senate Bill S6769A

Signed by Governor Amended

Relates to the duties of providers of mammography services to notify and inform patients if a mammogram demonstrates dense breast tissue

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed by Governor
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actions

  • 20 / Mar / 2012
    • REFERRED TO INSURANCE
  • 11 / May / 2012
    • AMEND AND RECOMMIT TO INSURANCE
  • 11 / May / 2012
    • PRINT NUMBER 6769A
  • 14 / Jun / 2012
    • AMEND (T) AND RECOMMIT TO INSURANCE
  • 14 / Jun / 2012
    • PRINT NUMBER 6769B
  • 19 / Jun / 2012
    • COMMITTEE DISCHARGED AND COMMITTED TO RULES
  • 19 / Jun / 2012
    • ORDERED TO THIRD READING CAL.1308
  • 19 / Jun / 2012
    • PASSED SENATE
  • 19 / Jun / 2012
    • DELIVERED TO ASSEMBLY
  • 19 / Jun / 2012
    • REFERRED TO CODES
  • 19 / Jun / 2012
    • SUBSTITUTED FOR A9586D
  • 19 / Jun / 2012
    • ORDERED TO THIRD READING RULES CAL.389
  • 19 / Jun / 2012
    • PASSED ASSEMBLY
  • 19 / Jun / 2012
    • RETURNED TO SENATE
  • 20 / Jul / 2012
    • DELIVERED TO GOVERNOR
  • 23 / Jul / 2012
    • SIGNED CHAP.265

Summary

Relates to duties of providers of mammography services to notify and inform patients if a mammogram demonstrates dense breast tissue.

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Bill Details

Versions:
S6769
S6769A
S6769B
Legislative Cycle:
2011-2012
Law Section:
Insurance Law
Laws Affected:
Amd §§3215, 3221 & 4303, Ins L; add §2404-c, Pub Health L

Sponsor Memo

BILL NUMBER:S6769A

TITLE OF BILL:
An act
to amend the insurance law and the public health law, in relation to
supplemental screenings

PURPOSE:
This bill requires health insurance policies to provide
additional coverage for supplementary screening tests for breast
cancer when a mammography indicates dense breast tissue. It also
requires specific written notification to the patient and the
patient's physician of a finding of dense tissue and the need to
consult with the physician about additional screening.

SUMMARY OF PROVISIONS:
Section one amends subparagraphs (A) and (C) of
paragraph 11 of subsection (i) of section 3216 of the insurance law,
as amended by chapter 219 of the laws of 2011, to require insurance
coverage for supplementary screening tests to detect occult breast
cancer upon recommendation of a physician in those cases where a
mammography demonstrates the presence of dense breast tissue as
defined by the breast imaging reporting and data system established
by the American College of Radiology, or a physician determines that
the covered person is potentially at high risk for breast cancer
according to recognized medical practice guidelines. Other imaging
modalities are defined as modalities approved by the Federal Food and
Drug Administration (FDA) used to screen for, or diagnose, breast
cancer.

Section two amends subparagraphs (A) and (C) of paragraph 11 of
subsection (1) of section 3221 of the insurance law, as amended by
chapter 219 of the laws of 2011, in exactly the same way as section
one above.

Section three amends subsection (p) of section 4303 of the insurance
law, as amended by chapter 219 of the laws of 2011, in exactly the
same way as section one above.

Section four amends paragraph of subsection (d) of section 4326 of the
insurance law, as added by chapter 1 of the laws of 1999, by adding a
cross reference to subsection (p) of section 4303 of the insurance law.

Section five amends the public health law by adding a new section
2404-c which requires mammography providers to include the following
information in the summary of the mammography report provided to
patients who have dense tissue as defined in the bill:

Your mammogram shows that your breast tissue is dense. Dense breast
tissue is very common and is not abnormal. However, dense breast
tissue can make it harder to find cancer on a mammogram and may also
increase your breast cancer risk.

This information about the result of your mammogram is given to you to
raise your awareness. Use this information to talk to your doctor
about your own risks for breast cancer. At that time, ask your doctor


if more screening tests might be useful, based on your risk. A report
of your results was sent to your physician.

Section six sets forth the effective date on the one hundred eightieth
day after it shall have become a law.

EXISTING LAW:
Current law requires coverage for mammography screening
for individuals, based upon personal or family history and the age of
the individual.
Mammography screening is defined as X-ray examination under current
law. There are no requirements for patients to be alerted to breast
density.

JUSTIFICATION:
One woman is diagnosed with breast cancer every three
minutes, and one woman dies of breast cancer every 13 minutes in the
United States. Cancer is four to six times more likely in women with
dense breast tissue and 40% of women have dense tissue. According to
a 2010 study published in the Annals of Surgical Oncology, 71% of
all breast cancers occur in women with dense breast tissue.
Mammograms fail to detect about half the tumors present in dense
breast tissue as dense tissue obscures the presence of the tumors.
Follow-up studies after a similar dense breast tissue law passed in
Connecticut in 2009 show that for women with dense tissue, the
addition of a screening ultrasound nearly doubles the number of
cancers found by mammography alone. In New York State, that number
extrapolates to at least 2000 cancers a year in women who are told
their mammogram results are "normal/negative," but who, in actuality,
have invasive breast cancer. Missed cancers, growing undetected until
at a later stage, are less treatable, least survivable and most
expensive to treat.

Over 20 years ago, elected officials and medical experts reached a
consensus that early breast cancer detection saved lives and states
began requiring insurance coverage for mammograms. In order to ensure
that patients received information about relevant mammographic
findings, a federal law was enacted requiring a mammography report be
issued to patients to help them partner with their physician in their
health care vigilance.

A woman's breast density is determined through the mammography exam.
Breast density not only dramatically compromises the effectiveness of
a mammogram, but is, in and of itself, a risk factor for developing
breast cancer. Women with dense breasts have a greater risk of
developing breast cancer than those who have a first degree relative
who have had
the disease. Unfortunately, there is currently no protocol for density
information to he shared with patients. The mammography reports to
patients, citing a "normal" finding when the radiologist does not
know, with any reasonable certainty what is lurking behind dense
tissue - give women a false sense of security.

Now, twenty years later, states are recognizing that, for a
significant percentage of women, the mammography insurance coverage
and notification requirements are not sufficient. The report a woman
receives after her mammogram is required to be a summary, in lay


language, of her mammographic findings, Information about breast
density is a material medical finding which must be shared with
patients. This legislation will give women with dense tissue the
information and opportunity to get adequate baseline and follow-up
screening. Without it, women with dense tissue are effectively denied
equal access to early cancer detection.

LEGISLATIVE HISTORY:
New bill.

FISCAL IMPLICATION
None.

LOCAL FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This bill takes effect on the one hundred eightieth
day after it shall have become a law.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

    S. 6769--A                                            A. 9586--A

                      S E N A T E - A S S E M B L Y

                             March 20, 2012
                               ___________

IN  SENATE -- Introduced by Sens. FLANAGAN, ALESI, BALL, GOLDEN, GRISAN-
  TI, HUNTLEY, JOHNSON, LAVALLE, OPPENHEIMER, PARKER, RITCHIE, STAVISKY,
  STEWART-COUSINS -- read twice and ordered printed, and when printed to
  be committed to the Committee on Insurance  --  committee  discharged,
  bill  amended,  ordered  reprinted  as amended and recommitted to said
  committee

IN ASSEMBLY -- Introduced by M. of A. JAFFEE, SWEENEY, GUNTHER, McENENY,
  ABINANTI, LANCMAN, COLTON, JACOBS, MILLMAN, BARRON, N. RIVERA, MAISEL,
  HOOPER, ROBERTS, RUSSELL, CASTRO, QUART, CAHILL,  GALEF,  ENGLEBRIGHT,
  O'DONNELL,  SCHIMEL,  SCARBOROUGH,  WEPRIN,  LINARES,  COOK, ROBINSON,
  CLARK, CYMBROWITZ, LATIMER, LIFTON, LAVINE, BRAUNSTEIN, PRETLOW, MOYA,
  J. RIVERA, GRAF -- Multi-Sponsored by -- M.  of  A.  AMEDORE,  ARROYO,
  AUBRY,  BRENNAN,  BURLING,  CALHOUN,  CONTE,  CROUCH,  CURRAN, DUPREY,
  HAWLEY, HEVESI, LOSQUADRO, PEOPLES-STOKES, PERRY, RA, RAIA, P. RIVERA,
  SALADINO, SAYWARD, TENNEY, THIELE, TITONE, WEISENBERG -- read once and
  referred to the Committee on Insurance -- committee  discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee

AN ACT to amend the insurance law and the public health law, in relation
  to supplemental screenings

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subparagraphs (A) and (C) of paragraph 11 of subsection (i)
of  section  3216 of the insurance law, as amended by chapter 219 of the
laws of 2011, are amended to read as follows:
  (A) Every policy that provides  coverage  for  hospital,  surgical  or
medical  care  shall  provide the following coverage for mammography AND
OTHER IMAGING screening for occult breast cancer:
  (i) upon the recommendation of a physician, a mammogram at any age for
covered persons having a prior history of breast cancer or  who  have  a
first degree relative with a prior history of breast cancer;
  (ii)  a single baseline mammogram for covered persons aged thirty-five
through thirty-nine, inclusive; [and]

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD15074-03-2

S. 6769--A                          2                         A. 9586--A

  (iii) an annual mammogram for covered persons aged  forty  and  older;
AND
  (IV)  UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING FOR A
COVERED PERSON USING OTHER IMAGING MODALITIES FOR ADJUVANT SCREENING IF:
  (A) A MAMMOGRAM PERFORMED PURSUANT TO THIS  SUBPARAGRAPH  DEMONSTRATES
THAT THE COVERED PERSON HAS DENSE BREAST TISSUE; OR,
  (B)  IT IS DETERMINED BY A PHYSICIAN THAT THE COVERED PERSON IS POTEN-
TIALLY AT HIGH RISK FOR BREAST  CANCER  IN  ACCORDANCE  WITH  RECOGNIZED
PRACTICE GUIDELINES OR RISK ASSESSMENT TOOLS.
  FOR  THE  PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE SHALL HAVE
THE SAME MEANING AS HETEROGENEOUSLY DENSE OR EXTREMELY DENSE  TISSUE  AS
DEFINED  BY  THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY
THE AMERICAN COLLEGE OF RADIOLOGY AND ANY EQUIVALENT NEW TERMS  AS  SUCH
SYSTEM IS UPDATED.
  (C)  (I)  For purposes of subparagraphs (A) and (B) of this paragraph,
mammography screening means an X-ray examination  of  the  breast  using
dedicated  equipment,  including X-ray tube, filter, compression device,
screens, films and cassettes, with an average glandular  radiation  dose
less than 0.5 rem per view per breast.
  (II)  FOR  PURPOSES  OF  SUBPARAGRAPHS  (A) AND (B) OF THIS PARAGRAPH,
IMAGING MODALITIES ARE MODALITIES, APPROVED BY THE FEDERAL FOOD AND DRUG
ADMINISTRATION, USED TO SCREEN FOR, OR DIAGNOSE, OCCULT BREAST CANCER.
  S 2. Subparagraphs (A) and (C) of paragraph 11 of  subsection  (l)  of
section 3221 of the insurance law, as amended by chapter 219 of the laws
of 2011, are amended to read as follows:
  (A)  Every  insurer  delivering a group or blanket policy or issuing a
group or blanket policy for delivery in this state that provides  cover-
age  for  hospital, surgical or medical care shall provide the following
coverage for mammography AND OTHER IMAGING screening for  occult  breast
cancer:
  (i) upon the recommendation of a physician, a mammogram at any age for
covered  persons  having  a prior history of breast cancer or who have a
first degree relative with a prior history of breast cancer;
  (ii) a single baseline mammogram for covered persons aged  thirty-five
through thirty-nine, inclusive; [and]
  (iii)  an  annual  mammogram for covered persons aged forty and older;
AND
  (IV) UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING FOR  A
COVERED PERSON USING OTHER IMAGING MODALITIES FOR ADJUVANT SCREENING IF:
  (A)  A  MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DEMONSTRATES
THAT THE COVERED PERSON HAS DENSE BREAST TISSUE; OR,
  (B) IT IS DETERMINED BY A PHYSICIAN THAT THE COVERED PERSON IS  POTEN-
TIALLY  AT  HIGH  RISK  FOR  BREAST CANCER IN ACCORDANCE WITH RECOGNIZED
PRACTICE GUIDELINES OR RISK ASSESSMENT TOOLS.
  FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE  SHALL  HAVE
THE  SAME  MEANING AS HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS
DEFINED BY THE BREAST IMAGING REPORTING AND DATA SYSTEM  ESTABLISHED  BY
THE  AMERICAN  COLLEGE OF RADIOLOGY AND ANY EQUIVALENT NEW TERMS AS SUCH
SYSTEM IS UPDATED.
  (C) (I) For purposes of subparagraphs (A) and (B) of  this  paragraph,
mammography  screening  means  an  X-ray examination of the breast using
dedicated equipment, including X-ray tube, filter,  compression  device,
screens,  films  and cassettes, with an average glandular radiation dose
less than 0.5 rem per view per breast.

S. 6769--A                          3                         A. 9586--A

  (II) FOR PURPOSES OF SUBPARAGRAPHS (A)  AND  (B)  OF  THIS  PARAGRAPH,
IMAGING MODALITIES ARE MODALITIES, APPROVED BY THE FEDERAL FOOD AND DRUG
ADMINISTRATION, USED TO SCREEN FOR, OR DIAGNOSE, OCCULT BREAST CANCER.
  S  3.  Subsection (p) of section 4303 of the insurance law, as amended
by chapter 219 of the laws of 2011, is amended to read as follows:
  (p) (1) A medical expense indemnity corporation,  a  hospital  service
corporation  or  a health service corporation that provides coverage for
hospital, surgical or medical care shall provide the following  coverage
for mammography AND OTHER IMAGING screening for occult breast cancer:
  (A) upon the recommendation of a physician, a mammogram at any age for
covered  persons  having  a prior history of breast cancer or who have a
first degree relative with a prior history of breast cancer;
  (B) a single baseline mammogram for covered persons  aged  thirty-five
through thirty-nine, inclusive; [and]
  (C)  an  annual mammogram for covered persons aged forty and older[.];
AND
  (D) UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING  FOR  A
COVERED PERSON USING OTHER IMAGING MODALITIES FOR ADJUVANT SCREENING IF:
  (A)  A  MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DEMONSTRATES
THAT THE COVERED PERSON HAS DENSE BREAST TISSUE; OR,
  (B) IT IS DETERMINED BY A PHYSICIAN THAT THE COVERED PERSON IS  POTEN-
TIALLY  AT  HIGH  RISK  FOR  BREAST CANCER IN ACCORDANCE WITH RECOGNIZED
PRACTICE GUIDELINES OR RISK ASSESSMENT TOOLS.
  FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE  SHALL  HAVE
THE  SAME  MEANING AS HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS
DEFINED BY THE BREAST IMAGING REPORTING AND DATA SYSTEM  ESTABLISHED  BY
THE  AMERICAN  COLLEGE OF RADIOLOGY AND ANY EQUIVALENT NEW TERMS AS SUCH
SYSTEM IS UPDATED.
  (E) The coverage required in this paragraph or paragraph two  of  this
subsection  may  be subject to annual deductibles and coinsurance as may
be deemed appropriate by the superintendent and as are  consistent  with
those established for other benefits within a given contract.
  (2)  (A) For purposes of paragraph one of this subsection, mammography
screening means an X-ray  examination  of  the  breast  using  dedicated
equipment,  including  X-ray  tube, filter, compression device, screens,
films and cassettes, with an average glandular radiation dose less  than
0.5 rem per view per breast.
  (B)  FOR PURPOSES OF PARAGRAPH ONE OF THIS SUBSECTION, IMAGING MODALI-
TIES ARE MODALITIES, APPROVED BY THE  FEDERAL  FOOD  AND  DRUG  ADMINIS-
TRATION, USED TO SCREEN FOR, OR DIAGNOSE, OCCULT BREAST CANCER.
  (3)  In  addition  to  paragraph  one or two of this subsection, every
contract that provides coverage for hospital, surgical or medical  care,
except  for  a  grandfathered  health  plan under paragraph four of this
subsection, shall provide coverage for the following mammography screen-
ing services, and such coverage shall not be subject to  annual  deduct-
ibles or coinsurance:
  (A)  evidence-based  items  or  services  for mammography that have in
effect a rating of 'A' or 'B' in  the  current  recommendations  of  the
United States preventive services task force; and
  (B) with respect to women, such additional preventive care and screen-
ings for mammography not described in subparagraph (A) of this paragraph
and  as provided for in comprehensive guidelines supported by the health
resources and services administration.
  (4) For purposes of this subsection, "grandfathered health plan" means
coverage provided by a corporation in which an individual  was  enrolled
on  March  twenty-third,  two  thousand  ten for as long as the coverage

S. 6769--A                          4                         A. 9586--A

maintains grandfathered status in accordance with section 1251(e) of the
Affordable Care Act, 42 U.S.C. S 18011(e).
  S  4.   Paragraph 7 of subsection (d) of section 4326 of the insurance
law, as added by chapter 1 of the laws of 1999, is amended  to  read  as
follows:
  (7) adult preventive health services consisting of mammography screen-
ing,  AS  PROVIDED  IN  SUBSECTION  (P)  OF  SECTION FOUR THOUSAND THREE
HUNDRED THREE OF THIS ARTICLE;  cervical  cytology  screening;  periodic
physical  examinations  no  more  than once every three years; and adult
immunizations;
  S 5. The public health law is amended by adding a new  section  2404-c
to read as follows:
  S  2404-C. BREAST CANCER; DUTY OF PROVIDERS OF MAMMOGRAPHY SERVICES TO
NOTIFY AND INFORM.  EVERY PROVIDER OF MAMMOGRAPHY SERVICES SHALL,  IF  A
PATIENT'S  MAMMOGRAM  DEMONSTRATES  DENSE  BREAST  TISSUE  AS DEFINED IN
SECTION THREE  THOUSAND  TWO  HUNDRED  SIXTEEN  OF  THE  INSURANCE  LAW,
INCLUDE, BUT NOT BE LIMITED TO, THE FOLLOWING INFORMATION, IN ANY SUMMA-
RY  OF  THE MAMMOGRAPHY REPORT SENT, PURSUANT TO THE FEDERAL MAMMOGRAPHY
QUALITY STANDARDS ACT, TO THE PATIENT AND THE PATIENT'S PHYSICIAN:
  YOUR MAMMOGRAM SHOWS THAT YOUR BREAST TISSUE IS  DENSE.  DENSE  BREAST
TISSUE  IS VERY COMMON AND IS NOT ABNORMAL. HOWEVER, DENSE BREAST TISSUE
CAN MAKE IT HARDER TO FIND CANCER ON A MAMMOGRAM AND MAY  ALSO  INCREASE
YOUR BREAST CANCER RISK.
  THIS INFORMATION ABOUT THE RESULT OF YOUR MAMMOGRAM IS GIVEN TO YOU TO
RAISE  YOUR AWARENESS. USE THIS INFORMATION TO TALK TO YOUR DOCTOR ABOUT
YOUR OWN RISKS FOR BREAST CANCER. AT THAT TIME, ASK YOUR DOCTOR IF  MORE
SCREENING  TESTS  MIGHT  BE USEFUL, BASED ON YOUR RISK. A REPORT OF YOUR
RESULTS WAS SENT TO YOUR PHYSICIAN.
  S 6. This act shall take effect on the one hundred eightieth day after
it shall have become a law.

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