H.B. 468 Mobile Mammography Amendments: transcript

Thank you, Madam Chair. May I begin? Yes, Please. Thank you. Okay. Um, breast cancer remains the most commonly diagnosed cancer among women and the second leading cause of cancer death in the United States. The evidence is clear. Early detection through regular mammography saves lives and lowers overall healthcare costs. When screenings are delayed. Cancers are found at later stages when treatment is more intensive. Outcomes are worse and the costs are significantly higher. In Utah, women living in rural communities are screened at lower rates than women in urban areas. The barrier is not awareness, it's access. For ma many rural women. Getting a mammogram can mean taking time off work, arranging childcare, driving long distances to an urban facility. And Utah already has a solution in place. Three qualified mobile mammography units that travel throughout Utah. Uh, rural communities delivering high quality screening services close to home. These programs are established, effective, and trusted. The problem is that not all insurance plans contract with these mobile units. As a result, women who are insured sometimes cannot use their coverage. When the mobile unit comes to their town, they're turned away not because of a lack of insurance, but because their panel has not, their plan has not paneled the provider. Uh, second substitute, HB uh, 4 68 addresses this gap in counties of the third, fourth, fifth, and sixth class Utah's rural counties. The bill directs insurers to contract with the state's mobile mammography providers. This ensures that women can receive their covered preventative screening screening in their own communities rather than traveling to urban centers. This bill is carefully structured. There is no fiscal note. Insurance carriers were engaged in crafting the language to ensure feasibility screenings must follow. The United States Preventive Services task force guidelines for appropriate frequency and mobile providers are prohibited from balance, balance billing, uh, patients. And this legislation does not expand benefits or mandate new services. It simply ensures that rural women can access the preventative care they always already have coverage for, but closer to home. Improving access to timely mammography increases early detection, improves survival outcomes, and reduces the long-term costs associated associated with late stage breast cancer treatment. I would appre appreciate your support and that's my presentation, Madam Chair. Thank you. Thank you so much.

Thank you. Uh, Madam Chair. So there are federal rules that require that screening tests be covered with no copay. Um, so I think all insurances that, at least that I'm aware of already, if something is considered screening, like which mammography is for a screening mammogram are already covered with no copay. So can you clarify for me what additional coverage past what is already required on a federal basis is covered by the bill?

I think that the, the issue here is that insurances have not, they have not approved the mobile unit. This is not a, a fiscal issue. This is not money. This is just the fact that they, um, haven't signed on to do this.

Okay. So they said it was a covered, a covered service, but they said we won't cover it with the mobile unit. Right. Right. So we're trying, that's the issue. So we'll cover it if you go, you travel a couple of hours or you know, all this kind of stuff. It's just, it hasn't been with the mobile, not all insurances. There probably are some, but not all. So some insurances also do go through a certain provider. So they would say, look, we for sure cover a mammogram with no copay, but we don't cover it at this hospital 'cause we're not contracted with them. We do cover it at, these are the places where we cover it. So does this cover it for a certain company that has a mobile unit or for any company that wa Do you see what I'm saying? What if there were different companies that had mobile units? Would the insurer be required to cover all of them? Or just at least one

Representative? I'm not sure as to the answer of that. I don't think there's a very many mobile units. It's not like we've got 25 of 'em out there. I'm Just, if if there were, I'm just not sure. I'm not sure what the bill is requiring It is that if a company has not signed on as a provider, that they, they would, I mean, least it's gonna cover it just like they already do. Yep. It's just they have not signed on with at least one mobile unit, but yeah, exactly.

Okay. Thank you. My name is Sarah Ey. I am a family physician. I practice with committee health centers and I work with the Association for Utah Community Health Centers. Half of our members are, um, in rural areas, and we speak in support of this bill. Um, just a couple of clarifying points for, uh, Dr. Ward. For example, if, if a Select Health patient is at a place where there is a bus that is supported by a University of Utah bus, they may not be able to be seen with their insurance. So the discrepancy sometimes between the credentialed bus and the what it takes, um, and, and then what the person's insurance is. So imagine your community has an event. You've paid for insurance. Your family's paid for insurance. You go out to the community event, you go up to the bus, and then you can't be seen because your insurance isn't taken by that bus. So the idea would be to extend in rural areas the coverage for whatever buses come through, um, uh, that occur. And then in terms of the, uh, this is just for screening. And so for people that needed more procedures, um, ultrasound may or may not be available. Some do, uh, provide that, some don't. But this would be for the, the basic screening is what we're asking for. And I would just say, uh, health centers, uh, appreciate this. We work hard to make screening available. Rural women do get to travel a long way. Take off time. Utah, we're 44 of 50 in the latest data on our screening rates as a state. And in some rural counties, it's 10% lower than our average. So we can do better. I really appreciate Representative Watkins talking about this is not awareness. This is often access. And whatever we can do to improve that makes a difference. I do have a paper that was, uh, written by University of Utah researchers, cancer researchers around the disparity between, um, survival and breast cancer between urban and rural women. If anyone's interested, I will leave those copies. And again, thank you for the opportunity to present.

I'll take 30 seconds. Maryanne Martin, Dell, Utah Academy Family Physicians. We love this bill. I will beat the early prevention drum over and over and over. You guys have heard me say that many times, but the earlier you detect, the greater the survival rate. And this is one of the ways that we're gonna do this, especially when it comes to rural areas where, where access is so limited. So we encourage your support. Thank you.

Chris Heseltine, Utah Medical Association. Um, we obviously support this bill very much. And, uh, I want to emphasize this is just for rural areas. There are currently three buses in the state of Utah that perform this service, and we have spoken to many of the larger insurers, and they're completely fine with it. Uh, which we were very pleased to hear Blue Cross and, and IHC and others. So that's why there's no fiscal note, and that's why this is a slam dunk, um, just to support, uh, what we really need to have. And, uh, what's already paid for If someone were forced to drive three hours to Salt Lake to go into a brick and mortar clinic. So thank you so much for, uh, listening and supporting the bill.

Yes, ma'am. Um, my name is Shalisa Hughes. I actually live in Green River, which is a rural community in Utah. I'm not only a patient of the rural, um, healthcare system. I also work in the healthcare system. For many, many years, I have worked with all three mobile units that serve Utah. My role is including coordinating their visits into the rural communities and working with insurance companies across the state to ensure coverage for patients. Through that work, I have seen firsthand the barriers that rural women face in accessing basic preventative care. I've watched women get turned away from screening mammograms, not because the service wasn't available, but because their insurance company would not contract or accept the mobile unit that provide care in these areas. These are very qualified providers bringing essential services to underserved communities, and yet, women are denied coverage simply because the contracting decision made by their insurance companies. I have seen women walk away frustrated, discouraged, and unable to get preventative service that could save their lives. In many rural areas, mammogram services are extremely limited. And for some women, the nearest facil fixed facility is more than 65 miles away. Travel requires re reliable transportation, time off work, fuel and cost for childcare. Many of these womens cannot take time off, pay time off, and the limited leave to limited leave they have is reserved for their children when they're sick. Preventative care for themselves becomes a low priority, and not because it's not important, but because rural life communities require difficult trade-offs, allowing women to receive mammograms in their own communities when the mobile units are available, will serve these areas and remove the significant barriers to care. No woman should be turned away from preventative screenings simply because their insurance company refuses to contract with the only provider willing to serve their area. Rural women deserve the same access to preventative care as anyone else in Utah. We've also received a letter of support from one of the mobile units, the Boob Bus, and it was emailed to the committee earlier today. Thank you for your time and your consideration.

I move that we pass out HP 4 68, um, with a favorable recommendation. Can you adopt The sub? Oh, I apologize. Thank You. So, um, I move that we, um, adopt, um, first, um, second substitute HB 4 68.

I waive. All right.

Thank you. Basically the bill, right? Yeah. Um, it's the bill I spoke to. Yep.

I move that we pass out HB 4 68 breast cancer prevention amendments with a favorable recommendation.

Sure. Um, for me, this is a no brainer. It's all about equality and access, um, for me. Um, and I think that, um, this bill does that, it provides it. I've known a number of women who have had breast cancer, and I know the importance of early prevention. So I support this.

Thank you. Um, yeah, there we've lost too many, uh, women to breast cancer, but with early detection and from personal experience, the medicines that they have nowadays, um, uh, there's no reason almost, unless it's a particular aggressive kind. So, the earlier we find out, and having lived in rural Utah all of my adult life, um, access can be a real problem for a lot of things. And this, this shouldn't be the case when we have these units that are available to come out. So, appreciate your support. Thank you.

of the motion I waive.

Thank you. I too wanted to vote yay and nay when I would hear your voice saying things 'cause it just seems so familiar. But thank you. Um, this mobile ma mammography amendments bill deals with, um, uh, women who live in rural Utah. Breast cancer remains the most commonly diagnosed cancer among women, and the second leading cause of cancer death in the United States. The evidence is clear. Early de detection through regular mammography saves lives, and it lowers overall healthcare costs. When screenings are delayed, cancers are found at later stages. When treatment is more intensive, outcomes are worse and the costs are significantly higher. So in Utah, women and live in living in rural communities are screened at lower rates than women in urban areas, areas the barrier is not awareness. It's access. For many rural women, getting a mammogram can mean taking time off work, arranging childcare, and driving long distances to get the to an urban facility. It, uh, but Utah has a strong solution in place. Three qualified mobile mammography units that travel throughout rural uk uh, communities delivering high quality screening services close to home. These programs are established, effective, and trusted. So the problem here is that not all insurance plans contract with these mobile providers. So as a result, women show up to have them done, have a a, a screening done, and they're turned away because their insurance is the, uh, is doesn't allow for this provider. So, um, this bill addresses that gap. And in the counties of third, fourth, fifth, and sixth class, the bill directs insurers to contract with the state's mobile mammography, uh, providers. And this means that anyone, uh, that lives out there, if they have insurance, that they would be able to have this screening done. There is no fiscal note. Insurance carriers were engaged in crafting the language to make sure that everything was feasible for them. They still have to follow, uh, the screenings, the US Preventative Services Tax Force guidelines for appropriate, uh, frequency. And the mobile providers are prohibited from balance billing patients. This does not expand or create new services. It just ensures that rural women can access the preventative care that they already have coverage for closer to home. And that is the bill. Uh, Mr. Chair.

Thank you, Mr. Chair. Um, we appreciate, uh, Representative Watkins running this bill for us. We, um, know that in Utah the screenings for mammograms are, are fairly low and quite abysmal in rural areas. And so this mobile ma mammography bill will help bring now those services to rural areas where hopefully women will get their screening done earlier and we can catch cancer earlier and we can prevent deaths. So we hope you can pass this out favorably. Thank you.

Martindale, Utah Academy Family Physicians. What she said. Love it. Pass it. Thanks.

So, um, my name is Shalisa Hughes. I live in Green River, which is a rural Utah community. And not only am I a patient of our rural healthcare system, but I also work in the healthcare system. Over the years, I have worked with all three mobile mammal units in Utah, and my role includes coordinating their visits to rural communities. It also coordinates working with insurance companies to help, um, make sure the coverage for the patients. Through working through that, I have seen the frustrations and barriers many rural women face in accessing basic preventative care. Hi, watched women be turned away from screening mammograms, not because the service wasn't available, but because insurance companies would not contract or accept to the mobile units that were in their area. These are fully qualified providers bringing essential services to our rural Utah. I have seen women walk away frustrated and discouraged, unable to receive preventative screenings to save their lives In many rural areas, mammogram services are extremely LI limited, and for some it is as much as 65 miles or more away. This requires, you know, standable, reliable transportation, time of work, fuel costs, and a lot of times childcare arrangements supposed to be made. Many of these women cannot take untimed paid off. They limit their leave to have it reserved when their children are sick. Preventative care for themselves become a very low priority, not because it's not important, but because in rural communities require difficult trade-offs. Allowing women to receive mammograms in their own communities when mobile units are there and willing to serve them will remove the significant barrier to care. No women should be turned away from a preventative service simply because their insurance company refuses to contract with the only provider willing to serve their area. Rural women deserve access to preventative care just as anybody else in Utah. Thank you for your time and consideration.

Um, my name is Rachel Craig. I'm the Government affairs manager, also at the Association for Utah Community Health. Ouch. And I will just echo Whatsa said and keep it short. We love this bill.

Thank you, Senator. Make a motion that we, um, favorably recommend second substitute HV 4 68 to the Senate

That. And Mr. Chair, I mean, I know we're in a role on the, the con, um, consent. Um, this is a, it is been supported by everyone. I saw that check. There was no naval. So are you okay if we make a motion to place it on consent?

Like. I'll make the motion, sir.

How would you feel about that? Absolutely, absolutely.

Thank you Mr. Speaker. Uh, Mr. Speaker, breast cancer remains the most common, uh, diagnosed, uh, cancer among women. And it is the second leading cause of death for women in the United States. The evidence is clear. Early detection is really, really important. If you can detect the breast cancer early, you um, prevent suffering, you prevent high costs and hopefully you will prevent a death in Utah. Women living in rural areas are not being, um, what's the word I want. We are not being, uh, screened at the same rate that women in urban parts of Utah are. It's not because they don't have insurance. It, it's not because they don't want to and they lack the education. It's the lack of the opportunity. A day off work, travel a long ways away to be screened. And Utah already has a solution to this problem. We have three mobile mammography units that travel all over Utah to screen women. The problem that we have run into is that there are insurance companies that don't ensure that screening for, um, women in rural Utah. So what we have done is, uh, we have worked with those insurance companies and they will now add those units to the panel that the, of the, uh, screening so that they can, um, the women can go and be insured. So there is 3, 3, 4 things we've done here. There is no fiscal note to this bill. The insurance carriers were engaged in drafting the language to ensure feasibility screenings must follow the United States Preventative Services task force guidelines for appropriate frequency. And the mobile providers are prohibited from balance billing. So, uh, the patients, so for the women who live in third, fourth, fifth, and sixth counties, they will be able to have the opportunity to have this cancer screening and their insurance pay for it. Mr. Speaker that I am open to any questions on this?

Thank you, Mr. Speaker. Will the sponsor yield to a series of questions?

Yes, yes. Representative Thurston, I, I'm, I'm very sensitive to the fact of making sure that these mobile units are compensated fairly. So in your discussions with them, do you think that their costs of operation are higher or lower than the corresponding in-network facilities?

I'm Mr. Speaker, I'm not sure. Uh, Do you want me to repeat the question? Well, Yeah, I'm just not sure what Mr. Speaker, what you're asking. So may Okay. Repeat it. Maybe change it a little.

Yeah, so let me rephrase the question. So if you have a mobile mammography unit, there is a certain cost associated with that program, right? They, the program, they have the bus or whatever, they have the equipment and all the people and they gotta travel and there's a lot of cost to that. Or if you have a clinic, a brick and mortar store, they also have costs, they have to pay for their utility and their lights and the people and all of that stuff. So I'm just wondering if the mobile mammography unit is actually more expensive than the brick and mortar store,

Mr. Speaker, I don't know the answer to that question, but the insurance companies were at the table and they, they were not forced to agree to something that they didn't want to participate in. So I, I don't, I personally don't believe that they will charge any more for a mobile unit than they would for a brick and mortar.

Thank you Mr. Speaker. I, I think that's part of my question. My biggest concern is that, for example, if Huntsman Cancer has a mobile mammography unit, which we know they do and that they're asked to accept, 'cause the bill says that they have to accept it as the actual, the same payment that they would get for in-person, but they're losing money on the mobile mammography units and that those will go away over time. I wanna make sure that the insurance companies are not just short changing the mobile mammography, but I think looking at the bill the way that it's structured is certainly better than what we're getting today. And maybe over time we will find out that they're under paying for the mobile service and that we'll have to come back and say, you know, you have to have a, a separate agreement that that actually covers the cost. That's the important thing to me, is that the provider of the care get paid fairly for the cost of the care, and if those are more expensive, they should get paid more. So with, I'm supportive of the bills, it just, I want to put a little asterisk on it, noting that there is a potential thing to keep an eye on to make sure that they are not getting shortchanged in the process. So thank you Mr. Speaker for sponsoring the legislation.

Oh, thank you Mr. Speaker. I want I rise to speak in support of the bill and take a crack at the last question. I think each of these providers have their own mobile mammography unit that they are comfortable with the rate that they pay to them. And I think the agreement is that they'll treat the, the others that typically would be outside of their network the same way in what they pay to them. So each of the ones, they, they kind of know for their own unit what it costs and what they're willing to pay to the provider. So I think they do have enough data to, to already know what a fair payment is and to be willing to take a mammogram done at a mobile unit of one of the other providers and give them the same payment. So I think that makes the bill work out fairly well.

Thank you Mr. Chair or Mr. Speaker. Um, I think this is an important bill for all of the women that live in rural Utah. Not all of them need this. They may live closer to a hospital, um, that can do this, but there are so many that it just takes so much time and they're so involved in their lives that to do it, they put it off and that's where we can end up with the tragic consequences. So I'd appreciate your support. Thank you, Mr. Speaker.

Thank. Thank you Mr. President. Uh, what this bill, the breast cancer remains the most commonly diagnosed cancer among women and the second leading cause of cancer deaths in the United States. What this bill does is it provides, uh, the insurance companies have to provide, uh, coverage in the counties of the third, fourth, fifth, and sixth class in rural Utah counties. And there's no fiscal note to the state here. And, uh, the insurance carriers were engaged in crafting the language to ensure feasibility. And with that, so I call the question.