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

                                  3760

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            January 29, 2013
                               ___________

Introduced  by M. of A. ESPINAL -- read once and referred to the Commit-
  tee on Insurance

AN ACT to amend the insurance  law,  in  relation  to  requiring  health
  insurance policies to cover comprehensive ultrasound screening, genet-
  ic  testing,  magnetic  resonance imaging and/or other screening tests
  for breast cancer in certain cases, requiring the provision of certain
  information relating to breast  density  to  patients;  and  requiring
  health  insurance  policies  to  cover comprehensive tests for ovarian
  cancer in certain cases

  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  (F)  to  read  as
follows:
  (F)  (I)  SUCH POLICY SHALL PROVIDE ADDITIONAL COVERAGE FOR COMPREHEN-
SIVE ULTRASOUND SCREENING, GENETIC TESTING, 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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06910-02-3
              

A. 3760                             2

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  2.  Paragraph 11 of subsection (l) of section 3221 of the insurance
law is amended by adding a new subparagraph (F) to read as follows:
  (F) (I) SUCH POLICY SHALL PROVIDE ADDITIONAL COVERAGE  FOR  COMPREHEN-
SIVE  ULTRASOUND  SCREENING, GENETIC TESTING, 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 5 to read as follows:
  (5) (A) SUCH COVERAGE SHALL PROVIDE ADDITIONAL COVERAGE FOR COMPREHEN-
SIVE ULTRASOUND SCREENING, GENETIC TESTING, 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

A. 3760                             3

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  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; OVARIAN CANCER SCREENING AS  PROVIDED  IN
SUBSECTION  (P-1)  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. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 11-b to read as follows:
  (11-B)  (A) EVERY POLICY THAT PROVIDES COVERAGE FOR HOSPITAL, SURGICAL
OR MEDICAL CARE SHALL PROVIDE THE FOLLOWING COVERAGE FOR  SCREENING  FOR
OVARIAN CANCER:
  (I)  UPON  THE  RECOMMENDATION  OF A PHYSICIAN, A PELVIC EXAM, GENETIC
TESTING, ULTRASOUND AND BLOOD TESTING AT ANY  AGE  FOR  COVERED  PERSONS
HAVING  A  HIGH  RISK  OF  DEVELOPING OVARIAN CANCER OR WHO HAVE A FIRST
DEGREE RELATIVE WITH A PRIOR HISTORY OF OVARIAN CANCER;
  (II) A SINGLE BASELINE ULTRASOUND FOR COVERED PERSONS AGED THIRTY-FIVE
THROUGH THIRTY-NINE, INCLUSIVE; AND
  (III) AN ANNUAL ULTRASOUND FOR COVERED PERSONS AGED FORTY AND OLDER.
  (B) SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS  PARA-
GRAPH  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.
  (C) (I) SUCH POLICY SHALL PROVIDE FOR ADDITIONAL COVERAGE FOR COMPUTED
TOMOGRAPHY, BARIUM ENEMA X-RAYS, MAGNETIC RESONANCE IMAGING (MRI), POSI-
TRON  EMISSION  TOMOGRAPHY,  LAPAROSCOPY,  COLONOSCOPY  AND  BIOPSY IF A
PERSON IS BELIEVED TO BE AT INCREASED RISK FOR  OVARIAN  CANCER  DUE  TO
FAMILY  HISTORY  OR  PRIOR  PERSONAL HISTORY OF OVARIAN CANCER, POSITIVE
GENETIC TESTING OR OTHER INDICATIONS  AS  DETERMINED  BY  SUCH  PERSON'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.
  S 6. Subsection (1) of section 3221 of the insurance law is amended by
adding a new paragraph 11-b to read as follows:
  (11-B) (A) EVERY INSURER DELIVERING A GROUP OR BLANKET POLICY OR ISSU-
ING  A  GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE THAT PROVIDES
COVERAGE FOR HOSPITAL,  SURGICAL  OR  MEDICAL  CARE  SHALL  PROVIDE  THE
FOLLOWING COVERAGE FOR SCREENING FOR OVARIAN CANCER:
  (I)  UPON  THE  RECOMMENDATION  OF A PHYSICIAN, A PELVIC EXAM, GENETIC
TESTING, ULTRASOUND AND BLOOD TESTING AT ANY  AGE  FOR  COVERED  PERSONS
HAVING  A  HIGH  RISK  OF  DEVELOPING OVARIAN CANCER OR WHO HAVE A FIRST
DEGREE RELATIVE WITH A PRIOR HISTORY OF OVARIAN CANCER;

A. 3760                             4

  (II) A SINGLE BASELINE ULTRASOUND FOR COVERED PERSONS AGED THIRTY-FIVE
THROUGH THIRTY-NINE, INCLUSIVE; AND
  (III) AN ANNUAL ULTRASOUND FOR COVERED PERSONS AGED FORTY AND OLDER.
  (B)  SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
GRAPH 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.
  (C) (I) SUCH POLICY SHALL PROVIDE FOR ADDITIONAL COVERAGE FOR COMPUTED
TOMOGRAPHY, BARIUM ENEMA X-RAYS, MAGNETIC RESONANCE IMAGING (MRI), POSI-
TRON EMISSION TOMOGRAPHY,  LAPAROSCOPY,  COLONOSCOPY  AND  BIOPSY  IF  A
PERSON  IS  BELIEVED  TO  BE AT INCREASED RISK FOR OVARIAN CANCER DUE TO
FAMILY HISTORY OR PRIOR PERSONAL HISTORY  OF  OVARIAN  CANCER,  POSITIVE
GENETIC  TESTING  OR  OTHER  INDICATIONS  AS DETERMINED BY SUCH PERSON'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.
  S 7. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (p-1) to read as follows:
  (P-1)  (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 SCREENING FOR OVARIAN CANCER:
  (A) UPON THE RECOMMENDATION OF A PHYSICIAN,  A  PELVIC  EXAM,  GENETIC
TESTING,  ULTRASOUND  AND  BLOOD  TESTING AT ANY AGE FOR COVERED PERSONS
HAVING A HIGH RISK OF DEVELOPING OVARIAN CANCER  OR  WHO  HAVE  A  FIRST
DEGREE RELATIVE WITH A PRIOR HISTORY OF OVARIAN CANCER;
  (B)  A SINGLE BASELINE ULTRASOUND FOR COVERED PERSONS AGED THIRTY-FIVE
THROUGH THIRTY-NINE, INCLUSIVE; AND
  (C) AN ANNUAL ULTRASOUND FOR COVERED PERSONS AGED FORTY AND OLDER.
  (2) SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS  PARA-
GRAPH  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.
  (3) (A) SUCH POLICY SHALL PROVIDE FOR ADDITIONAL COVERAGE FOR COMPUTED
TOMOGRAPHY, BARIUM ENEMA X-RAYS, MAGNETIC RESONANCE IMAGING (MRI), POSI-
TRON  EMISSION  TOMOGRAPHY,  LAPAROSCOPY,  COLONOSCOPY  AND  BIOPSY IF A
PERSON IS BELIEVED TO BE AT INCREASED RISK FOR  OVARIAN  CANCER  DUE  TO
FAMILY  HISTORY  OR  PRIOR  PERSONAL HISTORY OF OVARIAN CANCER, POSITIVE
GENETIC TESTING OR OTHER INDICATIONS  AS  DETERMINED  BY  SUCH  PERSON'S
PHYSICIAN OR NURSE PRACTITIONER.
  (B)  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.
  S 8. This act shall take effect on the sixtieth  day  after  it  shall
have become a law.