``(F)''; and
(4) by inserting before the semicolon at the end the
following: ``; and (G) an annual lung cancer screening for
individuals who are eligible under the State plan or under a
waiver of such plan and for whom such screening is recommended
under guidelines published by the United States Preventive
Services Task Force (provided that such guidelines do not
decrease the recommended frequency of lung cancer screenings
for such individuals or narrow the population recommended for
lung cancer screening published by the United States Preventive
Services Task Force on March 9, 2021), without regard to prior
authorization''.
(b) No Cost Sharing.--
(1) In general.--Subsections (a)(2) and (b)(2) of section
1916 of the Social Security Act (42 U.S.C. 1396o) are each
amended--
(A) in subparagraph (I), by striking ``or'' at the
end;
(B) in subparagraph (J), by striking ``; and'' and
inserting ``, or'' at the end; and
(C) by adding at the end the following new
subparagraph:
``(K) lung cancer screening for which payment may
be made under the State plan or under a waiver of such
plan pursuant section to 1905(a)(4)(G); and''.
(2) Application to alternative cost sharing.--Section
1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o-
1(b)(3)(B)) is amended by adding at the end the following new
clause:
``(xv) Lung cancer screening for which
payment may be made under the State plan or
under a waiver of such plan pursuant to section
1905(a)(4)(G).''.
(c) Application to Medicaid Managed Care Organizations.--Section
1932(b) of the Social Security Act (42 U.S.C. 1396u-2(b)) is amended by
adding at the end the following new paragraph:
``(9) Lung cancer screening.--Each contract with a medicaid
managed care organization under section 1903(m) shall require
the organization to provide coverage for lung cancer screening
for which payment may be made under the State plan or under a
waiver of such plan pursuant to section 1905(a)(4)(G) without
regard to prior authorization.''.
(d) Effective Date.--
(1) In general.--Subject to paragraph (2), the amendments
made by this section shall apply with respect to items and
services furnished on or after January 1, 2028.
(2) Exception if state legislation required.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirements imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet such additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of the enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
SEC. 3. EXPANDING COVERAGE UNDER MEDICAID OF COUNSELING AND
PHARMACOTHERAPY FOR CESSATION OF TOBACCO USE TO ALL
MEDICAID INDIVIDUALS.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (a)(4)(D)--
(A) by striking ``by pregnant women''; and
(B) by inserting ``without regard to prior
authorization'' after ``(as defined in subsection
(bb))''; and
(2) in subsection (bb)--
(A) by striking ``by pregnant women'' each place it
appears;
(B) in paragraph (1), by striking ``tobacco use
who'' and inserting ``tobacco use (including the use of
e-cigarettes or vape pens) by individuals who''; and
(C) in paragraph (2)(A), by striking ``with respect
to pregnant women''.
(b) Conforming Amendments.--
(1) Section 1927(d)(2)(F) of the Social Security Act (42
U.S.C. 1396r-8(d)(2)(F)) is amended by striking ``, in the case
of pregnant women''.
(2) Section 1916 of the Social Security Act (42 U.S.C.
1396o), as amended by section 2(b)(1), is further amended in
each of subsections (a)(2) and (b)(2)--
(A) in subparagraph (B), by striking ``, and
counseling and pharmacotherapy for cessation of tobacco
use by pregnant women (as defined in section 1905(bb))
and covered outpatient drugs (as defined in subsection
(k)(2) of section 1927 and including nonprescription
drugs described in subsection (d)(2) of such section)
that are prescribed for purposes of promoting, and when
used to promote, tobacco cessation by pregnant women in
accordance with the Guideline referred to in section
1905(bb)(2)(A)'';
(B) in subparagraph (J), by striking ``or'' at the
end;
(C) in subparagraph (K), by striking ``; and'' at
the end and inserting ``, or''; and
(D) by adding at the end the following new
subparagraph:
``(L) counseling and pharmacotherapy for cessation
of tobacco use (as defined in section 1905(bb)) and
covered outpatient drugs (as defined in subsection
(k)(2) of section 1927 and including nonprescription
drugs described in subsection (d)(2) of such section)
that are prescribed for purposes of promoting, and when
used to promote, tobacco cessation in accordance with
the Guideline referred to in section 1905(bb)(2)(A);
and''.
(3) Section 1916A(b)(3)(B) of such Act (42 U.S.C. 1396o-
1(b)(3)(B)), as amended by section 2(b)(2), is further
amended--
(A) in clause (iii), by striking ``, and counseling
and pharmacotherapy for cessation of tobacco use by
pregnant women (as defined in section 1905(bb))''; and
(B) by adding at the end the following new clause:
``(xvi) Counseling and pharmacotherapy for
cessation of tobacco use (as defined in section
1905(bb)).''.
(c) Application to Medicaid Managed Care Organizations.--Section
1932(b) of the Social Security Act (42 U.S.C. 1396u-2(b)), as amended
by section 2(c), is further amended by adding at the end the following
new paragraph:
``(10) Cessation of tobacco use.--Each contract with a
medicaid managed care organization under section 1903(m) shall
require the organization to provide coverage for counseling and
pharmacotherapy for cessation of tobacco use without regard to
prior authorization.''.
(d) Effective Date.--
(1) In general.--Subject to paragraph (2), the amendments
made by this section shall apply with respect to items and
services furnished on or after January 1, 2028.
(2) Exception if state legislation required.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirements imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet such additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of the enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
SEC. 4. COVERAGE UNDER MEDICARE AND PRIVATE HEALTH INSURANCE OF ANNUAL
LUNG CANCER SCREENING WITHOUT UTILIZATION MANAGEMENT
REQUIREMENTS.
(a) Medicare.--
(1) In general.--Section 1834 of the Social Security Act
(42 U.S.C. 1395m) is amended by adding at the end the following
new subsection:
``(bb) Special Rule for Annual Lung Cancer Screening.--
Notwithstanding any other provision of this title, in the case of an
annual lung cancer screening for which benefits are provided under this
part for any individual for whom such screening is recommended in
accordance with guidelines issued by the Secretary, such benefits shall
be provided without application of any prior authorization.''.
(2) Application under medicare advantage.--Section
1852(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w-
22(a)(1)(B)) is amended by adding at the end the following new
clause:
``(vii) Prohibition of application of
certain requirements for annual lung cancer
screening.--In the case of an annual lung
cancer screening for which benefits are
provided under part B for any individual for
whom such screening is recommended in
accordance with guidelines issued by the
Secretary for purposes of section 1834(bb), an
MA plan may not impose any prior authorization
with respect to the coverage of such screening
under such plan.''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to services furnished on or after
January 1, 2028.
(b) Individual and Group Health Insurance Markets.--
(1) In general.--Section 2713 of the Public Health Service
Act (42 U.S.C. 300gg-13) is amended by adding at the end the
following new subsection:
``(d) Prohibition of Application of Certain Requirements for Annual
Lung Cancer Screening.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage may not
require any prior authorization with respect to the benefits under such
plan or coverage for an annual lung cancer screening for any individual
for whom such screening is recommended by the United States Preventive
Services Task Force.''.
(2) Effective date.--The amendments made by this subsection
shall apply with respect to plan years beginning on or after
January 1, 2028.
SEC. 5. LUNG CANCER SCREENING EDUCATION AND OUTREACH.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary''), in consultation with
patient and lung cancer advocacy groups, shall conduct an education and
outreach campaign for purposes of informing individuals and health care
providers of--
(1) the importance of lung cancer screenings; and
(2) the categories of individuals who should receive such
screenings.
(b) Manner of Outreach.--The Secretary may carry out the campaign
described in subsection (a) directly, by contract, through the issuance
of grants, or otherwise. In carrying out such campaign, the Secretary
shall ensure that the campaign is targeted to reach individuals at high
risk of lung cancer.
(c) Funding.--There are authorized to be appropriated $10,000,000
for each of fiscal years 2028 through 2032 for purposes of carrying out
this section.
SEC. 6. REPORT.
Not later than 1 year after the date of the enactment of this Act,
the Comptroller General of the United States shall conduct a study and
submit to Congress a report on the demographics of individuals
diagnosed with lung cancer and individuals screened for such cancer.
Such report shall identify--
(1) any segments of the population diagnosed with lung
cancer but not captured in current screening eligibility
guidelines (such as firefighters, veterans, and women under 50
years of age); and
(2) recommendations for how the Federal Government can
improve screening for such cancer among such segments.
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