Assembly Bill A10747

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10747
 
                           I N  A S S E M B L Y
 
                              March 27, 2026
                                ___________
 
 Introduced  by M. of A. REYES -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance  law,  in  relation  to  requiring  health
   insurance  plans  to  cover  a  medically  necessary peripheral artery
   disease screening test for any at-risk individual
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
 amended by adding a new paragraph 42 to read as follows:
   (42) (A) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR  SIMI-
 LAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE MEDICALLY NECESSARY COVER-
 AGE FOR A PERIPHERAL ARTERY DISEASE SCREENING TEST FOR ANY AT-RISK INDI-
 VIDUAL,  AS  DEFINED  BY  THE  AMERICAN  COLLEGE  OF  CARDIOLOGY AND THE
 AMERICAN HEART ASSOCIATION'S JOINT COMMITTEE ON CLINICAL PRACTICE GUIDE-
 LINES.
   (B) NOTWITHSTANDING ANY  OTHER  PROVISION  OF  LAW,  ANY  POLICY  THAT
 PROVIDES  COVERAGE  REQUIRED  BY THIS PARAGRAPH SHALL NOT IMPOSE PATIENT
 COST SHARING FOR FOLLOW-UP SCREENING OR DIAGNOSTIC SERVICES FOR  PERIPH-
 ERAL ARTERY DISEASE.
   (C)  (I)  NOTHING  IN  THIS  PARAGRAPH  SHALL  BE CONSTRUED TO PREVENT
 MEDICAL MANAGEMENT OR UTILIZATION  REVIEW  OF  THE  SERVICES,  INCLUDING
 PREAUTHORIZATION,  TO  ENSURE  THAT  SUCH  SERVICES  ARE CONSISTENT WITH
 NATIONALLY RECOGNIZED CLINICAL PRACTICE GUIDELINES FOR THE DETECTION  OF
 PERIPHERAL ARTERY DISEASE.
   (II)  FOR  THE  PURPOSES  OF  THIS  SUBPARAGRAPH, THE TERM "NATIONALLY
 RECOGNIZED CLINICAL  PRACTICE  GUIDELINES"  MEANS  EVIDENCE-BASED,  PEER
 REVIEWED CLINICAL PRACTICE GUIDELINES INFORMED BY A SYSTEMATIC REVIEW OF
 EVIDENCE  AND  AN  ASSESSMENT  OF THE BENEFITS, AND RISKS OF ALTERNATIVE
 CARE OPTIONS INTENDED TO OPTIMIZE PATIENT CARE DEVELOPED BY  INDEPENDENT
 ORGANIZATIONS  OR MEDICAL PROFESSIONAL SOCIETIES UTILIZING A TRANSPARENT
 METHODOLOGY AND REPORTING STRUCTURE AND  WITH  A  CONFLICT  OF  INTEREST
 POLICY.
   (D)  IF  THE  POLICY  IS  A  HIGH DEDUCTIBLE HEALTH PLAN AS DEFINED IN
 SECTION 223(C)(2) OF THE INTERNAL REVENUE CODE OF  1986,  SUCH  COVERAGE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD15315-01-6
 A. 10747                            2
 
 MAY  BE  SUBJECT  TO THE PLAN'S ANNUAL DEDUCTIBLE IF APPLICATION OF THIS
 REQUIREMENT WOULD RESULT IN INELIGIBILITY FOR A HEALTH SAVINGS ACCOUNT.
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph (24) to read as follows:
   (24)  (A) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMI-
 LAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE MEDICALLY NECESSARY COVER-
 AGE FOR A PERIPHERAL ARTERY DISEASE SCREENING TEST FOR ANY AT-RISK INDI-
 VIDUAL, AS DEFINED  BY  THE  AMERICAN  COLLEGE  OF  CARDIOLOGY  AND  THE
 AMERICAN HEART ASSOCIATION'S JOINT COMMITTEE ON CLINICAL PRACTICE GUIDE-
 LINES.
   (B)  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF  LAW,  ANY POLICY THAT
 PROVIDES COVERAGE REQUIRED BY THIS PARAGRAPH SHALL  NOT  IMPOSE  PATIENT
 COST  SHARING FOR FOLLOW-UP SCREENING OR DIAGNOSTIC SERVICES FOR PERIPH-
 ERAL ARTERY DISEASE.
   (C) (I) NOTHING IN  THIS  PARAGRAPH  SHALL  BE  CONSTRUED  TO  PREVENT
 MEDICAL  MANAGEMENT  OR  UTILIZATION  REVIEW  OF THE SERVICES, INCLUDING
 PREAUTHORIZATION, TO ENSURE  THAT  SUCH  SERVICES  ARE  CONSISTENT  WITH
 NATIONALLY  RECOGNIZED CLINICAL PRACTICE GUIDELINES FOR THE DETECTION OF
 PERIPHERAL ARTERY DISEASE.
   (II) FOR THE PURPOSES  OF  THIS  SUBPARAGRAPH,  THE  TERM  "NATIONALLY
 RECOGNIZED  CLINICAL  PRACTICE  GUIDELINES"  MEANS  EVIDENCE-BASED, PEER
 REVIEWED CLINICAL PRACTICE GUIDELINES INFORMED BY A SYSTEMATIC REVIEW OF
 EVIDENCE AND AN ASSESSMENT OF THE BENEFITS,  AND  RISKS  OF  ALTERNATIVE
 CARE  OPTIONS INTENDED TO OPTIMIZE PATIENT CARE DEVELOPED BY INDEPENDENT
 ORGANIZATIONS OR MEDICAL PROFESSIONAL SOCIETIES UTILIZING A  TRANSPARENT
 METHODOLOGY  AND  REPORTING  STRUCTURE  AND  WITH A CONFLICT OF INTEREST
 POLICY.
   (D) IF THE POLICY IS A HIGH  DEDUCTIBLE  HEALTH  PLAN  AS  DEFINED  IN
 SECTION  223(C)(2)  OF  THE INTERNAL REVENUE CODE OF 1986, SUCH COVERAGE
 MAY BE SUBJECT TO THE PLAN'S ANNUAL DEDUCTIBLE IF  APPLICATION  OF  THIS
 REQUIREMENT WOULD RESULT IN INELIGIBILITY FOR A HEALTH SAVINGS ACCOUNT.
   §  3.  Section  4303  of  the insurance law is amended by adding a new
 subsection (yy) to read as follows:
   (YY) (1) EVERY CONTRACT UNDER THIS  SECTION  WHICH  PROVIDES  MEDICAL,
 MAJOR  MEDICAL,  OR  SIMILAR  COMPREHENSIVE-TYPE  COVERAGE SHALL PROVIDE
 MEDICALLY NECESSARY COVERAGE FOR A PERIPHERAL ARTERY  DISEASE  SCREENING
 TEST  FOR  ANY AT-RISK INDIVIDUAL, AS DEFINED BY THE AMERICAN COLLEGE OF
 CARDIOLOGY AND THE AMERICAN HEART ASSOCIATION'S JOINT COMMITTEE ON CLIN-
 ICAL PRACTICE GUIDELINES.
   (2) NOTWITHSTANDING ANY OTHER PROVISION OF  LAW,  ANY  CONTRACT  UNDER
 THIS  SECTION  THAT  PROVIDES COVERAGE REQUIRED BY THIS SUBSECTION SHALL
 NOT IMPOSE PATIENT COST SHARING FOR FOLLOW-UP  SCREENING  OR  DIAGNOSTIC
 SERVICES FOR PERIPHERAL ARTERY DISEASE.
   (3)  (A)  NOTHING  IN  THIS  SUBSECTION  SHALL BE CONSTRUED TO PREVENT
 MEDICAL MANAGEMENT OR UTILIZATION  REVIEW  OF  THE  SERVICES,  INCLUDING
 PREAUTHORIZATION,  TO  ENSURE  THAT  SUCH  SERVICES  ARE CONSISTENT WITH
 NATIONALLY RECOGNIZED CLINICAL PRACTICE GUIDELINES FOR THE DETECTION  OF
 PERIPHERAL ARTERY DISEASE.
   (B)  FOR  THE  PURPOSES OF THIS PARAGRAPH, THE TERM "NATIONALLY RECOG-
 NIZED CLINICAL PRACTICE GUIDELINES" MEANS EVIDENCE-BASED, PEER  REVIEWED
 CLINICAL PRACTICE GUIDELINES INFORMED BY A SYSTEMATIC REVIEW OF EVIDENCE
 AND AN ASSESSMENT OF THE BENEFITS, AND RISKS OF ALTERNATIVE CARE OPTIONS
 INTENDED TO OPTIMIZE PATIENT CARE DEVELOPED BY INDEPENDENT ORGANIZATIONS
 OR  MEDICAL  PROFESSIONAL  SOCIETIES UTILIZING A TRANSPARENT METHODOLOGY
 AND REPORTING STRUCTURE AND WITH A CONFLICT OF INTEREST POLICY.
 A. 10747                            3
 
   (4) IF THE CONTRACT IS A HIGH DEDUCTIBLE HEALTH  PLAN  AS  DEFINED  IN
 SECTION  223(C)(2)  OF  THE INTERNAL REVENUE CODE OF 1986, SUCH COVERAGE
 MAY BE SUBJECT TO THE PLAN'S ANNUAL DEDUCTIBLE IF  APPLICATION  OF  THIS
 REQUIREMENT WOULD RESULT IN INELIGIBILITY FOR A HEALTH SAVINGS ACCOUNT.
   §  4.  This  act shall take effect January 1, 2027, and shall apply to
 all policies and contracts issued, renewed, modified, altered or amended
 on or after such date.