Bill Text: NY S08156 | 2021-2022 | General Assembly | Introduced
Bill Title: Requires certain insurance policies and Medicaid to allow patients a one hundred twenty-day window for additional screening for breast cancer, which may include an additional mammogram, when the provider deems such screening is necessary.
Spectrum: Moderate Partisan Bill (Democrat 7-1)
Status: (Engrossed - Dead) 2022-06-01 - referred to insurance [S08156 Detail]
Download: New_York-2021-S08156-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 8156 IN SENATE January 26, 2022 ___________ Introduced by Sen. PERSAUD -- 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- 23 malities due to dense breast or the provider deems another mammogram is 24 needed. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD13334-05-2S. 8156 2 1 § 2. Subparagraph (A) of paragraph 11 of subsection (l) of section 2 3221 of the insurance law, as amended by chapter 143 of the laws of 3 2019, is amended to read as follows: 4 (A) Every insurer delivering a group or blanket policy or issuing a 5 group or blanket policy for delivery in this state that provides cover- 6 age for hospital, surgical or medical care shall provide the following 7 coverage for mammography screening for occult breast cancer: 8 (i) [upon the recommendation of a physician] where a provider, 9 licensed to issue prescriptions pursuant to section sixty-five hundred 10 twenty-two of the education law, assessed the risk and then makes a 11 recommendation for an additional screening including mammogram, a mammo- 12 gram, which may be provided by breast tomosynthesis, at any age for 13 covered persons having a prior history of breast cancer or dense breast 14 or who have a first degree relative with a prior history of breast 15 cancer or dense breast; 16 (ii) a single baseline mammogram, which may be provided by breast 17 tomosynthesis, for covered persons aged thirty-five through thirty-nine, 18 inclusive; 19 (iii) an annual mammogram, which may be provided by breast tomosynthe- 20 sis, for covered persons aged forty and older; [and] 21 (iv) for large group policies that provide coverage for hospital, 22 surgical or medical care, an annual mammogram for covered persons aged 23 thirty-five through thirty-nine, inclusive, [upon the recommendation of24a physician] where a provider, licensed to issue prescriptions pursuant 25 to section sixty-five hundred twenty-two of the education law, assessed 26 the risk and then makes a recommendation for an additional screening 27 including mammogram, subject to the insurer's determination that the 28 mammogram is medically necessary; and 29 (v) an additional screening including mammogram, which may be provided 30 by breast tomosynthesis, for covered persons whose mammogram, which 31 occurred in the previous one hundred twenty days, showed abnormalities 32 due to dense breast or the provider deems another mammogram is needed. 33 § 3. Subparagraph (E) of paragraph 1 of subsection (p) of section 4303 34 of the insurance law, as amended by chapter 143 of the laws of 2019, is 35 amended to read as follows: 36 (E) an additional screening including mammogram, which may be provided 37 by breast tomosynthesis, for covered persons whose mammogram, which 38 occurred in the previous one hundred twenty days, showed abnormalities 39 due to dense breast or the provider deems another mammogram is needed. 40 (F) The coverage required in this paragraph or paragraph two of this 41 subsection shall not be subject to annual deductibles or coinsurance. 42 § 4. Subdivision 2 of section 365-a of the social services law is 43 amended by adding a new paragraph (jj) to read as follows: 44 (jj) a mammogram, which may be provided by breast tomosynthesis, for 45 covered persons whose mammogram, which occurred in the previous one 46 hundred twenty days, showed abnormalities due to dense breast or the 47 provider deems another mammogram is needed. 48 § 5. This act shall take effect on the thirtieth day after it shall 49 have become a law, and shall apply to policies and contracts issued, 50 renewed, modified, altered or amended on or after such effective date.