The New York State Senate

 
                     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.