Bill Text: NY S02465 | 2023-2024 | General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          2465

                               2023-2024 Regular Sessions

                    IN SENATE

                                    January 20, 2023
                                       ___________

        Introduced by Sens. PERSAUD, JACKSON, KENNEDY, MYRIE, PALUMBO, SEPULVEDA
          -- read twice and ordered printed, and when printed to be committed to
          the Committee on Insurance

        AN  ACT  to  amend  the  insurance  law  and the social services law, in
          relation to requiring certain insurance policies and Medicaid to allow
          patients a one hundred twenty-day window for additional  breast  exams
          when the provider deems another breast exam is needed

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Subparagraph (A) of  paragraph  11  of  subsection  (i)  of
     2  section 3216 of the insurance law, as amended by chapter 414 of the laws
     3  of 2017, is amended to read as follows:
     4    (A)  Every  policy  that  provides  coverage for hospital, surgical or
     5  medical care  shall  provide  the  following  coverage  for  mammography
     6  screening for occult breast cancer:
     7    (i)  [upon  the  recommendation  of  a  physician]  where  a provider,
     8  licensed to issue prescriptions pursuant to section  sixty-five  hundred
     9  twenty-two  of  the  education  law,  assessed the risk and then makes a
    10  recommendation for an additional screening including mammogram, a mammo-
    11  gram, which may be provided by breast  tomosynthesis,  at  any  age  for
    12  covered  persons having a prior history of breast cancer or dense breast
    13  or who have a first degree relative  with  a  prior  history  of  breast
    14  cancer or dense breast;
    15    (ii)  a  single  baseline  mammogram,  which may be provided by breast
    16  tomosynthesis, for covered persons aged thirty-five through thirty-nine,
    17  inclusive; [and]
    18    (iii) an annual mammogram, which may be provided by breast tomosynthe-
    19  sis, for covered persons aged forty and older; and
    20    (iv)  an  additional  screening  including  mammogram,  which  may  be
    21  provided  by  breast tomosynthesis, for covered persons whose mammogram,
    22  which occurred in the previous one hundred twenty  days,  showed  abnor-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02639-01-3
        S. 2465                             2

     1  malities  due to dense breast or the provider deems another mammogram is
     2  needed.
     3    §  2.  Subparagraph  (A)  of paragraph 11 of subsection (l) of section
     4  3221 of the insurance law, as amended by chapter  143  of  the  laws  of
     5  2019, is amended to read as follows:
     6    (A)  Every  insurer  delivering a group or blanket policy or issuing a
     7  group or blanket policy for delivery in this state that provides  cover-
     8  age  for  hospital, surgical or medical care shall provide the following
     9  coverage for mammography screening for occult breast cancer:
    10    (i) [upon  the  recommendation  of  a  physician]  where  a  provider,
    11  licensed  to  issue prescriptions pursuant to section sixty-five hundred
    12  twenty-two of the education law, assessed the  risk  and  then  makes  a
    13  recommendation for an additional screening including mammogram, a mammo-
    14  gram,  which  may  be  provided  by breast tomosynthesis, at any age for
    15  covered persons having a prior history of breast cancer or dense  breast
    16  or  who  have  a  first  degree  relative with a prior history of breast
    17  cancer or dense breast;
    18    (ii) a single baseline mammogram, which  may  be  provided  by  breast
    19  tomosynthesis, for covered persons aged thirty-five through thirty-nine,
    20  inclusive;
    21    (iii) an annual mammogram, which may be provided by breast tomosynthe-
    22  sis, for covered persons aged forty and older; [and]
    23    (iv)  for  large  group  policies  that provide coverage for hospital,
    24  surgical or medical care, an annual mammogram for covered  persons  aged
    25  thirty-five  through thirty-nine, inclusive, [upon the recommendation of
    26  a physician] where a provider, licensed to issue prescriptions  pursuant
    27  to  section sixty-five hundred twenty-two of the education law, assessed
    28  the risk and then makes a recommendation  for  an  additional  screening
    29  including  mammogram,  subject  to  the insurer's determination that the
    30  mammogram is medically necessary; and
    31    (v) an additional screening including mammogram, which may be provided
    32  by breast tomosynthesis, for  covered  persons  whose  mammogram,  which
    33  occurred  in  the previous one hundred twenty days, showed abnormalities
    34  due to dense breast or the provider deems another mammogram is needed.
    35    § 3. Subparagraph (E) of paragraph 1 of subsection (p) of section 4303
    36  of the insurance law, as amended by chapter 143 of the laws of 2019,  is
    37  amended to read as follows:
    38    (E) an additional screening including mammogram, which may be provided
    39  by  breast  tomosynthesis,  for  covered  persons whose mammogram, which
    40  occurred in the previous one hundred twenty days,  showed  abnormalities
    41  due to dense breast or the provider deems another mammogram is needed.
    42    (F)  The  coverage required in this paragraph or paragraph two of this
    43  subsection shall not be subject to annual deductibles or coinsurance.
    44    § 4. Subdivision 2 of section 365-a of  the  social  services  law  is
    45  amended by adding a new paragraph (kk) to read as follows:
    46    (kk)  a  mammogram, which may be provided by breast tomosynthesis, for
    47  covered persons whose mammogram, which  occurred  in  the  previous  one
    48  hundred  twenty  days,  showed  abnormalities due to dense breast or the
    49  provider deems another mammogram is needed.
    50    § 5. This act shall take effect on the thirtieth day  after  it  shall
    51  have  become  a  law,  and shall apply to policies and contracts issued,
    52  renewed, modified, altered or amended on or after such effective date.