S. 4566

[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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