Bill Text: NY S08156 | 2021-2022 | General Assembly | Introduced

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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

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                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.
                                                                   LBD13334-05-2
        S. 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 of
    24  a 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.