H.R. 6178 — Increasing Access to Lung Cancer Screening Act

This section requires state Medicaid programs to cover annual lung cancer screenings recommended by the U.S. Preventive Services Task Force for eligible individuals described in 42 U.S.C. 1396d(a) (i.e., mandatory coverage groups such as children under age 21, pregnant women, elderly individuals age 65 or older, and certain blind or disabled individuals), without cost-sharing or prior authorization. The requirement applies to fee-for-service and alternative cost-sharing plans, as well as Medicaid managed care organizations. The amendments apply to items and services furnished on or after January 1, 2026 (with an exception delaying implementation in states requiring legislation until the first calendar quarter after the first regular legislative session following enactment).

This section expands Medicaid coverage for counseling and pharmacotherapy for cessation of tobacco use (as defined in SSA §1905(bb), i.e., during quit attempts and in accordance with evidence-based guidelines) from pregnant women to all individuals eligible for medical assistance under SSA §1905(a), without regard to prior authorization. It makes conforming amendments to (1) remove the pregnant women limitation from the Medicaid drug rebate exclusion under SSA §1927(d)(2)(F); (2) revise cost-sharing exemptions and alternative cost-sharing rules under SSA §§1916(a)(2)(B), (b)(2), and 1916A(b)(3)(B) to apply such services to all Medicaid enrollees; and (3) require Medicaid managed care organizations under SSA §1932(b) to cover such services without prior authorization. The amendments apply to items and services furnished on or after January 1, 2026 (with an exception for states requiring state legislation to conform their plans).

This section prohibits prior authorization for annual lung cancer screening under Medicare Part B for individuals for whom such screening is recommended in accordance with guidelines issued by the Secretary of Health and Human Services. It further prohibits Medicare Advantage plans from imposing prior authorization for such screenings. The Medicare provisions apply to services furnished on or after January 1, 2026. This section also prohibits group health plans and health insurance issuers offering group or individual coverage from imposing prior authorization for USPSTF-recommended annual lung cancer screenings, effective for plan years beginning on or after January 1, 2026. (As background, Medicare covers annual low-dose computed tomography lung cancer screening for asymptomatic adults aged 50-80 with a 20 pack-year smoking history who currently smoke or quit within the past 15 years.)

This section directs the Secretary of Health and Human Services, in consultation with patient and lung cancer advocacy groups, to conduct an education and outreach campaign informing individuals and health care providers about the importance of lung cancer screenings and the categories of individuals who should receive them, targeting high-risk individuals. The section authorizes appropriations of $10 million for each of FY2026 through 2030 for this purpose.

This section directs the Comptroller General of the United States to conduct a study and submit to Congress, not later than one year after enactment, a report on the demographics of individuals diagnosed with lung cancer and individuals screened for such cancer. The report must identify (1) any population segments diagnosed with lung cancer but not captured in current screening eligibility guidelines (e.g., firefighters, veterans, and women under 50 years of age), and (2) actions the federal government could take to improve screening for such segments.