S T A T E O F N E W Y O R K
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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.
