Senate Bill S10480

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10480
 
                             I N  S E N A T E
 
                               May 15, 2026
                                ___________
 
 Introduced  by Sen. SCARCELLA-SPANTON -- read twice and ordered printed,
   and when printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance  law,  in  relation  to  mandatory  health
   insurance coverage for coronary artery calcium diagnostic testing
 
   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  COVERAGE  FOR  CORONARY
 ARTERY  CALCIUM  DIAGNOSTIC  TESTING UPON THE RECOMMENDATION OF A HEALTH
 CARE PROVIDER ACTING WITHIN SUCH PROVIDER'S SCOPE OF  PRACTICE  PURSUANT
 TO  TITLE  EIGHT  OF THE EDUCATION LAW, AND AS RECOMMENDED BY NATIONALLY
 RECOGNIZED CLINICAL PRACTICE GUIDELINES FOR THE PREVENTION OF CARDIOVAS-
 CULAR DISEASE.
   (B) NOTWITHSTANDING ANY  OTHER  PROVISION  OF  LAW,  ANY  POLICY  THAT
 PROVIDES  COVERAGE  REQUIRED  BY THIS PARAGRAPH SHALL NOT IMPOSE PATIENT
 COST SHARING FOR CORONARY ARTERY CALCIUM DIAGNOSTIC TESTING.
   (C) FOR THE PURPOSES OF THIS PARAGRAPH, THE  TERM  "NATIONALLY  RECOG-
 NIZED  CLINICAL  PRACTICE  GUIDELINES"  SHALL  MEAN 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 PREVENTION OF CARDIOVAS-
 CULAR DISEASE.
   (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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD15931-01-6
              

 S. 10480                            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  COVERAGE  FOR  CORONARY
 ARTERY  CALCIUM  DIAGNOSTIC  TESTING UPON THE RECOMMENDATION OF A HEALTH
 CARE PROVIDER ACTING WITHIN SUCH PROVIDER'S SCOPE OF  PRACTICE  PURSUANT
 TO  TITLE  EIGHT  OF THE EDUCATION LAW, AND AS RECOMMENDED BY NATIONALLY
 RECOGNIZED CLINICAL PRACTICE GUIDELINES FOR THE PREVENTION OF CARDIOVAS-
 CULAR DISEASE.
   (B) NOTWITHSTANDING ANY  OTHER  PROVISION  OF  LAW,  ANY  POLICY  THAT
 PROVIDES  COVERAGE  REQUIRED  BY THIS PARAGRAPH SHALL NOT IMPOSE PATIENT
 COST SHARING FOR CORONARY ARTERY CALCIUM DIAGNOSTIC TESTING.
   (C) FOR THE PURPOSES OF THIS PARAGRAPH, THE  TERM  "NATIONALLY  RECOG-
 NIZED  CLINICAL  PRACTICE  GUIDELINES"  SHALL  MEAN 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 PREVENTION OF CARDIOVAS-
 CULAR DISEASE.
   (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 (yy) to read as follows:
   (YY)  (1)  EVERY  CONTRACT  WHICH  PROVIDES MEDICAL, MAJOR MEDICAL, OR
 SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE FOR  CORONARY
 ARTERY  CALCIUM  DIAGNOSTIC  TESTING UPON THE RECOMMENDATION OF A HEALTH
 CARE PROVIDER ACTING WITHIN SUCH PROVIDER'S SCOPE OF  PRACTICE  PURSUANT
 TO  TITLE  EIGHT  OF THE EDUCATION LAW, AND AS RECOMMENDED BY NATIONALLY
 RECOGNIZED CLINICAL PRACTICE GUIDELINES FOR THE PREVENTION OF CARDIOVAS-
 CULAR DISEASE.
   (2) NOTWITHSTANDING ANY OTHER PROVISION  OF  LAW,  ANY  CONTRACT  THAT
 PROVIDES  COVERAGE  REQUIRED BY THIS SUBSECTION SHALL NOT IMPOSE PATIENT
 COST SHARING FOR CORONARY ARTERY CALCIUM DIAGNOSTIC TESTING.
   (3) FOR THE PURPOSES OF THIS SUBSECTION, THE TERM  "NATIONALLY  RECOG-
 NIZED  CLINICAL  PRACTICE  GUIDELINES"  SHALL  MEAN 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.
   (4) NOTHING IN THIS SUBSECTION 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 PREVENTION OF CARDIOVAS-
 CULAR DISEASE.
 S. 10480                            3

   (5)  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.