S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1195--A
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 9, 2025
                                ___________
 
 Introduced  by  M.  of A. PEOPLES-STOKES, WEPRIN, REYES, SHIMSKY, SIMON,
   HEVESI, LUNSFORD, CRUZ,  MEEKS,  STECK,  RAGA,  LUPARDO,  BUTTENSCHON,
   O'PHARROW, SIMONE, BURDICK, ZACCARO, LAVINE, BRONSON, EPSTEIN, STIRPE,
   SANTABARBARA, MAHER, SLATER -- read once and referred to the Committee
   on  Insurance -- committee discharged, bill amended, ordered reprinted
   as amended and recommitted to said committee
 
 AN ACT to amend the insurance  law,  in  relation  to  mandatory  health
   insurance  coverage for follow-up screening or diagnostic services for
   lung cancer
 
   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 41 to read as follows:
   (41) (A) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR  SIMI-
 LAR  COMPREHENSIVE-TYPE  COVERAGE  SHALL  PROVIDE COVERAGE FOR FOLLOW-UP
 SCREENING OR DIAGNOSTIC SERVICES FOR LUNG CANCER UPON THE RECOMMENDATION
 OF A HEALTH CARE PROVIDER ACTING WITHIN THE PROVIDER'S SCOPE OF PRACTICE
 PURSUANT TO TITLE EIGHT OF THE EDUCATION  LAW,  AND  AS  RECOMMENDED  BY
 NATIONALLY  RECOGNIZED CLINICAL PRACTICE GUIDELINES FOR THE DETECTION OF
 LUNG CANCER.
   (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  LUNG
 CANCER.
   (C)  FOR  THE PURPOSES OF THIS PARAGRAPH, "NATIONALLY RECOGNIZED CLIN-
 ICAL 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.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02876-02-5
              

 A. 1195--A                          2
 
   (D) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED  TO  PREVENT  MEDICAL
 MANAGEMENT  OR UTILIZATION REVIEW OF THE SERVICES, INCLUDING PREAUTHORI-
 ZATION, TO ENSURE THAT SUCH  SERVICES  ARE  CONSISTENT  WITH  NATIONALLY
 RECOGNIZED  CLINICAL  PRACTICE  GUIDELINES  FOR  THE  DETECTION  OF LUNG
 CANCER.
   (E)  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.
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 23 to read as follows:
   (23) (A) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR  SIMI-
 LAR  COMPREHENSIVE-TYPE  COVERAGE  SHALL  PROVIDE COVERAGE FOR FOLLOW-UP
 SCREENING OR DIAGNOSTIC SERVICES FOR LUNG CANCER UPON THE RECOMMENDATION
 OF A HEALTH CARE PROVIDER ACTING WITHIN THE PROVIDER'S SCOPE OF PRACTICE
 PURSUANT TO TITLE EIGHT OF THE EDUCATION  LAW,  AND  AS  RECOMMENDED  BY
 NATIONALLY  RECOGNIZED CLINICAL PRACTICE GUIDELINES FOR THE DETECTION OF
 LUNG CANCER.
   (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  LUNG
 CANCER.
   (C)  FOR  THE PURPOSES OF THIS PARAGRAPH, "NATIONALLY RECOGNIZED CLIN-
 ICAL 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) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED  TO  PREVENT  MEDICAL
 MANAGEMENT  OR UTILIZATION REVIEW OF THE SERVICES, INCLUDING PREAUTHORI-
 ZATION, TO ENSURE THAT SUCH  SERVICES  ARE  CONSISTENT  WITH  NATIONALLY
 RECOGNIZED  CLINICAL  PRACTICE  GUIDELINES  FOR  THE  DETECTION  OF LUNG
 CANCER.
   (E) 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 (ww) to read as follows:
   (WW) (1) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR  SIMI-
 LAR  COMPREHENSIVE-TYPE  COVERAGE  SHALL  PROVIDE COVERAGE FOR FOLLOW-UP
 SCREENING OR DIAGNOSTIC SERVICES FOR LUNG CANCER UPON THE RECOMMENDATION
 OF A HEALTH CARE PROVIDER ACTING WITHIN THE PROVIDER'S SCOPE OF PRACTICE
 PURSUANT TO TITLE EIGHT OF THE EDUCATION  LAW,  AND  AS  RECOMMENDED  BY
 NATIONALLY  RECOGNIZED CLINICAL PRACTICE GUIDELINES FOR THE DETECTION OF
 LUNG CANCER.
   (2) NOTWITHSTANDING ANY  OTHER  PROVISION  OF  LAW,  ANY  POLICY  THAT
 PROVIDES  COVERAGE  REQUIRED BY THIS SUBSECTION SHALL NOT IMPOSE PATIENT
 COST SHARING FOR FOLLOW-UP SCREENING OR  DIAGNOSTIC  SERVICES  FOR  LUNG
 CANCER.
   (3)  FOR  THE PURPOSES OF THIS PARAGRAPH, "NATIONALLY RECOGNIZED CLIN-
 ICAL 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
 A. 1195--A                          3
 
 OR  MEDICAL  PROFESSIONAL  SOCIETIES UTILIZING A TRANSPARENT METHODOLOGY
 AND REPORTING STRUCTURE AND WITH A CONFLICT OF INTEREST POLICY.
   (4)  NOTHING  IN  THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT MEDICAL
 MANAGEMENT OR UTILIZATION REVIEW OF THE SERVICES, INCLUDING  PREAUTHORI-
 ZATION,  TO  ENSURE  THAT  SUCH  SERVICES ARE CONSISTENT WITH NATIONALLY
 RECOGNIZED CLINICAL  PRACTICE  GUIDELINES  FOR  THE  DETECTION  OF  LUNG
 CANCER.
   (5)  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.
   § 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.