S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6151
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               March 5, 2025
                                ___________
 
 Introduced  by  Sens. PARKER, ADDABBO, PALUMBO -- read twice and ordered
   printed, and when printed to be committed to the Committee  on  Insur-
   ance
 
 AN  ACT  to  amend  the  insurance  law, in relation to coverage for the
   detection of 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 (i) of
 section 3216 of the insurance law, as amended by chapter 424 of the laws
 of 2024, is amended and a new subparagraph  (G)  is  added  to  read  as
 follows:
   (A)  Every  policy  that  provides  coverage 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]  TWENTY-FIVE
 through [thirty-nine] TWENTY-NINE, inclusive;
   (iii) an annual mammogram, which may be provided by breast tomosynthe-
 sis, for covered persons aged [forty] THIRTY and older; and
   (iv) 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

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10609-01-5
              

 S. 6151                             2
 
 independent  organizations or medical professional societies utilizing a
 transparent methodology and reporting structure and with a  conflict  of
 interest policy.
   (G)  COVERAGE  SHALL  ALSO  BE  PROVIDED, UPON THE RECOMMENDATION OF A
 PHYSICIAN, FOR FOLLOW-UP DIAGNOSTIC TESTING FOR THE DETECTION OF  BREAST
 CANCER,  INCLUDING BREAST BIOPSIES, IN THE EVENT THAT A PHYSICIAN DETER-
 MINES THAT A COVERED PERSON HAS HAD AN ABNORMAL MAMMOGRAM. SUCH  FOLLOW-
 UP  DIAGNOSTIC  TESTING  SHALL  NOT  BE SUBJECT TO ANNUAL DEDUCTIBLES OR
 COINSURANCE.
   § 2. 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 and a new subparagraph (G) is added 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]  TWENTY-FIVE
 through [thirty-nine] TWENTY-NINE, inclusive;
   (iii) an annual mammogram, which may be provided by breast tomosynthe-
 sis, for covered persons aged [forty] THIRTY and older;
   (iv) for large group policies  that  provide  coverage  for  hospital,
 surgical  or  medical care, an annual mammogram for covered persons aged
 [thirty-five] TWENTY-FIVE through [thirty-nine] TWENTY-NINE,  inclusive,
 upon  the recommendation of a physician, subject to the insurer's deter-
 mination 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.
   (G)  COVERAGE  SHALL  ALSO  BE  PROVIDED, UPON THE RECOMMENDATION OF A
 PHYSICIAN, FOR FOLLOW-UP DIAGNOSTIC TESTING FOR THE DETECTION OF  BREAST
 CANCER,  INCLUDING BREAST BIOPSIES, IN THE EVENT THAT A PHYSICIAN DETER-
 MINES THAT A COVERED PERSON HAS HAD AN ABNORMAL MAMMOGRAM. SUCH  FOLLOW-
 UP  DIAGNOSTIC  TESTING  SHALL  NOT  BE SUBJECT TO ANNUAL DEDUCTIBLES OR
 COINSURANCE.
   § 3. Subparagraphs (B), (C) and (D) of paragraph 1 of  subsection  (p)
 of  section  4303 of the insurance law, as amended by chapter 424 of the
 laws of 2024, are amended and a new paragraph 6  is  added  to  read  as
 follows:
   (B) a single baseline mammogram, which may be provided by breast tomo-
 synthesis,  for  covered  persons aged [thirty-five] TWENTY-FIVE through
 [thirty-nine] TWENTY-NINE, inclusive;
   (C) an annual mammogram, which may be provided by breast tomosythesis,
 for covered persons aged [forty] THIRTY and older;
 S. 6151                             3
 
   (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  covered  persons  aged [thirty-five] TWENTY-FIVE
 through [thirty-nine] TWENTY-NINE, inclusive, upon the recommendation of
 a  physician, subject to the corporation's determination that the mammo-
 gram is medically necessary;
   (6) COVERAGE SHALL ALSO BE PROVIDED,  UPON  THE  RECOMMENDATION  OF  A
 PHYSICIAN,  FOR FOLLOW-UP DIAGNOSTIC TESTING FOR THE DETECTION OF BREAST
 CANCER, INCLUDING BREAST BIOPSIES, IN THE EVENT THAT A PHYSICIAN  DETER-
 MINES  THAT A COVERED PERSON HAS HAD AN ABNORMAL MAMMOGRAM. SUCH FOLLOW-
 UP DIAGNOSTIC TESTING SHALL NOT BE  SUBJECT  TO  ANNUAL  DEDUCTIBLES  OR
 COINSURANCE.
   §  4.  This  act shall take effect on the ninetieth day after it shall
 have become a law and shall apply to all policies and contracts  issued,
 renewed,  modified,  altered or amended on or after such date; provided,
 however, that if chapter 424 of the laws of 2024 shall  not  have  taken
 effect  on  or before such date then sections one, two and three of this
 act shall take effect on the same date and in the same  manner  as  such
 chapter of the laws of 2024, takes effect.