As Introduced
136th General Assembly
Regular Session H. B. No. 271
2025-2026
Representatives Schmidt, Williams
Cosponsors: Representatives Newman, Johnson, Brewer, White, E., Troy, Brennan, Rogers, Brownlee, Ray, Click, Richardson, Robb Blasdel, Hall, T., Odioso, White, A., Abrams
To amend sections 1751.62, 3923.52, 3923.53, 5162.20, and 5164.08 of the Revised Code to revise the law governing insurance and Medicaid coverage of breast cancer screenings and examinations and to name this act the Breast Examination and Screening Transformation Act, or BEST Act.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 1751.62, 3923.52, 3923.53, 5162.20, and 5164.08 of the Revised Code be amended to read as follows:
Sec. 1751.62. (A) As used in this section:
(1)
"Screening mammography" means a radiologic examination
that, in accordance with applicable American college of radiology
guidelines, is
utilized to detect unsuspected
breast
cancer at
an early stage in an asymptomatic woman and
includes the x-ray examination of the breast using equipment that is
dedicated specifically for mammography, including, but not limited
to, the x-ray tube, filter, compression device, screens, film, and
cassettes, and that has an average radiation exposure delivery of
less than one rad mid-breast. "Screening mammography"
includes digital breast tomosynthesis. "Screening mammography"
includes two views for each breast. The term also includes the
professional interpretation of the film.
"Screening mammography" does not include diagnostic mammography.
(2)
"Medicare
reimbursement rate" means the reimbursement rate paid in Ohio
under the medicare program for screening mammography that does not
include digitization or computer-aided detection, regardless of
whether the actual benefit includes digitization or computer-aided
detection.
(3)
"Diagnostic
breast examination" means any examination that, in accordance
with applicable American college of radiology guidelines, is deemed
medically necessary by a treating health care provider to diagnose
breast cancer, including diagnostic mammography, magnetic resonance
imaging, ultrasound, or biopsy.
(3) "Supplemental breast cancer screening" means any additional screening method deemed medically necessary by a treating health care provider for proper breast cancer screening in accordance with applicable American college of radiology guidelines, including magnetic resonance imaging, ultrasound, contrast enhanced mammography, or molecular breast imaging.
(4) "Cost-sharing" means the cost to an enrollee under an individual or group health insuring corporation policy, contract, or agreement according to any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense requirements imposed by the policy, contract, or agreement.
(B) Notwithstanding section 3901.71 of the Revised Code, every individual or group health insuring corporation policy, contract, or agreement providing basic health care services that is delivered, issued for delivery, or renewed in this state shall provide benefits for the expenses of all of the following:
(1)
To detect the presence of breast cancer in adult womenindividuals,
a
screening
mammography;
(2)
To detect the presence of breast cancer in adult women
individuals
meeting
either or
both of
the conditions described in division (C)(2) of this section,
supplemental breast cancer screening;
(3) To diagnose breast cancer in adult individuals meeting the condition described in division (C)(3) of this section, a diagnostic breast examination;
(4) To detect the presence of cervical cancer, cytologic screening.
(C)(1) The benefits provided under division (B)(1) of this section shall cover expenses for one screening mammography every year, including digital breast tomosynthesis.
(2)
The benefits provided under division (B)(2) of this section shall
cover expenses for supplemental breast cancer screening for an adult
woman
individual
who
meets either or
both of
the following conditions:
(a)
The woman's
individual's
screening
mammography demonstrates, based on the breast imaging reporting and
data system established by the American college of radiology, that
the woman
individual
has
dense breast tissue;
(b)
The woman
individual
is
at an increased risk of breast cancer due to family history, prior
personal history of breast cancer, ancestry, genetic predisposition,
or other reasons as determined by the woman's
individual's
health
care provider.
(3) The benefits provided under division (B)(3) of this section shall cover expenses for diagnostic breast examination for an adult individual who has an abnormality seen or suspected from, or detected by, a screening mammography, supplemental breast cancer screening, or another means of examination.
(D)(1)
Subject to divisions (D)(2) and (3) of this section, if a provider,
hospital, or other health care facility provides a service that is a
component of the
screening mammography a
benefit
in
provided
under division
(B)(1),
(2), or (3)
of this section or
a component of the supplemental breast cancer screening benefit in
division (B)(2) of this section and
submits a separate claim for that component, a separate payment shall
be made to the provider, hospital, or other health care facility
in an amount that corresponds to the ratio paid by medicare in this
state for that component.
(2)
Regardless
of whether separate payments are made for the The
total benefit
provided under division (B)(1),
or
(2),
or (3)
of this section, the
total benefit for a screening mammography or supplemental breast
cancer screening shall not exceed one hundred thirty per cent of the
medicare reimbursement rate in this state for screening mammography
or supplemental breast cancer screening. If there is more than one
medicare reimbursement rate in this state for screening mammography
or a component of a screening mammography or supplemental breast
cancer screening or a component of supplemental breast cancer
screening, the reimbursement limit shall be one hundred thirty per
cent of the lowest medicare and
any separate payment for a service that is a component of such a
benefit under division (D)(1) of this section, shall not be less than
any reimbursement
rate previously
paid by the same individual or group health insuring corporation
under a policy, contract, or agreement providing basic health care
services that is delivered, issued for delivery, or renewed in
this state
after the effective date of this amendment to the same provider,
hospital, or other health care facility for the same benefit or
service that is a component of such benefit.
(3)
The benefit paid in accordance with division
divisions
(D)(1)
and
(2) of
this section shall constitute full payment. No provider, hospital, or
other health care facility shall seek or receive remuneration in
excess of the payment made in accordance with division
divisions
(D)(1)
and
(2) of
this section,
except for approved deductibles and copayments.
(E)
The (E)(1)
Except as provided in division (E)(2) of this section, the benefits
provided under division (B)(1)
or ,
(2),
or (3)
of this section shall be provided only for screening mammographies
or ,
supplemental
breast cancer screenings,
or diagnostic breast examinations
that are performed in a health care facility or mobile mammography
screening unit that is accredited under the American college of
radiology mammography accreditation program or in a hospital as
defined in section 3727.01 of the Revised Code.
(2) With respect to diagnostic breast examinations that are biopsies, the policy shall not, as a condition of coverage, require biopsies to be performed in a facility, mobile mammography screening unit, or hospital as described in division (E)(1) of this section.
(F) The benefits provided under division (B) of this section shall be provided according to the terms of the subscriber contract.
(G)
The benefits provided under division (B)(3)
(B)(4)
of
this section shall be provided only for cytologic screenings that are
processed and interpreted in a laboratory certified by the college of
American pathologists or in a hospital as defined in section 3727.01
of the Revised Code.
(H) No individual or group health insuring corporation policy, contract, or agreement providing basic health care services that is delivered, issued for delivery, or renewed in this state shall impose a cost-sharing requirement for the benefits provided under division (B) of this section.
Sec. 3923.52. (A) As used in this section and section 3923.53 of the Revised Code:
(1)
"Screening mammography" means a radiologic examination
that, in accordance with applicable American college of radiology
guidelines, is
utilized to detect unsuspected
breast
cancer at
an early stage in asymptomatic women and
includes the x-ray examination of the breast using equipment that is
dedicated specifically for mammography, including, but not limited
to, the x-ray tube, filter, compression device, screens, film, and
cassettes, and that has an average radiation exposure delivery of
less than one rad mid-breast. "Screening mammography"
includes digital breast tomosynthesis. "Screening mammography"
includes two views for each breast. The term also includes the
professional interpretation of the film.
"Screening mammography" does not include diagnostic mammography.
(2) "Diagnostic breast examination" means any examination that, in accordance with applicable American college of radiology guidelines, is deemed medically necessary by a treating health care provider to diagnose breast cancer, including diagnostic mammography, magnetic resonance imaging, ultrasound, or biopsy.
(3) "Cost-sharing" means the cost to an individual insured under an individual or group policy of sickness and accident insurance or a public employee benefit plan according to any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense requirements imposed by the policy or plan.
(4) "Supplemental breast cancer screening" means any additional screening method deemed medically necessary by a treating health care provider for proper breast cancer screening in accordance with applicable American college of radiology guidelines, including magnetic resonance imaging, ultrasound, contrast enhanced mammography, or molecular breast imaging.
(B) Notwithstanding section 3901.71 of the Revised Code, every policy of individual or group sickness and accident insurance that is delivered, issued for delivery, or renewed in this state shall provide benefits for the expenses of all of the following:
(1)
To detect the presence of breast cancer in adult womenindividuals,
a
screening
mammography;
(2)
To detect the presence of breast cancer in adult women
individuals
meeting
either or
both of
the conditions described in division (C)(2) of this section,
supplemental breast cancer screening;
(3) To diagnose breast cancer in adult individuals meeting the condition described in division (C)(3) of this section, a diagnostic breast examination;
(4) To detect the presence of cervical cancer, cytologic screening.
(C)(1) The benefits provided under division (B)(1) of this section shall cover expenses for one screening mammography every year, including digital breast tomosynthesis.
(2)
The benefits provided under division (B)(2) of this section shall
cover expenses for supplemental breast cancer screening for an adult
woman
individual
who
meets either or
both of
the following conditions:
(a)
The woman's
individual's
screening
mammography demonstrates, based on the breast imaging reporting and
data system established by the American college of radiology, that
the woman
individual
has
dense breast tissue;
(b)
The woman
individual
is
at an increased risk of breast cancer due to family history, prior
personal history of breast cancer, ancestry, genetic predisposition,
or other reasons as determined by the woman's
individual's
health
care provider.
(3) The benefits provided under division (B)(3) of this section shall cover expenses for diagnostic breast examination for an adult individual who has an abnormality seen or suspected from, or detected by, a screening mammography, supplemental breast cancer screening, or another means of examination.
(D)
As used in this division, "medicare reimbursement rate"
means the reimbursement rate paid in this state under the medicare
program for screening mammography that does not include digitization
or computer-aided detection, regardless of whether the actual benefit
includes digitization or computer-aided detection.
(1)
(D)(1)
Subject
to divisions (D)(2) and (3) of this section, if a provider, hospital,
or other health care facility provides a service that is a component
of the
screening mammography a
benefit
in
provided
under division
(B)(1),
(2), or (3)
of this section or
a component of the supplemental breast cancer screening benefit in
division (B)(2) of this section and
submits a separate claim for that component, a separate payment shall
be made to the provider, hospital, or other health care facility
in an amount that corresponds to the ratio paid by medicare in this
state for that component.
(2)
Regardless
of whether separate payments are made for the The
total benefit
provided under division (B)(1),
or
(2),
or (3)
of this section, the
total benefit for a screening mammography or supplemental breast
cancer screening shall not exceed one hundred thirty per cent of the
medicare reimbursement rate in this state for screening mammography
or supplemental breast cancer screening. If there is more than one
medicare reimbursement rate in this state for screening mammography
or a component of a screening mammography or supplemental breast
cancer screening or a component of supplemental breast cancer
screening, the reimbursement limit shall be one hundred thirty per
cent of the lowest medicare and
any separate payment for a service that is a component of such a
benefit under division (D)(1) of this section, shall not be less than
any reimbursement
rate previously
paid by the same insurer under a policy of individual or group
sickness and accident insurance that is delivered, issued for
delivery, or renewed in
this state
after the effective date of this amendment to the same provider,
hospital, or other health care facility for the same benefit or
service that is a component of such benefit.
(3)
The benefit paid in accordance with division
divisions
(D)(1)
and
(2) of
this section shall constitute full payment. No provider, hospital, or
other health care facility shall seek or receive compensation in
excess of the payment made in accordance with division
divisions
(D)(1)
and
(2) of
this section,
except for approved deductibles and copayments.
(E)
The (E)(1)
Except as provided in division (E)(2) of this section, the benefits
provided under division (B)(1)
or ,
(2),
or (3)
of this section shall be provided only for screening mammographies
or ,
supplemental
breast cancer screenings,
or diagnostic breast examinations
that are performed in a facility or mobile mammography screening unit
that is accredited under the American college of radiology
mammography accreditation program or in a hospital as defined in
section 3727.01 of the Revised Code.
(2) With respect to diagnostic breast examinations that are biopsies, the policy shall not, as a condition of coverage, require biopsies to be performed in a facility, mobile mammography screening unit, or hospital as described in division (E)(1) of this section.
(F)
The benefits provided under division (B)(3)
(B)(4)
of
this section shall be provided only for cytologic screenings that are
processed and interpreted in a laboratory certified by the college of
American pathologists or in a hospital as defined in section 3727.01
of the Revised Code.
(G) No policy of individual or group sickness and accident insurance that is delivered, issued for delivery, or renewed in this state shall impose a cost-sharing requirement for the benefits provided under division (B) of this section.
(H) This section does not apply to any policy that provides coverage for specific diseases or accidents only, or to any hospital indemnity, medicare supplement, or other policy that offers only supplemental benefits.
Sec. 3923.53. (A) Notwithstanding section 3901.71 of the Revised Code, every public employee benefit plan that is established or modified in this state shall provide benefits for the expenses of all of the following:
(1)
To detect the presence of breast cancer in adult womenindividuals,
a
screening
mammography;
(2)
To detect the presence of breast cancer in adult women
individuals
meeting
any
either
or both of
the conditions described in division (B)(2) of this section,
supplemental breast cancer screening;
(3) To diagnose breast cancer in adult individuals meeting the condition described in division (B)(3) of this section, a diagnostic breast examination;
(4) To detect the presence of cervical cancer, cytologic screening.
(B)(1) The benefits provided under division (A)(1) of this section shall cover expenses for one screening mammography every year, including digital breast tomosynthesis.
(2)
The benefits provided under division (A)(2) of this section shall
cover expenses for supplemental breast cancer screening for an adult
woman
individual
who
meets any
either
or both of
the following conditions:
(a)
The woman's
individual's
screening
mammography demonstrates, based on the breast imaging reporting and
data system established by the American college of radiology, that
the woman
individual
has
dense breast tissue;
(b)
The woman
individual
is
at an increased risk of breast cancer due to family history, prior
personal history of breast cancer, ancestry, genetic predisposition,
or other reasons as determined by the woman's
individual's
health
care provider.
(3) The benefits provided under division (B)(3) of this section shall cover expenses for diagnostic breast examination for an adult individual who has an abnormality seen or suspected from, or detected by, a screening mammography, supplemental breast cancer screening, or another means of examination.
(C)
As used in this division, "medicare reimbursement rate"
means the reimbursement rate paid in this state under the medicare
program for screening mammography that does not include digitization
or computer-aided detection, regardless of whether the actual benefit
includes digitization or computer-aided detection.
(1)
(C)(1)
Subject
to divisions (C)(2) and (3) of this section, if a provider, hospital,
or other health care facility provides a service that is a component
of the
screening mammography a
benefit
in
provided
under division
(A)(1),
(2), or (3)
of this section or
a component of the supplemental breast cancer screening benefit in
division (A)(2) of this section and
submits a separate claim for that component, a separate payment shall
be made to the provider, hospital, or other health care facility
in an amount that corresponds to the ratio paid by medicare in this
state for that component.
(2)
Regardless
of whether separate payments are made for the The
total benefit
provided under division (A)(1),
or
(2),
or (3)
of this section, the
total benefit for a screening mammography or supplemental breast
cancer screening shall not exceed one hundred thirty per cent of the
medicare reimbursement rate in this state for screening mammography
or supplemental breast cancer screening. If there is more than one
medicare reimbursement rate in this state for screening mammography
or a component of a screening mammography or supplemental breast
cancer screening or a component of supplemental breast cancer
screening, the reimbursement limit shall be one hundred thirty per
cent of the lowest medicare and
any separate payment for a service that is a component of such a
benefit under division (D)(1) of this section, shall not be less than
any reimbursement
rate previously
paid by the same insurer under a public employee benefit plan that is
delivered, issued for delivery, or renewed in
this state
after the effective date of this amendment to the same provider,
hospital, or other health care facility for the same benefit or
service that is a component of such benefit.
(3)
The benefit paid in accordance with division
divisions
(C)(1)
and
(2) of
this section shall constitute full payment. No provider, hospital, or
other health care facility shall seek or receive compensation in
excess of the payment made in accordance with division
divisions
(C)(1)
and
(2) of
this section,
except for approved deductibles and copayments.
(D)
The(D)(1)
Except as provided in division (D)(2) of this section, the
benefits provided under division (A)(1)
or ,
(2),
or (3)
of this section shall be provided only for screening mammographies
or ,
supplemental
breast cancer screenings,
or diagnostic breast examinations
that are performed in a facility or mobile mammography screening unit
that is accredited under the American college of radiology
mammography accreditation program or in a hospital as defined in
section 3727.01 of the Revised Code.
(2) With respect to diagnostic breast examinations that are biopsies, the public employee benefit plan shall not, as a condition of coverage, require biopsies to be performed in a facility, mobile mammography screening unit, or hospital as described in division (D)(1) of this section.
(E)
The benefits provided under division (A)(3)
(A)(4)
of
this section shall be provided only for cytologic screenings that are
processed and interpreted in a laboratory certified by the college of
American pathologists or in a hospital as defined in section 3727.01
of the Revised Code.
(F) No public employee benefit plan that is established or modified in this state shall impose a cost-sharing requirement for the benefits provided under division (A) of this section.
Sec. 5162.20. (A) The department of medicaid shall institute cost-sharing requirements for the medicaid program. The department shall not institute cost-sharing requirements in a manner that does either of the following:
(1) Disproportionately impacts the ability of medicaid recipients with chronic illnesses to obtain medically necessary medicaid services;
(2) Violates section 5164.08, 5164.09, or 5164.10 of the Revised Code.
(B)(1) No provider shall refuse to provide a service to a medicaid recipient who is unable to pay a required copayment for the service.
(2) Division (B)(1) of this section shall not be considered to do either of the following with regard to a medicaid recipient who is unable to pay a required copayment:
(a) Relieve the medicaid recipient from the obligation to pay a copayment;
(b) Prohibit the provider from attempting to collect an unpaid copayment.
(C) Except as provided in division (F) of this section, no provider shall waive a medicaid recipient's obligation to pay the provider a copayment.
(D) No provider or drug manufacturer, including the manufacturer's representative, employee, independent contractor, or agent, shall pay any copayment on behalf of a medicaid recipient.
(E) If it is the routine business practice of a provider to refuse service to any individual who owes an outstanding debt to the provider, the provider may consider an unpaid copayment imposed by the cost-sharing requirements as an outstanding debt and may refuse service to a medicaid recipient who owes the provider an outstanding debt. If the provider intends to refuse service to a medicaid recipient who owes the provider an outstanding debt, the provider shall notify the recipient of the provider's intent to refuse service.
(F) In the case of a provider that is a hospital, the cost-sharing program shall permit the hospital to take action to collect a copayment by providing, at the time services are rendered to a medicaid recipient, notice that a copayment may be owed. If the hospital provides the notice and chooses not to take any further action to pursue collection of the copayment, the prohibition against waiving copayments specified in division (C) of this section does not apply.
(G) The department of medicaid may collaborate with a state agency that is administering, pursuant to a contract entered into under section 5162.35 of the Revised Code, one or more components, or one or more aspects of a component, of the medicaid program as necessary for the state agency to apply the cost-sharing requirements to the components or aspects of a component that the state agency administers.
Sec. 5164.08. (A) As used in this section:
(1) "Diagnostic breast examination" means any examination that, in accordance with applicable American college of radiology guidelines, is deemed medically necessary by a treating health care provider to diagnose breast cancer, including diagnostic mammography, magnetic resonance imaging, ultrasound, or biopsy.
(2)
"Screening
mammography" means a radiologic examination
that, in accordance with applicable American college of radiology
guidelines, is
utilized to detect unsuspected
breast
cancer at
an early stage in asymptomatic women and
includes the x-ray examination of the breast using equipment that is
dedicated specifically for mammography, including the x-ray tube,
filter, compression device, screens, film, and cassettes, and that
has an average radiation exposure delivery of less than one rad
mid-breast. "Screening mammography" includes digital breast
tomosynthesis. "Screening mammography" includes two views
for each breast. The term also includes the professional
interpretation of the film.
"Screening mammography" does not include diagnostic mammography.
(2)
(3)
"Supplemental
breast cancer screening" means any additional screening method
deemed medically necessary by a treating health care provider for
proper breast cancer screening in accordance with applicable American
college of radiology guidelines, including magnetic resonance
imaging, ultrasound, contrast
enhanced mammography, or
molecular breast imaging.
(B) The medicaid program shall cover all of the following:
(1)
To detect the presence of breast cancer in adult womenindividuals,
screening mammography;
(2)
To detect the presence of breast cancer in adult women
individuals
meeting
any
either
or both of
the conditions described in division (C)(2) of this section,
supplemental breast cancer screening;
(3) To diagnose breast cancer in adult individuals meeting the condition described in division (C)(3) of this section, diagnostic breast examination;
(4) To detect the presence of cervical cancer, cytologic screening.
(C)(1) The medicaid program's coverage pursuant to division (B)(1) of this section shall cover expenses for one screening mammography every year, including digital breast tomosynthesis.
(2)
The medicaid program's coverage pursuant to division (B)(2) of this
section shall cover expenses for supplemental breast cancer screening
for an adult woman
individual
who
meets any
either
or both of
the following conditions:
(a)
The woman's
individual's
screening
mammography demonstrates, based on the breast imaging reporting and
data system established by the American college of radiology, that
the woman
individual
has
dense breast tissue;
(b)
The woman
individual
is
at an increased risk of breast cancer due to family history, prior
personal history of breast cancer, ancestry, genetic predisposition,
or other reasons as determined by the woman's
individual's
health
care provider.
(3) The medicaid program's coverage pursuant to division (B)(3) of this section shall cover expenses for diagnostic breast examination for an adult individual who has an abnormality seen or suspected from, or detected by, any of the following: screening mammography, supplemental breast cancer screening, or another means of examination.
(D) The medicaid program shall not impose cost-sharing requirements on the coverage described in division (B) of this section.
(E)(1)
Except as provided in division (E)(2) of this section, the medicaid
program's
coverage of
screening mammographies pursuant
to division (B)(1)
or ,
(2),
or (3)
of this section shall be provided only for screening mammographies or
,
supplemental
breast cancer screenings,
or diagnostic breast examinations
that are performed in a facility or mobile mammography screening unit
that is accredited under the American college of radiology
mammography accreditation program or in a hospital as defined in
section 3727.01 of the Revised Code.
(2) With respect to diagnostic breast examinations that are biopsies, the medicaid program shall not, as a condition of coverage, require biopsies to be performed in a facility, mobile mammography screening unit, or hospital as described in division (E)(1) of this section.
(E)
(F)
The
medicaid program's coverage of cytologic screenings pursuant to
division (B)(3)
(B)(4)
of
this section shall be provided only for cytologic screenings that are
processed and interpreted in a laboratory certified by the college of
American pathologists or in a hospital as defined in section 3727.01
of the Revised Code.
Section 2. That existing sections 1751.62, 3923.52, 3923.53, 5162.20, and 5164.08 of the Revised Code are hereby repealed.
Section 3. Section 1751.62 of the Revised Code, as amended by this act, applies only to arrangements, policies, contracts, and agreements that are created, delivered, issued for delivery, or renewed in this state on or after the effective date of the amendment. Section 3923.52 of the Revised Code, as amended by this act, applies only to policies of sickness and accident insurance delivered, issued for delivery, or renewed in this state on or after the effective date of the amendment. Section 3923.53 of the Revised Code, as amended by this act, applies only to public employee benefit plans that are established or modified in this state on or after the effective date of the amendment.
Section 4. (A) As used in this section:
(1) "Health plan issuer" has the same meaning as in section 3922.01 of the Revised Code.
(2) "Hospital" has the same meaning as in section 3722.01 of the Revised Code.
(3) "Physician" means an individual authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.
(B) Not later than three months after the effective date of this section, all of the following apply:
(1) The Director of Health shall notify each hospital and physician of this act's enactment.
(2) The Superintendent of Insurance shall notify each health plan issuer of this act's enactment.
(3) The notice shall be completed by certified mail.
(C) When notifying a health plan issuer, hospital, or physician under this section, the Director or Superintendent shall summarize the provisions of sections 1751.62, 3923.52, 3923.53, 5162.20, and 5164.08 of the Revised Code, each as amended by this act, and shall describe the act's impact on those provisions.
(D) The Director of Health may consult with the State Medical Board of Ohio to assist the Director in identifying physicians and determining their business addresses for purposes of satisfying the notice requirements of this section.
Section 5. This act shall be known as the Breast Examination and Screening Transformation Act, or BEST Act.