Assembly Bill A7572

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7572
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               April 1, 2025
                                ___________
 
 Introduced  by  M. of A. GONZALEZ-ROJAS -- read once and referred to the
   Committee on Insurance
 
 AN ACT to amend the insurance law, in relation to  coverage  of  certain
   procedures to detect breast cancer
 
   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  (l)  of
 section 3221 of the insurance law, as amended by chapter 424 of the laws
 of 2024, 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, a mammogram, which may  be
 provided  by breast tomosynthesis, at any age for covered persons having
 a prior history of breast cancer or who have  a  first  degree  relative
 with a prior history of breast cancer;
   (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 tomosyn-
 thesis, for covered persons aged forty and older;
   (iv)] for large group policies that  provide  coverage  for  hospital,
 surgical  or  medical care, [an annual mammogram] MAMMOGRAMS for covered
 persons [aged thirty-five through thirty-nine, inclusive] HAVING A PRIOR
 HISTORY OF BREAST CANCER OR WHO HAVE A  FIRST  DEGREE  RELATIVE  WITH  A
 PRIOR  HISTORY  OF  BREAST  CANCER,  OR ANY SONOGRAM OR OTHER DIAGNOSTIC
 PROCEDURE USED TO DETECT BREAST CANCER, upon  the  recommendation  of  a
 physician,  subject to the insurer's determination that the mammogram is
 medically necessary; and

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01242-01-5
 A. 7572                             2
              

 
   [(v)] (IV) upon the recommendation of a physician, screening and diag-
 nostic imaging, including diagnostic mammograms, breast ultrasounds,  or
 magnetic  resonance  imaging, recommended by nationally recognized clin-
 ical practice guidelines for the detection of  breast  cancer.  For  the
 purposes  of  this item, "nationally recognized clinical practice guide-
 lines" means evidence-based 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.
   § 2. Subparagraph (D) of paragraph 1 of subsection (p) of section 4303
 of the insurance law, as amended by chapter 424 of the laws of 2024,  is
 amended to read as follows:
   (D)  for  large group contracts offered by a medical expense indemnity
 corporation, a hospital service corporation or a health  service  corpo-
 ration that provide coverage for hospital, surgical or medical care, [an
 annual  mammogram]  MAMMOGRAMS  for  covered  persons  [aged thirty-five
 through thirty-nine, inclusive] HAVING A PRIOR HISTORY OF BREAST  CANCER
 OR  WHO  HAVE  A  FIRST  DEGREE  RELATIVE WITH A PRIOR HISTORY OF BREAST
 CANCER, OR ANY SONOGRAM OR OTHER DIAGNOSTIC  PROCEDURE  USED  TO  DETECT
 BREAST  CANCER,  upon  the recommendation of a physician, subject to the
 corporation's determination that the mammogram is medically necessary;
   § 3. This act shall take effect on the  same  date  and  in  the  same
 manner as chapter 424 of the laws of 2024, takes effect.