Senate Bill S4072

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  4072--A
     Cal. No. 920
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             January 31, 2025
                                ___________
 
 Introduced by Sens. BYNOE, RHOADS -- read twice and ordered printed, and
   when printed to be committed to the Committee on Insurance -- reported
   favorably  from  said  committee,  ordered to first and second report,
   ordered to a third reading, amended and ordered  reprinted,  retaining
   its place in the order of third reading

 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,  AND  A  SINGLE  BASELINE MAMMOGRAM, WHICH MAY BE PROVIDED BY
 BREAST TOMOSYNTHESIS, FOR ALL OTHER COVERED PERSONS UPON THE RECOMMENDA-
 TION OF A PHYSICIAN, SUBJECT TO THE  INSURER'S  DETERMINATION  THAT  THE
 MAMMOGRAM IS MEDICALLY NECESSARY;
   (iii) an annual mammogram, which may be provided by breast tomosynthe-
 sis, for covered persons aged forty and older;
   (iv)  for  large  group  policies  that provide coverage for hospital,
 surgical or medical care, an annual mammogram for  ALL  covered  persons
 aged  thirty-five through thirty-nine, inclusive AND ALL COVERED PERSONS
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD01242-06-5
 S. 4072--A                          2
 
 HAVING A PRIOR HISTORY OF BREAST CANCER OR WHO HAVE A FIRST DEGREE RELA-
 TIVE WITH A PRIOR HISTORY OF BREAST CANCER, AND ANY  SONOGRAM  OR  OTHER
 DIAGNOSTIC  PROCEDURE USED TO DETECT BREAST CANCER, upon the recommenda-
 tion  of  a  physician,  subject to the insurer's determination that the
 mammogram is medically necessary; and
   (v) upon the recommendation of a physician, screening  and  diagnostic
 imaging, including diagnostic mammograms, breast ultrasounds, or magnet-
 ic  resonance  imaging,  recommended  by  nationally recognized clinical
 practice guidelines for the detection of breast cancer. For the purposes
 of this item, "nationally recognized clinical practice guidelines" 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 for ALL covered persons aged thirty-five through thir-
 ty-nine, inclusive, AND ALL COVERED PERSONS HAVING A  PRIOR  HISTORY  OF
 BREAST  CANCER  OR WHO HAVE A FIRST DEGREE RELATIVE WITH A PRIOR HISTORY
 OF BREAST CANCER, AND FOR ALL COVERED  PERSONS  ANY  SONOGRAM  OR  OTHER
 DIAGNOSTIC  PROCEDURE USED TO DETECT BREAST CANCER, upon the recommenda-
 tion 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.