NY State Assembly Bill 2023-A1696A

Assembly Bill A1696A

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

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Current Bill Status - In Assembly 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 15, 2024	print number 1696a
Mar 15, 2024	amend and recommit to insurance
Jan 03, 2024	referred to insurance
Jan 17, 2023	referred to insurance

Bill Amendments

Original

A (Active)

co-Sponsors

2023-A1696 - Details

See Senate Version of this Bill:: S2465
Current Committee:: Assembly Insurance
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:: A9150, S8156

2023-A1696 - 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-A1696 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1696
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 17, 2023
                                ___________
 
 Introduced by M. of A. HUNTER -- read once and referred 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
 A. 1696                             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

2023-A1696A (ACTIVE) - Details

See Senate Version of this Bill:: S2465
Current Committee:: Assembly Insurance
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:: A9150, S8156

2023-A1696A (ACTIVE) - Summary

2023-A1696A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1696--A
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 17, 2023
                                ___________
 
 Introduced  by  M.  of  A. HUNTER, RAGA -- read once and referred to the
   Committee on Insurance -- recommitted to the Committee on Insurance in
   accordance with Assembly Rule 3, sec. 2 -- committee discharged,  bill
   amended,  ordered reprinted as amended and recommitted to said commit-
   tee

 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,
 WHICH OCCURRED IN THE PREVIOUS  ONE  HUNDRED  AND  TWENTY  DAYS,  SHOWED

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02639-07-4
 A. 1696--A                          2

 
 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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Assembly Bill A1696A

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Sponsored By

HUNTER

Current Bill Status - In Assembly Committee

Bill Amendments

co-Sponsors

Steven Raga

2023-A1696 - Details

2023-A1696 - Summary

2023-A1696 - Bill Text download pdf

co-Sponsors

Steven Raga

2023-A1696A (ACTIVE) - Details

2023-A1696A (ACTIVE) - Summary

2023-A1696A (ACTIVE) - Bill Text download pdf

Comments