April 14, 2026
Mrs. Cherfilus-McCormick introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
To amend title XXVII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to require coverage of certain cardiovascular tests without cost sharing under group health plans, group and individual health insurance coverage, and the Medicare and Medicaid programs.
Section 1. Short title
This Act may be cited as the Cardiovascular Disease Early Detection and Prevention Act of 2026
.
Sec. 2. Findings
Congress finds the following:
(1)
Cardiovascular disease is the leading cause of death in the United States.
(2)
Routine cholesterol panels often fail to detect elevated Lipoprotein(a) (Lp(a)) and Apolipoprotein B (ApoB) levels.
(3)
Approximately 1 in 5 Americans have elevated Lp(a) levels.
(4)
Elevated ApoB levels predict cardiovascular risk better than LDL cholesterol alone.
(5)
Nearly 50 percent of heart attack survivors die within five years without effective risk management.
Sec. 3. Requiring coverage of certain cardiovascular tests without cost sharing under group health plans, group and individual health insurance coverage, and the Medicare and Medicaid programs
(a) Public Health Service Act
Section 2713(a) of the Public Health Service Act (42 U.S.C. 300gg–13(a)) is amended—
(1)
in paragraph (2), by striking and
at the end;
(2)
in paragraph (3), by striking the period and inserting a semicolon;
(3)
by redesignating paragraphs (4) and (5) as paragraphs (5) and (6), respectively; and
(4)
by inserting after paragraph (3) the following new paragraph:
(4)
with respect to individuals with a family history of premature cardiovascular disease, a personal history of myocardial infarction, stroke, or elevated LDL cholesterol, a diagnosis of diabetes mellitus or obesity, or other recognized cardiovascular risk factors, testing for lipoprotein(a) and apolipoprotein B levels; and
(b) Medicare
(1) In general
Section 1861(xx)(1) of the Social Security Act (42 U.S.C. 1395x(xx)(1)) is amended—
(A)
by redesignating subparagraph (B) as subparagraph (C);
(B)
by inserting after subparagraph (A) the following new subparagraph:
(B)
In the case of an individual with a family history of premature cardiovascular disease, a personal history of myocardial infarction, stroke, or elevated LDL cholesterol, a diagnosis of diabetes mellitus or obesity, or other recognized cardiovascular risk factors, lipoprotein(a) and apolipoprotein B levels.; and
(C)
in the flush matter at the end, by striking subparagraph (B)
and inserting subparagraph (C)
.
(2) No application of cost sharing
Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended—
(A)
in subsection (a)(1)(Y), by inserting (other than tests for levels described in section 1861(ww)(1)(B) furnished to an individual described in such section)
after described in subparagraph (A)
; and
(B)
in subsection (b)(1), by striking for the individual.
inserting for the individual or that are tests for levels described in section 1861(ww)(1)(B) furnished to an individual described in such section
.
(c) Medicaid
(1) In general
Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended—
(A)
in paragraph (31), by striking and
at the end;
(B)
by redesignating paragraph (32) as paragraph (33); and
(C)
by inserting after paragraph (31) the following new paragraph:
(32)
testing for lipoprotein(a) and apolipoprotein B levels furnished to an individual with a family history of premature cardiovascular disease, a personal history of myocardial infarction, stroke, or elevated LDL cholesterol, a diagnosis of diabetes mellitus or obesity, or other recognized cardiovascular risk factors; and
(2) No cost sharing
(A) In general
Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o) are each amended—
(i)
in subparagraph (I), by striking or
at the end;
(ii)
in subparagraph (J), by striking ; and
and inserting , or
; and
(iii)
by adding at the end the following new subparagraph:
(K)
testing for lipoprotein(a) and apolipoprotein B levels furnished to an individual described in section 1905(a)(32); and
(B) 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)
Testing for lipoprotein(a) and apolipoprotein B levels furnished to an individual described in section 1905(a)(32).
(3) Mandatory coverage
Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by striking and (30)
and inserting (30), and (32)
.
(4) Benchmark coverage and benchmark-equivalent coverage
Section 1937(b) of the Social Security Act (42 U.S.C. 1396u–7(b)) is amended by adding at the end the following new paragraph:
(9) Coverage of certain lipid level testing
Notwithstanding the previous provisions of this section, a State may not provide for medical assistance through enrollment of an individual with benchmark coverage or benchmark-equivalent coverage under this section unless such coverage provides, with respect to an individual described in section 1905(a)(32), testing for lipoprotein(a) and apolipoprotein B levels.
(d) Effective date
The amendments made by—
(1)
subsection (a) shall apply with respect to plan years beginning on or after the date that is 180 days after the date of the enactment of this Act; and
(2)
subsections (b) and (c) shall apply with respect to items and services and medical assistance, respectively, furnished on or after such date.