NY State Senate Bill 2023-S2465A

Senate Bill S2465A

2023-2024 Legislative Session

Requires certain insurance policies and Medicaid to allow patients a one hundred twenty-day window for additional screening for breast cancer when the provider deems such screening is necessary

download bill text pdf

Current Bill Status - In Senate Committee Finance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Mar 05, 2024	print number 2465a
Mar 05, 2024	amend and recommit to finance
Mar 04, 2024	reported and committed to finance
Jan 03, 2024	referred to insurance returned to senate died in assembly
Jun 06, 2023	referred to insurance delivered to assembly passed senate
Jun 01, 2023	ordered to third reading cal.1463 committee discharged and committed to rules
May 22, 2023	reported and committed to finance
Jan 20, 2023	referred to insurance

Votes

- Jun 6, 2023 - Floor Vote
  S2465A
  
  62
  
  Aye
  
  0
  
  Nay
  
  0
  
  Absent
  
  1
  
  Excused
  
  0
  
  Abstained
  - - Floor Vote: Jun 6, 2023
      
      aye (62)
      
      Addabbo Jr.
      
      Ashby
      
      Bailey
      
      Borrello
      
      Breslin
      
      Brisport
      
      Brouk
      
      Canzoneri-Fitzpatrick
      
      Chu
      
      Cleare
      
      Comrie
      
      Cooney
      
      Fernandez
      
      Gallivan
      
      Gianaris
      
      Gonzalez
      
      Gounardes
      
      Griffo
      
      Harckham
      
      Helming
      
      Hinchey
      
      Hoylman-Sigal
      
      Jackson
      
      Kavanagh
      
      Kennedy
      
      Krueger
      
      Lanza
      
      Liu
      
      Mannion
      
      Martinez
      
      Martins
      
      Mattera
      
      May
      
      Mayer
      
      Murray
      
      Myrie
      
      O'Mara
      
      Oberacker
      
      Ortt
      
      Palumbo
      
      Parker
      
      Persaud
      
      Ramos
      
      Rhoads
      
      Rivera
      
      Rolison
      
      Ryan
      
      Salazar
      
      Sanders Jr.
      
      Scarcella-Spanton
      
      Sepúlveda
      
      Serrano
      
      Skoufis
      
      Stavisky
      
      Stec
      
      Stewart-Cousins
      
      Tedisco
      
      Thomas
      
      Walczyk
      
      Webb
      
      Weber
      
      Weik
      
      excused (1)
      
      Felder
  Jun 1, 2023 - Rules Committee Vote
  S2465A
  
  21
  
  Aye
  
  0
  
  Nay
  
  0
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Rules Committee Vote: Jun 1, 2023
      
      aye (21)
      
      Addabbo Jr.
      
      Bailey
      
      Breslin
      
      Comrie
      
      Fernandez
      
      Gallivan
      
      Gianaris
      
      Griffo
      
      Helming
      
      Kennedy
      
      Krueger
      
      Lanza
      
      Liu
      
      Mayer
      
      O'Mara
      
      Ortt
      
      Parker
      
      Sepúlveda
      
      Stec
      
      Stewart-Cousins
      
      Thomas
  Mar 4, 2024 - Insurance Committee Vote
  S2465A
  
  11
  
  Aye
  
  0
  
  Nay
  
  0
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Insurance Committee Vote: Mar 4, 2024
      
      aye (11)
      
      Addabbo Jr.
      
      Ashby
      
      Breslin
      
      Cooney
      
      Harckham
      
      Helming
      
      Kennedy
      
      Martinez
      
      O'Mara
      
      Sanders Jr.
      
      Scarcella-Spanton
  May 22, 2023 - Insurance Committee Vote
  S2465A
  
  10
  
  Aye
  
  0
  
  Nay
  
  1
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Insurance Committee Vote: May 22, 2023
      
      aye (10)
      
      Addabbo Jr.
      
      Breslin
      
      Cooney
      
      Harckham
      
      Helming
      
      Kennedy
      
      Martinez
      
      O'Mara
      
      Sanders Jr.
      
      Scarcella-Spanton
      
      aye wr (1)
      
      Borrello

Bill Amendments

Original

A (Active)

co-Sponsors

View additional co-sponsors

2023-S2465 - Details

See Assembly Version of this Bill:: A1696
Current Committee:: Senate Finance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L; amd §365-a, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:: S8156, A9150

2023-S2465 - Summary

Requires certain insurance policies and Medicaid to allow patients a one hundred twenty-day window for additional screening for breast cancer, which may include an additional mammogram, when the provider deems such screening is necessary.

2023-S2465 - Sponsor Memo

                                 
BILL NUMBER: S2465

SPONSOR: PERSAUD
 
TITLE OF BILL:

An act to amend the insurance law and the social services law, in
relation to requiring certain insurance policies and Medicaid to allow
patients a one hundred twenty-day window for additional breast exams
when the provider deems another breast exam is needed

 
PURPOSE OR GENERAL IDEA OF BILL:

Mandates certain insurance policies and Medicaid to allow patients a one
hundred twenty-day window for additional breast exams when the provider
deems another breast exam is needed.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 and 2. Allows a patient one hundred and twenty days to get an
additional breast exam done should the provider finds it necessary.
Defines the word "physician" in accordance with secion sixty five-
hundred twenty- two of the educational law.

Section 3 and 4. Adds new provision to allows abnormal mammogram exam
completed within the past one hundred and twenty days be repeated.

Section 5. Provides for the effective date.

 
JUSTIFICATION:

Many individuals that identify as women end up with breast cancer
despite completing a routine mammogram. Women in the United States have
a higher breast cancer mortality rate than other cancer. A publication
done by the University of Rochester Medical Center showed approximately
67 percent of women age 40 and older receive a screening mammogram every
one or two years. 16 percent of those screened will require additional
screening by their providers if it is their first mammogram, and 10
percent will be called to undergo further mammography exams.

In 2015, the American Association for Cancer Research reported that
women who have a history of false-positives screening for mammogram
exams or negative biopsibs are at greater risk of getting breast cancer
for at least a decade. False-positive mammogram screening helps provid-
ers to detect early breast cancer. Allowing women more time to get an
additional mammogram is an early intervention method that can save many
lives, and this legislation aims to do just that.

 
PRIOR LEGISLATIVE HISTORY:

2022: S8156 Referred to Insurance

 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
The act shall take effect on the thirtieth day after it shall become
law.

2023-S2465 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2465
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 20, 2023
                                ___________
 
 Introduced by Sens. PERSAUD, JACKSON, KENNEDY, MYRIE, PALUMBO, SEPULVEDA
   -- 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 social services law, in
   relation to requiring certain insurance policies and Medicaid to allow
   patients a one hundred twenty-day window for additional  breast  exams
   when the provider deems another breast exam is needed
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (A) of  paragraph  11  of  subsection  (i)  of
 section 3216 of the insurance law, as amended by chapter 414 of the laws
 of 2017, is amended to read as follows:
   (A)  Every  policy  that  provides  coverage for hospital, surgical or
 medical care  shall  provide  the  following  coverage  for  mammography
 screening for occult breast cancer:
   (i)  [upon  the  recommendation  of  a  physician]  WHERE  A PROVIDER,
 LICENSED TO ISSUE PRESCRIPTIONS PURSUANT TO SECTION  SIXTY-FIVE  HUNDRED
 TWENTY-TWO  OF  THE  EDUCATION  LAW,  ASSESSED THE RISK AND THEN MAKES A
 RECOMMENDATION FOR AN ADDITIONAL SCREENING INCLUDING MAMMOGRAM, a mammo-
 gram, which may be provided by breast  tomosynthesis,  at  any  age  for
 covered  persons having a prior history of breast cancer OR DENSE BREAST
 or who have a first degree relative  with  a  prior  history  of  breast
 cancer OR DENSE BREAST;
   (ii)  a  single  baseline  mammogram,  which may be provided by breast
 tomosynthesis, for covered persons aged thirty-five through thirty-nine,
 inclusive; [and]
   (iii) an annual mammogram, which may be provided by breast tomosynthe-
 sis, for covered persons aged forty and older; AND
   (IV)  AN  ADDITIONAL  SCREENING  INCLUDING  MAMMOGRAM,  WHICH  MAY  BE
 PROVIDED  BY  BREAST TOMOSYNTHESIS, FOR COVERED PERSONS WHOSE MAMMOGRAM,
 WHICH OCCURRED IN THE PREVIOUS ONE HUNDRED TWENTY  DAYS,  SHOWED  ABNOR-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02639-01-3

 S. 2465                             2
 
 MALITIES  DUE TO DENSE BREAST OR THE PROVIDER DEEMS ANOTHER MAMMOGRAM IS
 NEEDED.
   §  2.  Subparagraph  (A)  of paragraph 11 of subsection (l) of section
 3221 of the insurance law, as amended by chapter  143  of  the  laws  of
 2019, is 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 screening for occult breast cancer:
   (i) [upon  the  recommendation  of  a  physician]  WHERE  A  PROVIDER,
 LICENSED  TO  ISSUE PRESCRIPTIONS PURSUANT TO SECTION SIXTY-FIVE HUNDRED
 TWENTY-TWO OF THE EDUCATION LAW, ASSESSED THE  RISK  AND  THEN  MAKES  A
 RECOMMENDATION FOR AN ADDITIONAL SCREENING INCLUDING MAMMOGRAM, a mammo-
 gram,  which  may  be  provided  by breast tomosynthesis, at any age for
 covered persons having a prior history of breast cancer OR DENSE  BREAST
 or  who  have  a  first  degree  relative with a prior history of breast
 cancer OR DENSE BREAST;
   (ii) a single baseline mammogram, which  may  be  provided  by  breast
 tomosynthesis, for covered persons aged thirty-five through thirty-nine,
 inclusive;
   (iii) an annual mammogram, which may be provided by breast tomosynthe-
 sis, for covered persons aged forty and older; [and]
   (iv)  for  large  group  policies  that provide coverage for hospital,
 surgical or medical care, an annual mammogram for covered  persons  aged
 thirty-five  through thirty-nine, inclusive, [upon the recommendation of
 a physician] WHERE A PROVIDER, LICENSED TO ISSUE PRESCRIPTIONS  PURSUANT
 TO  SECTION SIXTY-FIVE HUNDRED TWENTY-TWO OF THE EDUCATION LAW, ASSESSED
 THE RISK AND THEN MAKES A RECOMMENDATION  FOR  AN  ADDITIONAL  SCREENING
 INCLUDING  MAMMOGRAM,  subject  to  the insurer's determination that the
 mammogram is medically necessary; AND
   (V) AN ADDITIONAL SCREENING INCLUDING MAMMOGRAM, WHICH MAY BE PROVIDED
 BY BREAST TOMOSYNTHESIS, FOR  COVERED  PERSONS  WHOSE  MAMMOGRAM,  WHICH
 OCCURRED  IN  THE PREVIOUS ONE HUNDRED TWENTY DAYS, SHOWED ABNORMALITIES
 DUE TO DENSE BREAST OR THE PROVIDER DEEMS ANOTHER MAMMOGRAM IS NEEDED.
   § 3. Subparagraph (E) of paragraph 1 of subsection (p) of section 4303
 of the insurance law, as amended by chapter 143 of the laws of 2019,  is
 amended to read as follows:
   (E) AN ADDITIONAL SCREENING INCLUDING MAMMOGRAM, WHICH MAY BE PROVIDED
 BY  BREAST  TOMOSYNTHESIS,  FOR  COVERED  PERSONS WHOSE MAMMOGRAM, WHICH
 OCCURRED IN THE PREVIOUS ONE HUNDRED TWENTY DAYS,  SHOWED  ABNORMALITIES
 DUE TO DENSE BREAST OR THE PROVIDER DEEMS ANOTHER MAMMOGRAM IS NEEDED.
   (F)  The  coverage required in this paragraph or paragraph two of this
 subsection shall not be subject to annual deductibles or coinsurance.
   § 4. Subdivision 2 of section 365-a of  the  social  services  law  is
 amended by adding a new paragraph (kk) to read as follows:
   (KK)  A  MAMMOGRAM, WHICH MAY BE PROVIDED BY BREAST TOMOSYNTHESIS, FOR
 COVERED PERSONS WHOSE MAMMOGRAM, WHICH  OCCURRED  IN  THE  PREVIOUS  ONE
 HUNDRED  TWENTY  DAYS,  SHOWED  ABNORMALITIES DUE TO DENSE BREAST OR THE
 PROVIDER DEEMS ANOTHER MAMMOGRAM IS NEEDED.
   § 5. This act shall take effect on the thirtieth day  after  it  shall
 have  become  a  law,  and shall apply to policies and contracts issued,
 renewed, modified, altered or amended on or after such effective date.

co-Sponsors

View additional co-sponsors

2023-S2465A (ACTIVE) - Details

See Assembly Version of this Bill:: A1696
Current Committee:: Senate Finance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L; amd §365-a, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:: S8156, A9150

2023-S2465A (ACTIVE) - Summary

2023-S2465A (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S2465A

SPONSOR: PERSAUD
 
TITLE OF BILL:

An act to amend the insurance law and the social services law, in
relation to requiring certain insurance policies and Medicaid to allow
patients a one hundred twenty-day window for additional breast exams
when the provider deems another breast exam is needed

 
PURPOSE OR GENERAL IDEA OF BILL:

Mandates certain insurance policies and Medicaid to allow patients a one
hundred twenty-day window for additional breast exams when the provider
deems another breast exam is needed.

 
SUMMARY OF SPECIFIC PROVISIONS:

Sections 1 and 2 of the bill allow a patient one hundred and twenty days
to get an additional breast exam done should the provider finds it
necessary. They also define the word "physician" in accordance with
section sixty-five hundred twenty-two of the educational law.

Sections 3 and 4 of the bill add a new provision to allow an abnormal
mammogram exam completed within the past one hundred and twenty days to
be repeated.

Section 5 of the bill sets the effective date.

 
JUSTIFICATION:

Many individuals that identify as women end up with breast cancer
despite completing a routine mammogram. Women in the United States have
a higher breast cancer mortality rate than other cancer. A publication
done by the University of Rochester Medical Center showed approximately
67 percent of women age 40 and older receive a screening mammogram every
one or two years. 16 percent of those screened will require additional
screening by their providers if it is their first mammogram, and 10
percent will be called to undergo further mammography exams.

In 2015, the American Association for Cancer Research reported that
women who have a history of false-positives screening for mammogram
exams or negative biopsies are at greater risk of getting breast cancer
for at least a decade. False-positive mammogram screening helps provid-
ers to detect early breast cancer. Allowing women more time to get an
additional mammogram is an early intervention method that can save many
lives, and this legislation aims to do just that.

 
PRIOR LEGISLATIVE HISTORY:

2022: S8156 - Passed Senate

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
The act shall take effect on January 1, 2026.

2023-S2465A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  2465--A
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 20, 2023
                                ___________
 
 Introduced  by  Sens.  PERSAUD,  CHU,  JACKSON, KENNEDY, MYRIE, PALUMBO,
   SEPULVEDA -- read twice and ordered printed, and when  printed  to  be
   committed  to the Committee on Insurance -- recommitted to the Commit-
   tee on Insurance in accordance with Senate Rule 6, sec. 8 --  reported
   favorably  from  said  committee  and  committed  to  the Committee on
   Finance -- committee discharged, bill amended,  ordered  reprinted  as
   amended and recommitted to said committee
 
 AN  ACT  to  amend  the  insurance  law  and the social services law, in
   relation to requiring certain insurance policies and Medicaid to allow
   patients a one hundred twenty-day window for additional  breast  exams
   when the provider deems another breast exam is needed
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (D) of  paragraph  11  of  subsection  (i)  of
 section 3216 of the insurance law, as amended by chapter 219 of the laws
 of 2011, is amended to read as follows:
   (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  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)  AN  ADDITIONAL  SCREENING  INCLUDING  A MAMMOGRAM, WHICH MAY BE
 PROVIDED BY BREAST TOMOSYNTHESIS, FOR COVERED PERSONS  WHOSE  MAMMOGRAM,
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02639-06-4

 S. 2465--A                          2
 
 WHICH  OCCURRED  IN  THE  PREVIOUS  ONE  HUNDRED AND TWENTY DAYS, SHOWED
 ABNORMALITIES DUE TO DENSE BREAST, OR WHEN THE  PROVIDER  DEEMS  ANOTHER
 MAMMOGRAM IS NEEDED.
   §  2.  Subparagraph  (D)  of paragraph 11 of subsection (l) of section
 3221 of the insurance law, as amended by chapter  219  of  the  laws  of
 2011, is amended to read as follows:
   (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 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) AN ADDITIONAL SCREENING INCLUDING  A  MAMMOGRAM,  WHICH  MAY  BE
 PROVIDED  BY  BREAST TOMOSYNTHESIS, FOR COVERED PERSONS WHOSE MAMMOGRAM,
 WHICH OCCURRED IN THE PREVIOUS  ONE  HUNDRED  AND  TWENTY  DAYS,  SHOWED
 ABNORMALITIES  DUE  TO  DENSE BREAST, OR WHEN THE PROVIDER DEEMS ANOTHER
 MAMMOGRAM IS NEEDED.
   § 3. Paragraph 3 of subsection (p) of section 4303  of  the  insurance
 law,  as added by chapter 219 of the laws of 2011, is amended to read as
 follows:
   (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[.]; AND
   (C)  AN  ADDITIONAL  SCREENING  INCLUDING  A  MAMMOGRAM,  WHICH MAY BE
 PROVIDED BY BREAST TOMOSYNTHESIS, FOR COVERED PERSONS  WHOSE  MAMMOGRAM,
 WHICH  OCCURRED  IN  THE  PREVIOUS  ONE  HUNDRED AND TWENTY DAYS, SHOWED
 ABNORMALITIES DUE TO DENSE BREAST, OR WHEN THE  PROVIDER  DEEMS  ANOTHER
 MAMMOGRAM IS NEEDED.
   §  4.  Subdivision  2  of  section 365-a of the social services law is
 amended by adding a new paragraph (nn) to read as follows:
   (NN) A MAMMOGRAM, WHICH MAY BE PROVIDED BY BREAST  TOMOSYNTHESIS,  FOR
 COVERED  PERSONS  WHOSE  MAMMOGRAM,  WHICH  OCCURRED IN THE PREVIOUS ONE
 HUNDRED TWENTY DAYS, SHOWED ABNORMALITIES DUE TO DENSE  BREAST  OR  WHEN
 THE PROVIDER DEEMS ANOTHER MAMMOGRAM IS NEEDED.
   §  5.  This  act shall take effect January 1, 2026  and shall apply to
 all policies and contracts issued, renewed, modified, altered or amended
 on or after such date.

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Senate Bill S2465A

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Sponsored By

Current Bill Status - In Senate Committee Finance Committee

Bill Amendments

co-Sponsors

2023-S2465 - Details

2023-S2465 - Summary

2023-S2465 - Sponsor Memo

2023-S2465 - Bill Text download pdf

co-Sponsors

2023-S2465A (ACTIVE) - Details

2023-S2465A (ACTIVE) - Summary

2023-S2465A (ACTIVE) - Sponsor Memo

2023-S2465A (ACTIVE) - Bill Text download pdf

Comments