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

                                  8319

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            December 18, 2013
                               ___________

Introduced by M. of A. JAFFEE -- read once and referred to the Committee
  on Insurance

AN ACT to amend the insurance law and the public health law, in relation
  to  authorizing  coverage  for mammography and other imaging screening
  for occult breast cancer and to provide notification of  dense  breast
  tissue results to the patient's physician

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

  Section  1.  Subparagraphs  (A),  (C)  and  (D)  of  paragraph  11  of
subsection (i) of section 3216 of the insurance law, as amended by chap-
ter 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]
  (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 AS DEEMED  APPROPRIATE  BY
THE  AMERICAN  COLLEGE OF RADIOLOGY OR THE AMERICAN CANCER SOCIETY OF AN
ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
  (A) A MAMMOGRAM PERFORMED PURSUANT TO THIS  SUBPARAGRAPH  DEMONSTRATES
THAT THE COVERED PERSON HAS DENSE BREAST TISSUE; OR
  (B)  A  COVERED  PERSON 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 A  PHYSI-
CIAN.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13128-01-3
              

A. 8319                             2

  FOR  THE  PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE SHALL MEAN
HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS DEFINED IN NATIONALLY
RECOGNIZED GUIDELINES OR SYSTEMS FOR BREAST IMAGING REPORTING OF MAMMOG-
RAPHY SCREENING, INCLUDING, BUT  NOT  LIMITED  TO,  THE  BREAST  IMAGING
REPORTING  AND DATA SYSTEM OF THE AMERICAN COLLEGE OF RADIOLOGY, AND ANY
EQUIVALENT NEW TERMS, AS SUCH GUIDELINES OR SYSTEMS ARE 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  USED  TO  SCREEN FOR, OR DIAGNOSE,
OCCULT BREAST CANCER.
  (D) In addition to subparagraph (A), (B) or  (C)  of  this  paragraph,
every  policy  that  provides coverage for hospital, surgical or medical
care, except for a grandfathered health plan under subparagraph  (E)  of
this  paragraph,  shall  provide  coverage for the following mammography
screening  services  AND  FOR  THE  FOLLOWING  COMPREHENSIVE  ULTRASOUND
SCREENINGS OF AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS, and such
coverage shall not be subject to annual deductibles or coinsurance:
  (i)  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]
  (ii)  with  respect  to  women,  such  additional  preventive care and
screenings for mammography not described in item (i)  of  this  subpara-
graph  and  as provided for in comprehensive guidelines supported by the
health resources and services administration[.]; AND
  (III) COMPREHENSIVE ULTRASOUND SCREENINGS AS LONG AS DEEMED  APPROPRI-
ATE  BY THE AMERICAN COLLEGE OF RADIOLOGY OR THE AMERICAN CANCER SOCIETY
OF AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
  (A) A MAMMOGRAM DEMONSTRATES THAT A WOMAN HAS DENSE BREAST TISSUE; OR
  (B) 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 A PHYSICIAN.
  FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE  SHALL  MEAN
HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS DEFINED IN NATIONALLY
RECOGNIZED GUIDELINES OR SYSTEMS FOR BREAST IMAGING REPORTING OF MAMMOG-
RAPHY  SCREENING,  INCLUDING,  BUT  NOT  LIMITED  TO, THE BREAST IMAGING
REPORTING AND DATA SYSTEM OF THE AMERICAN COLLEGE OF RADIOLOGY, AND  ANY
EQUIVALENT NEW TERMS, AS SUCH GUIDELINES OR SYSTEMS ARE UPDATED.
  S  2. Subparagraphs (A), (C) and (D) of paragraph 11 of subsection (1)
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

A. 8319                             3

  (IV)  UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING FOR A
COVERED PERSON USING OTHER IMAGING MODALITIES AS DEEMED  APPROPRIATE  BY
THE  AMERICAN  COLLEGE OF RADIOLOGY OR THE AMERICAN CANCER SOCIETY OF AN
ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
  (A)  A  MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DEMONSTRATES
THAT THE COVERED PERSON HAS DENSE BREAST TISSUE; OR,
  (B) A COVERED PERSON 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 A PHYSI-
CIAN.
  FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE  SHALL  MEAN
HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS DEFINED IN NATIONALLY
RECOGNIZED GUIDELINES OR SYSTEMS FOR BREAST IMAGING REPORTING OF MAMMOG-
RAPHY  SCREENING,  INCLUDING,  BUT  NOT  LIMITED  TO, THE BREAST IMAGING
REPORTING AND DATA SYSTEM OF THE AMERICAN COLLEGE OF RADIOLOGY, AND  ANY
EQUIVALENT NEW TERMS, AS SUCH GUIDELINES OR SYSTEMS ARE 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  USED  TO  SCREEN  FOR,  OR  DIAGNOSE,
OCCULT BREAST CANCER.
  (D)  In  addition  to  subparagraph (A), (B) or (C) of this paragraph,
every group or blanket  policy  that  provides  coverage  for  hospital,
surgical  or  medical care, except for a grandfathered health plan under
subparagraph (E) of this  paragraph,  shall  provide  coverage  for  the
following  mammography  screening  services AND FOR COMPREHENSIVE ULTRA-
SOUND SCREENINGS OF AN ENTIRE BREAST OR THE ENTIRETY  OF  BOTH  BREASTS,
and  such coverage shall not be subject to annual deductibles or coinsu-
rance:
  (i) 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]
  (ii) with respect  to  women,  such  additional  preventive  care  and
screenings  for  mammography  not described in item (i) of this subpara-
graph and as provided for in comprehensive guidelines supported  by  the
health resources and services administration[.]; AND
  (III)  COMPREHENSIVE ULTRASOUND SCREENINGS AS LONG AS DEEMED APPROPRI-
ATE BY THE AMERICAN COLLEGE OF RADIOLOGY OR THE AMERICAN CANCER  SOCIETY
OF AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
  (A) A MAMMOGRAM DEMONSTRATES THAT A WOMAN HAS DENSE BREAST TISSUE; OR
  (B)  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 A PHYSICIAN.
  FOR  THE  PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE SHALL MEAN
HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS DEFINED IN NATIONALLY
RECOGNIZED GUIDELINES OR SYSTEMS FOR BREAST IMAGING REPORTING OF MAMMOG-
RAPHY SCREENING, INCLUDING, BUT  NOT  LIMITED  TO,  THE  BREAST  IMAGING
REPORTING  AND DATA SYSTEM OF THE AMERICAN COLLEGE OF RADIOLOGY, AND ANY
EQUIVALENT NEW TERMS, AS SUCH GUIDELINES OR SYSTEMS ARE UPDATED.
  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

A. 8319                             4

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 AS DEEMED APPROPRIATE BY
THE AMERICAN COLLEGE OF RADIOLOGY OR THE AMERICAN CANCER SOCIETY  OF  AN
ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
  (A)  A  MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DEMONSTRATES
THAT THE COVERED PERSON HAS DENSE BREAST TISSUE; OR
  (B) A COVERED PERSON 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 A PHYSI-
CIAN.
  FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE  SHALL  MEAN
HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS DEFINED IN NATIONALLY
RECOGNIZED GUIDELINES OR SYSTEMS FOR BREAST IMAGING REPORTING OF MAMMOG-
RAPHY  SCREENING,  INCLUDING,  BUT  NOT  LIMITED  TO, THE BREAST IMAGING
REPORTING AND DATA SYSTEM OF THE AMERICAN COLLEGE OF RADIOLOGY, AND  ANY
EQUIVALENT NEW TERMS, AS SUCH GUIDELINES OR SYSTEMS ARE 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  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  FOR COMPREHENSIVE ULTRASOUND SCREENINGS OF AN ENTIRE
BREAST OR THE ENTIRETY OF BOTH BREASTS, and such coverage shall  not  be
subject to annual deductibles 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[.]; AND
  (C) COMPREHENSIVE ULTRASOUND SCREENINGS AS LONG AS DEEMED  APPROPRIATE
BY  THE  AMERICAN COLLEGE OF RADIOLOGY OR THE AMERICAN CANCER SOCIETY OF
AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
  (I) A MAMMOGRAM DEMONSTRATES THAT A WOMAN HAS DENSE BREAST TISSUE; OR

A. 8319                             5

  (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 A PHYSICIAN.
  FOR  THE  PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE SHALL MEAN
HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS DEFINED IN NATIONALLY
RECOGNIZED GUIDELINES OR SYSTEMS FOR BREAST IMAGING REPORTING OF MAMMOG-
RAPHY SCREENING, INCLUDING, BUT  NOT  LIMITED  TO,  THE  BREAST  IMAGING
REPORTING  AND DATA SYSTEM OF THE AMERICAN COLLEGE OF RADIOLOGY, AND ANY
EQUIVALENT NEW TERMS, AS SUCH GUIDELINES OR SYSTEMS ARE UPDATED.
  (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
maintains grandfathered status in accordance with section 1251(e) of the
Affordable Care Act, 42 U.S.C. S 18011(e).
  S 4. Section 2404-c of the public health law, as added by chapter  265
of the laws of 2012, is amended 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, provide notifica-
tion to such patient that shall include, but  not  be  limited  to,  the
following  information,  in  any summary 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 be associ-
ated with an increased risk of breast cancer.
  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.
  For the purposes of this section dense breast tissue shall mean heter-
ogeneously dense or extremely dense  tissue  as  defined  in  nationally
recognized guidelines or systems for breast imaging reporting of mammog-
raphy  screening,  including,  but  not  limited  to, the breast imaging
reporting and data system of the American College of Radiology, and  any
equivalent new terms, as such guidelines or systems are updated.
  S 5. This act shall take effect on the one hundred eightieth day after
it shall have become a law.