S T A T E O F N E W Y O R K
________________________________________________________________________
7774
2011-2012 Regular Sessions
I N A S S E M B L Y
May 16, 2011
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Introduced by M. of A. JAFFEE -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to requiring health
insurance policies to cover comprehensive ultrasound screening,
magnetic resonance imaging and/or other screening tests for breast
cancer in certain cases and requiring the provision of certain infor-
mation relating to breast density to patients
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 11 of subsection (i) of section 3216 of the
insurance law is amended by adding a new subparagraph (D) to read as
follows:
(D) (I) SUCH POLICY SHALL PROVIDE ADDITIONAL COVERAGE FOR COMPREHEN-
SIVE ULTRASOUND SCREENING, MAGNETIC RESONANCE IMAGING (MRI), AND/OR
OTHER SCREENING TESTS APPROVED BY THE AMERICAN COLLEGE OF RADIOLOGY OF
AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
(I) A MAMMOGRAM DEMONSTRATES HETEROGENEOUS OR DENSE BREAST TISSUE
BASED ON THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY THE
AMERICAN COLLEGE OF RADIOLOGY; OR
(II) A WOMAN IS BELIEVED TO BE AT INCREASED RISK FOR BREAST CANCER DUE
TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER, POSITIVE
GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH WOMAN'S
PHYSICIAN OR NURSE PRACTITIONER.
(II) SUCH ADDITIONAL COVERAGE 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
POLICY.
(III) EACH MAMMOGRAPHY REPORT PROVIDED TO A PATIENT SHALL INCLUDE
INFORMATION ABOUT BREAST DENSITY, BASED ON THE BREAST IMAGING REPORTING
AND DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY. WHERE
APPLICABLE, SUCH REPORT SHALL INCLUDE THE FOLLOWING NOTICE: "IF YOUR
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00386-05-1
A. 7774 2
MAMMOGRAM DEMONSTRATES THAT YOU HAVE DENSE BREAST TISSUE, WHICH COULD
HIDE SMALL ABNORMALITIES, YOU MIGHT BENEFIT FROM SUPPLEMENTARY SCREENING
TESTS, DEPENDING ON YOUR INDIVIDUAL RISK FACTORS AND THE RECOMMENDATION
OF YOUR INTERPRETING PHYSICIAN. A REPORT OF YOUR MAMMOGRAPHY RESULTS,
WHICH CONTAINS INFORMATION ABOUT YOUR BREAST DENSITY, HAS BEEN SENT TO
YOUR TREATING PHYSICIAN'S OFFICE AND YOU SHOULD CONTACT YOUR TREATING
PHYSICIAN IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR REPORT."
S 2. Paragraph 11 of subsection (l) of section 3221 of the insurance
law is amended by adding a new subparagraph (D) to read as follows:
(D) (I) SUCH POLICY SHALL PROVIDE ADDITIONAL COVERAGE FOR COMPREHEN-
SIVE ULTRASOUND SCREENING, MAGNETIC RESONANCE IMAGING (MRI), AND/OR
OTHER SCREENING TESTS APPROVED BY THE AMERICAN COLLEGE OF RADIOLOGY OF
AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
(I) A MAMMOGRAM DEMONSTRATES HETEROGENEOUS OR DENSE BREAST TISSUE
BASED ON THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY THE
AMERICAN COLLEGE OF RADIOLOGY; OR
(II) A WOMAN IS BELIEVED TO BE AT AN INCREASED RISK FOR BREAST CANCER
DUE TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER, POSI-
TIVE GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH WOMAN'S
PHYSICIAN OR NURSE PRACTITIONER.
(II) SUCH ADDITIONAL COVERAGE 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
POLICY.
(III) EACH MAMMOGRAPHY REPORT PROVIDED TO A PATIENT SHALL INCLUDE
INFORMATION ABOUT BREAST DENSITY, BASED ON THE BREAST IMAGING REPORTING
AND DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY. WHERE
APPLICABLE, SUCH REPORT SHALL INCLUDE THE FOLLOWING NOTICE: "IF YOUR
MAMMOGRAM DEMONSTRATES THAT YOU HAVE DENSE BREAST TISSUE, WHICH COULD
HIDE SMALL ABNORMALITIES, YOU MIGHT BENEFIT FROM SUPPLEMENTARY SCREENING
TESTS, DEPENDING ON YOUR INDIVIDUAL RISK FACTORS AND THE RECOMMENDATION
OF YOUR INTERPRETING PHYSICIAN. A REPORT OF YOUR MAMMOGRAPHY RESULTS,
WHICH CONTAINS INFORMATION ABOUT YOUR BREAST DENSITY, HAS BEEN SENT TO
YOUR TREATING PHYSICIAN'S OFFICE AND YOU SHOULD CONTACT YOUR TREATING
PHYSICIAN IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR REPORT."
S 3. Subsection (p) of section 4303 of the insurance law is amended by
adding a new paragraph 4 to read as follows:
(4) (A) SUCH COVERAGE SHALL PROVIDE ADDITIONAL COVERAGE FOR COMPREHEN-
SIVE ULTRASOUND SCREENING, MAGNETIC RESONANCE IMAGING (MRI), AND/OR
OTHER SCREENING TESTS APPROVED BY THE AMERICAN COLLEGE OF RADIOLOGY OF
AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
(I) A MAMMOGRAM DEMONSTRATES HETEROGENEOUS OR DENSE BREAST TISSUE
BASED ON THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY THE
AMERICAN COLLEGE OF RADIOLOGY; OR
(II) A WOMAN IS BELIEVED TO BE AT INCREASED RISK FOR BREAST CANCER DUE
TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER, POSITIVE
GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH WOMAN'S
PHYSICIAN OR NURSE PRACTITIONER.
THE ADDITIONAL COVERAGE REQUIRED IN THIS SUBPARAGRAPH 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 POLICY.
(B) EACH MAMMOGRAPHY REPORT PROVIDED TO A PATIENT SHALL INCLUDE INFOR-
MATION ABOUT BREAST DENSITY, BASED ON THE BREAST IMAGING REPORTING AND
DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY. WHERE
APPLICABLE, SUCH REPORT SHALL INCLUDE THE FOLLOWING NOTICE: "IF YOUR
A. 7774 3
MAMMOGRAM DEMONSTRATES THAT YOU HAVE DENSE BREAST TISSUE, WHICH COULD
HIDE SMALL ABNORMALITIES, YOU MIGHT BENEFIT FROM SUPPLEMENTARY SCREENING
TESTS, DEPENDING ON YOUR INDIVIDUAL RISK FACTORS AND THE RECOMMENDATION
OF YOUR INTERPRETING PHYSICIAN. A REPORT OF YOUR MAMMOGRAPHY RESULTS,
WHICH CONTAINS INFORMATION ABOUT YOUR BREAST DENSITY, HAS BEEN SENT TO
YOUR TREATING PHYSICIAN'S OFFICE AND YOU SHOULD CONTACT YOUR TREATING
PHYSICIAN IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR REPORT."
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. This act shall take effect on the sixtieth day after it shall
have become a law.