Bill Text: NY S02465 | 2023-2024 | General Assembly | Amended
Bill Title: Requires certain insurance policies allow patients additional screenings for breast cancer when the provider deems such screening is necessary under nationally recognized clinical practice guidelines.
Spectrum: Slight Partisan Bill (Democrat 6-2)
Status: (Engrossed - Dead) 2024-06-03 - SUBSTITUTED BY A1696C [S02465 Detail]
Download: New_York-2023-S02465-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 2465--C 2023-2024 Regular Sessions IN SENATE January 20, 2023 ___________ Introduced by Sens. PERSAUD, CHU, JACKSON, MYRIE, PALUMBO, SEPULVEDA -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- recommitted to the Committee on Insur- ance in accordance with Senate Rule 6, sec. 8 -- reported favorably from said committee and committed to the Committee on Finance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to requiring certain insurance policies allow patients additional screenings for breast cancer when the provider deems such screening is necessary under nationally recognized clinical practice guidelines; and to repeal certain provisions of such law relating thereto The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subparagraphs (A) and (B) of paragraph 11 of subsection (i) 2 of section 3216 of the insurance law, subparagraph (A) as amended by 3 chapter 414 of the laws of 2017, and subparagraph (B) as amended by 4 chapter 74 of the laws of 2016, are amended to read as follows: 5 (A) Every policy that provides coverage for hospital, surgical or 6 medical care shall provide the following coverage for mammography 7 screening for occult breast cancer: 8 (i) upon the recommendation of a physician, a mammogram, which may be 9 provided by breast tomosynthesis, at any age for covered persons having 10 a prior history of breast cancer or who have a first degree relative 11 with a prior history of breast cancer; 12 (ii) a single baseline mammogram, which may be provided by breast 13 tomosynthesis, for covered persons aged thirty-five through thirty-nine, 14 inclusive; [and] EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD02639-11-4S. 2465--C 2 1 (iii) an annual mammogram, which may be provided by breast tomosynthe- 2 sis, for covered persons aged forty and older; and 3 (iv) upon the recommendation of a physician, screening and diagnostic 4 imaging, including diagnostic mammograms, breast ultrasounds, or magnet- 5 ic resonance imaging, recommended by nationally recognized clinical 6 practice guidelines for the detection of breast cancer. For the purposes 7 of this item, "nationally recognized clinical practice guidelines" means 8 evidence-based clinical practice guidelines informed by a systematic 9 review of evidence and an assessment of the benefits, and risks of 10 alternative care options intended to optimize patient care developed by 11 independent organizations or medical professional societies utilizing a 12 transparent methodology and reporting structure and with a conflict of 13 interest policy. 14 (B) Such coverage required pursuant to subparagraph (A) or (C) of this 15 paragraph shall not be subject to annual deductibles or coinsurance. If 16 under federal law, application of this requirement would result in 17 health savings account ineligibility under 26 USC 223, this requirement 18 shall apply for health savings account-qualified high deductible health 19 plans with respect to the deductible of such a plan after the enrollee 20 has satisfied the minimum deductible under 26 USC 223, except for with 21 respect to items or services that are preventive care pursuant to 26 22 USC 223(c)(2)(C), in which case the requirements of this paragraph shall 23 apply regardless of whether the minimum deductible under 26 USC 223 has 24 been satisfied. 25 § 2. Subparagraph (F) of paragraph 11 of subsection (i) of section 26 3216 of the insurance laws is REPEALED. 27 § 3. Subparagraphs (A) and (B) of paragraph 11 of subsection (l) of 28 section 3221 of the insurance law, subparagraph (A) as amended by chap- 29 ter 143 of the laws of 2019, and subparagraph (B) as amended by chapter 30 74 of the laws of 2016, are amended to read as follows: 31 (A) Every insurer delivering a group or blanket policy or issuing a 32 group or blanket policy for delivery in this state that provides cover- 33 age for hospital, surgical or medical care shall provide the following 34 coverage for mammography screening for occult breast cancer: 35 (i) upon the recommendation of a physician, a mammogram, which may be 36 provided by breast tomosynthesis, at any age for covered persons having 37 a prior history of breast cancer or who have a first degree relative 38 with a prior history of breast cancer; 39 (ii) a single baseline mammogram, which may be provided by breast 40 tomosynthesis, for covered persons aged thirty-five through thirty-nine, 41 inclusive; 42 (iii) an annual mammogram, which may be provided by breast tomosynthe- 43 sis, for covered persons aged forty and older; [and] 44 (iv) for large group policies that provide coverage for hospital, 45 surgical or medical care, an annual mammogram for covered persons aged 46 thirty-five through thirty-nine, inclusive, upon the recommendation of a 47 physician, subject to the insurer's determination that the mammogram is 48 medically necessary; and 49 (v) upon the recommendation of a physician, screening and diagnostic 50 imaging, including diagnostic mammograms, breast ultrasounds, or magnet- 51 ic resonance imaging, recommended by nationally recognized clinical 52 practice guidelines for the detection of breast cancer. For the purposes 53 of this item, "nationally recognized clinical practice guidelines" means 54 evidence-based clinical practice guidelines informed by a systematic 55 review of evidence and an assessment of the benefits, and risks of 56 alternative care options intended to optimize patient care developed byS. 2465--C 3 1 independent organizations or medical professional societies utilizing a 2 transparent methodology and reporting structure and with a conflict of 3 interest policy. 4 (B) Such coverage required pursuant to subparagraph (A) or (C) of this 5 paragraph shall not be subject to annual deductibles or coinsurance. If 6 under federal law, application of this requirement would result in 7 health savings account ineligibility under 26 USC 223, this requirement 8 shall apply for health savings account-qualified high deductible health 9 plans with respect to the deductible of such a plan after the enrollee 10 has satisfied the minimum deductible under 26 USC 223, except for with 11 respect to items or services that are preventive care pursuant to 26 12 USC 223(c)(2)(C), in which case the requirements of this paragraph shall 13 apply regardless of whether the minimum deductible under 26 USC 223 has 14 been satisfied. 15 § 4. Subparagraph (F) of paragraph 11 of subsection (l) of section 16 3221 of the insurance law is REPEALED. 17 § 5. Paragraph 1 of subsection (p) of section 4303 of the insurance 18 law, as amended by chapter 219 of the laws of 2011, subparagraph (A) as 19 amended by chapter 414 of the laws of 2017, and subparagraphs (B), (C), 20 (D), and (E) as amended by chapter 143 of the laws of 2019, is amended 21 to read as follows: 22 (1) A medical expense indemnity corporation, a hospital service corpo- 23 ration or a health service corporation that provides coverage for hospi- 24 tal, surgical or medical care shall provide the following coverage for 25 mammography screening for occult breast cancer: 26 (A) upon the recommendation of a physician, a mammogram, which may be 27 provided by breast tomosynthesis, at any age for covered persons having 28 a prior history of breast cancer or who have a first degree relative 29 with a prior history of breast cancer; 30 (B) a single baseline mammogram, which may be provided by breast tomo- 31 synthesis, for covered persons aged thirty-five through thirty-nine, 32 inclusive; 33 (C) an annual mammogram, which may be provided by breast tomosythesis, 34 for covered persons aged forty and older; 35 (D) for large group contracts offered by a medical expense indemnity 36 corporation, a hospital service corporation or a health service corpo- 37 ration that provide coverage for hospital, surgical or medical care, an 38 annual mammogram for covered persons aged thirty-five through thirty- 39 nine, inclusive, upon the recommendation of a physician, subject to the 40 corporation's determination that the mammogram is medically necessary; 41 [and] 42 (E) upon the recommendation of a physician, screening and diagnostic 43 imaging, including diagnostic mammograms, breast ultrasounds, or magnet- 44 ic resonance imaging, recommended by nationally recognized clinical 45 practice guidelines for the detection of breast cancer. For the purposes 46 of this subparagraph, "nationally recognized clinical practice guide- 47 lines" means evidence-based clinical practice guidelines informed by a 48 systematic review of evidence and an assessment of the benefits, and 49 risks of alternative care options intended to optimize patient care 50 developed by independent organizations or medical professional societies 51 utilizing a transparent methodology and reporting structure and with a 52 conflict of interest policy; and 53 (F) The coverage required in this paragraph or paragraph two of this 54 subsection shall not be subject to annual deductibles or coinsurance. 55 If under federal law, application of this requirement would result in 56 health savings account ineligibility under 26 USC 223, this requirementS. 2465--C 4 1 shall apply for health savings account-qualified high deductible health 2 plans with respect to the deductible of such a plan after the enrollee 3 has satisfied the minimum deductible under 26 USC 223, except for with 4 respect to items or services that are preventive care pursuant to 26 5 USC 223(c)(2)(C), in which case the requirements of this paragraph shall 6 apply regardless of whether the minimum deductible under 26 USC 223 has 7 been satisfied. 8 § 6. Paragraph 5 of subsection (p) of section 4303 of the insurance 9 law is REPEALED. 10 § 7. This act shall take effect January 1, 2026 and shall apply to 11 all policies and contracts issued, renewed, modified, altered or amended 12 on or after such date.
