HR6178-119

What This Bill Does

The Increasing Access to Lung Cancer Screening Act amends Medicaid, Medicare, Medicare Advantage, and private insurance rules for lung cancer screening. Medicaid State plans must cover annual lung cancer screening for eligible people for whom the United States Preventive Services Task Force recommends screening, without prior authorization and without cost-sharing. Medicaid managed care contracts must cover the same screening without prior authorization. The bill also expands Medicaid tobacco-cessation counseling, pharmacotherapy, and related covered outpatient drugs from the current pregnancy-focused structure to all Medicaid individuals, again without prior authorization and cost-sharing. For Medicare Part B and Medicare Advantage, annual lung cancer screening recommended under Secretary-issued guidelines must be covered without prior authorization for services furnished on or after January 1, 2026. Group health plans and individual-market issuers may not impose prior authorization for USPSTF-recommended annual lung cancer screening for plan years beginning on or after January 1, 2026. HHS must run an education and outreach campaign with patient and lung cancer advocacy groups, targeted to people at high risk, and the bill authorizes $10 million per year for fiscal years 2026 through 2030. GAO must report within one year on diagnosed and screened populations, including gaps affecting firefighters, veterans, and women under 50.

Who Benefits and How

Medicaid beneficiaries at high risk of lung cancer benefit because annual USPSTF-recommended screening becomes covered without prior authorization and without cost-sharing. Medicaid beneficiaries who use tobacco benefit because cessation counseling, pharmacotherapy, and covered outpatient drugs become available beyond pregnancy-specific coverage. Medicare beneficiaries recommended for lung cancer screening benefit because Part B and Medicare Advantage plans cannot impose prior authorization. Privately insured people at high risk of lung cancer benefit because group and individual market plans cannot use prior authorization for USPSTF-recommended annual screening. Lung cancer screening providers benefit from more covered, less administratively blocked screening volume. Patient advocacy organizations benefit because HHS must consult them and may use grants or contracts for outreach.

Who Bears the Burden and How

State Medicaid programs must add annual lung cancer screening and broader tobacco-cessation benefits without cost-sharing and prior authorization barriers. Medicaid managed care organizations must update contracts and utilization-management practices for lung cancer screening and cessation services. Medicare Advantage plans must remove prior authorization for covered annual lung cancer screening. Private health insurance issuers and group health plans must cover USPSTF-recommended annual lung cancer screening without prior authorization. HHS outreach staff must conduct a targeted education campaign and administer up to $10 million per year in authorized outreach resources. GAO health auditors must study screening demographics and identify populations missed by current eligibility guidelines.

Key Provisions

• Requires Medicaid coverage of annual USPSTF-recommended lung cancer screening without prior authorization.
• Prohibits Medicaid cost-sharing for covered lung cancer screening.
• Expands Medicaid tobacco-cessation counseling, pharmacotherapy, and related drug coverage to all Medicaid individuals.
• Prohibits Medicare Part B and Medicare Advantage prior authorization for covered annual lung cancer screening.
• Prohibits group and individual health plans from imposing prior authorization for USPSTF-recommended annual lung cancer screening.
• Authorizes $10 million per year from fiscal years 2026 through 2030 for HHS lung cancer screening outreach.
• Requires GAO to study screening gaps affecting firefighters, veterans, women under 50, and other populations.