Senate Bill S6523

                                 
BILL NUMBER: S6523

SPONSOR: CLEARE
 
TITLE OF BILL:

An act to amend the insurance law, the social services law and the
public health law, in relation to requiring insurance companies to reim-
burse all health care practitioners at the same rate for cervical cytol-
ogy screening

 
PURPOSE OR GENERAL IDEA OF BILL::

To improve health care access and reduce health care disparities faced
by women who otherwise would need to see two different doctors to have
annual cervical cancer screenings.

 
SUMMARY OF SPECIFIC PROVISIONS::

Section 1. Subparagraph (B) of paragraph 15 of subsection (1) of section
3216 of the insurance law, as amended by chapter 219 of the laws of
2011, is amended to read as follows:

              

An insurer shall provide the same rate of reimbursement for cervical
cytology screening whether such screening is performed by a licensed
health care practitioner or by a provider of obstetrical and/or gyneco-
logic services.

Section 2: Subparagraph (B) of paragraph 14 of subsection (I) of section
3221 of the insurance law, as amended by chapter 219 of the laws of
2011, is amended to read as follows:

An insurer shall provide the same rate of reimbursement for cervical
cytology screening whether such screening is performed by a licensed
health care practitioner or by a provider of obstetrical and/or gyneco-
logic services.

Section 3: Paragraph 2 of subsection (t) of section 4303 of the insur-
ance law, as amended by chapter 219 of the laws of 2011, is amended to
read as follows:

An insurer shall provide the same rate of reimbursement for cervical
cytology screening whether such screening is performed by a licensed
health care practitioner or by a provider of obstetrical and/or gyneco-
logic services.

Section 4: Section 364-j is amended by adding a new subdivision 18-a to
read as follows:

Managed care providers shall be reimbursed at the same rate for cervical
cytology screening, including but not limited to the preparation of a
Pap smear, whether such screening is performed by a primary care practi-
tioner or by a medical services provider of obstetrical and/or gyneco-
logic services.

Section 5: Title 6 of article 2 of the public health law, as added by
chapter 342 of the laws of 2014, is amended by adding a new section
266-a to read as follows:


Cervical cytology screening. Notwithstanding any provision of law to the
contrary, a primary care practitioner shall not refuse to perform cervi-
cal cytology screening, including but not limited to the preparation of
a Pap smear, during a patient's regular annual checkup or for new
patients who have not had a Pap smear done by a primary care practition-
er or by a provider of obstetrical and/or gynecologic services within
the preceding twelve months.

Section 6: This act shall take effect on the one hundred eightieth day
after it shall have become a law; Effective immediately, the addition,
amendment and/or repeal of any rule or regulation necessary for the
implementation of this act on its effective date are authorized to be
made and completed on or before such effective date.

 
JUSTIFICATION::

Having women visit two doctors to get their complete annual physical
exam is a clear example of institutional barriers to wellness that have
been put in place by bad public policy. This is currently the case for
women who must visit their primary doctor and then make a second
appointment to see an OBGYN to be screened for cervical cancer.

For many women, taking two days off from work instead of just one
creates complications with their jobs. Many low-wage workers have limit-
ed time off allowed by their employers, others with limited or no health
insurance find that the current practice of seeing two doctors for
complete health screening is costly.

Over a decade ago, New York State decided to require that only OBGYNs
would be reimbursed for pap smear exams. Previously, general practice
doctors could and would do the exams at yearly physical exams of their
patients. The practice has endured causing countless women to forgo
these life saving cancer screenings and an unknown number have lost
their lives by forgoing the two doctor visits to get the full annual
health screening, had cancer and never knew it till it was too late for
modern medicine to save their lives.

This legislation aims to revert the practice of allowing general MDs to
perform the pap smear to detect cervical cancer by setting the same
insurance (private and public) reimbursement rate for the exam.

This legislation also prevents primary care physicians from denying such
screenings when the reimbursement rate is equalized. Ensuring proper
access and lower health care disparities in women is a matter of disman-
tling bad public policy. This legislation aims to accomplish exactly
this.

 
PRIOR LEGISLATIVE HISTORY::

New legislation

 
FISCAL IMPLICATIONS::

None.

 
EFFECTIVE DATE::

This act shall take effect in 180 days.