S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7881
 
                             I N  S E N A T E
 
                             January 18, 2022
                                ___________
 
 Introduced  by Sen. STAVISKY -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to providing coverage and information  on  chest  wall  reconstruction
   surgery after a mastectomy or partial mastectomy
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (A) of  paragraph  20  of  subsection  (i)  of
 section 3216 of the insurance law, as added by chapter 21 of the laws of
 1997,  the opening paragraph and clause (i) as amended by chapter 302 of
 the laws of 2012, is amended to read as follows:
   (A) Every policy which provides medical,  major  medical,  or  similar
 comprehensive-type  coverage  shall  provide  the following coverage for
 breast OR CHEST  WALL  reconstruction  surgery  after  a  mastectomy  or
 partial mastectomy:
   (i)  all stages of reconstruction of the breast OR CHEST WALL on which
 the mastectomy or partial mastectomy has been performed; and
   (ii) surgery and reconstruction of the other breast OR CHEST  WALL  to
 produce a symmetrical appearance;
 in  the  manner determined by the attending physician and the patient to
 be appropriate. CHEST WALL RECONSTRUCTION SURGERY SHALL INCLUDE AESTHET-
 IC FLAT CLOSURE AS SUCH TERM IS DEFINED BY THE  NATIONAL  CANCER  INSTI-
 TUTE. Such coverage may be subject to annual deductibles and coinsurance
 provisions as may be deemed appropriate by the superintendent and as are
 consistent  with  those  established  for  other benefits within a given
 policy. Written notice of the availability of  such  coverage  shall  be
 delivered  to  the  policyholder  prior  to inception of such policy and
 annually thereafter.
   § 2. Subparagraph (A) of paragraph 10 of  subsection  (k)  of  section
 3221  of  the insurance law, as added by chapter 21 of the laws of 1997,
 the opening paragraph and clause (i) as amended by chapter  302  of  the
 laws of 2012, is amended to read as follows:
   (A)  Every group or blanket policy delivered or issued for delivery in
 this state which provides medical, major medical, or similar  comprehen-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD13570-01-1
 S. 7881                             2
 
 sive-type  coverage  shall  provide the following coverage for breast OR
 CHEST WALL reconstruction surgery after a mastectomy or partial  mastec-
 tomy:
   (i)  all stages of reconstruction of the breast OR CHEST WALL on which
 the mastectomy or partial mastectomy has been performed; and
   (ii) surgery and reconstruction of the other breast OR CHEST  WALL  to
 produce a symmetrical appearance;
 in  the  manner determined by the attending physician and the patient to
 be appropriate. CHEST WALL RECONSTRUCTION SURGERY SHALL INCLUDE AESTHET-
 IC FLAT CLOSURE AS SUCH TERM IS DEFINED BY THE  NATIONAL  CANCER  INSTI-
 TUTE. Such coverage may be subject to annual deductibles and coinsurance
 provisions as may be deemed appropriate by the superintendent and as are
 consistent  with  those  established  for  other benefits within a given
 policy. Written notice of the availability of  such  coverage  shall  be
 delivered  to  the  policyholder  prior  to inception of such policy and
 annually thereafter.
   § 3. Paragraph 1 of subsection (x) of section 4303  of  the  insurance
 law,  as  added by chapter 21 of the laws of 1997, the opening paragraph
 and subparagraph (A) as amended by chapter 302 of the laws of  2012,  is
 amended to read as follows:
   (1)  Every contract issued by a medical expense indemnity corporation,
 hospital  service  corporation  or  health  service  corporation   which
 provides coverage for surgical or medical care shall provide the follow-
 ing  coverage  for  breast  OR CHEST WALL reconstruction surgery after a
 mastectomy or partial mastectomy:
   (A) all stages of reconstruction of the breast OR CHEST WALL on  which
 the mastectomy or partial mastectomy has been performed; and
   (B)  surgery  and  reconstruction of the other breast OR CHEST WALL to
 produce a symmetrical appearance;
 in the manner determined by the attending physician and the  patient  to
 be appropriate. CHEST WALL RECONSTRUCTION SURGERY SHALL INCLUDE AESTHET-
 IC  FLAT  CLOSURE  AS SUCH TERM IS DEFINED BY THE NATIONAL CANCER INSTI-
 TUTE. Such coverage may be subject to annual deductibles or  coinsurance
 provisions as may be deemed appropriate by the superintendent and as are
 consistent  with  those  established  for  other benefits within a given
 policy. Written notice of the availability of  such  coverage  shall  be
 delivered to the group remitting agent or group contract holder prior to
 the inception of such contract and annually thereafter.
   §  4. Subdivisions 1 and 1-a of section 2404 of the public health law,
 subdivision 1 as amended by chapter 179 of the laws of 1991 and subdivi-
 sion 1-a as added by chapter 20 of the laws of 1997, are amended to read
 as follows:
   1. The commissioner shall develop a standardized written  summary,  in
 plain  non-technical  language,  which  shall  explain  the  alternative
 medically viable methods of treating breast cancer,  including  but  not
 limited  to  hormonal, radiological, chemotherapeutic or surgical treat-
 ments, or combinations thereof. The summary shall contain information on
 breast OR CHEST WALL reconstructive surgery, including but  not  limited
 to,  the  use  of  breast  implants, their side effects, risks and other
 pertinent information to aid a person in deciding on a course of  treat-
 ment.    CHEST WALL RECONSTRUCTIVE INFORMATION SHALL INCLUDE INFORMATION
 ON AESTHETIC FLAT CLOSURE AS SUCH TERM IS DEFINED BY THE NATIONAL CANCER
 INSTITUTE.
   1-a. The informational summary shall also include  an  explanation  of
 the special provisions relating to mastectomy, lymph node dissection, or
 lumpectomy,  and  breast  OR CHEST WALL reconstructive surgery coverage,
 S. 7881                             3
 
 and second opinion coverage (including out-of-network options) under the
 insurance law and section twenty-eight hundred three-o of this  chapter,
 and  suggest that patients undergoing such procedures check their health
 plans and/or insurance policies for the details of their coverage.
   §  5.  Subdivision  2  of  section 2803-o of the public health law, as
 added by chapter 354 of the laws of 2010, is amended to read as follows:
   2. Every general hospital that provides mastectomy surgery, lymph node
 dissection or a lumpectomy shall  provide  information  to  the  patient
 concerning  the  option  of reconstructive surgery following such proce-
 dures, including BOTH BREAST AND CHEST WALL RECONSTRUCTIVE  SURGERY  AND
 the  availability  of coverage for reconstructive surgery, in accordance
 with the provisions of sections  three  thousand  two  hundred  sixteen,
 three  thousand  two  hundred twenty-one and four thousand three hundred
 three of the insurance law and applicable provisions of federal law. The
 information shall be provided to the patient in writing and  in  advance
 of obtaining consent to the surgical procedure. The information provided
 shall include at least the following:
   (a) a description of the various reconstructive options and the advan-
 tages and disadvantages of each. SUCH DESCRIPTION SHALL INCLUDE AESTHET-
 IC  FLAT  CLOSURE  AS  SUCH  TERM  IS  DEFINED  BY  THE  NATIONAL CANCER
 INSTITUTE;
   (b) a description of the provisions assuring coverage  by  public  and
 private  insurance  plans of the costs related to reconstructive surgery
 under federal and state law;
   (c) a description of how a patient  may  access  reconstructive  care,
 including the potential of transferring care to a facility that provides
 reconstructive   care   or   choosing  to  pursue  reconstruction  after
 completion  of  breast  cancer  surgery   and   chemo/radiotherapy,   if
 warranted;
   (d) such other information as may be required by the commissioner.
   §6.  This  act  shall  take effect on the ninetieth day after it shall
 have become a law and shall apply to all policies and contracts  issued,
 renewed, modified, altered or amended on or after such date.