STATE OF NEW YORK ________________________________________________________________________ 1696--A 2023-2024 Regular Sessions IN ASSEMBLY January 17, 2023 ___________ Introduced by M. of A. HUNTER, RAGA -- read once and referred to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said commit- tee AN ACT to amend the insurance law and the social services law, in relation to requiring certain insurance policies and Medicaid to allow patients a one hundred twenty-day window for additional breast exams when the provider deems another breast exam is needed The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subparagraph (D) of paragraph 11 of subsection (i) of 2 section 3216 of the insurance law, as amended by chapter 219 of the laws 3 of 2011, is amended to read as follows: 4 (D) In addition to subparagraph (A), (B) or (C) of this paragraph, 5 every policy that provides coverage for hospital, surgical or medical 6 care, except for a grandfathered health plan under subparagraph (E) of 7 this paragraph, shall provide coverage for the following mammography 8 screening services, and such coverage shall not be subject to annual 9 deductibles or coinsurance: 10 (i) evidence-based items or services for mammography that have in 11 effect a rating of 'A' or 'B' in the current recommendations of the 12 United States preventive services task force; [and] 13 (ii) with respect to women, such additional preventive care and 14 screenings for mammography not described in item (i) of this subpara- 15 graph and as provided for in comprehensive guidelines supported by the 16 health resources and services administration[.]; and 17 (iii) an additional screening including a mammogram, which may be 18 provided by breast tomosynthesis, for covered persons whose mammogram, 19 which occurred in the previous one hundred and twenty days, showed EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02639-07-4
A. 1696--A 2 1 abnormalities due to dense breast, or when the provider deems another 2 mammogram is needed. 3 § 2. Subparagraph (D) of paragraph 11 of subsection (l) of section 4 3221 of the insurance law, as amended by chapter 219 of the laws of 5 2011, is amended to read as follows: 6 (D) In addition to subparagraph (A), (B) or (C) of this paragraph, 7 every group or blanket policy that provides coverage for hospital, 8 surgical or medical care, except for a grandfathered health plan under 9 subparagraph (E) of this paragraph, shall provide coverage for the 10 following mammography screening services, and such coverage shall not be 11 subject to annual deductibles or coinsurance: 12 (i) evidence-based items or services for mammography that have in 13 effect a rating of 'A' or 'B' in the current recommendations of the 14 United States preventive services task force; [and] 15 (ii) with respect to women, such additional preventive care and 16 screenings for mammography not described in item (i) of this subpara- 17 graph and as provided for in comprehensive guidelines supported by the 18 health resources and services administration[.]; and 19 (iii) an additional screening including a mammogram, which may be 20 provided by breast tomosynthesis, for covered persons whose mammogram, 21 which occurred in the previous one hundred and twenty days, showed 22 abnormalities due to dense breast, or when the provider deems another 23 mammogram is needed. 24 § 3. Paragraph 3 of subsection (p) of section 4303 of the insurance 25 law, as added by chapter 219 of the laws of 2011, is amended to read as 26 follows: 27 (3) In addition to paragraph one or two of this subsection, every 28 contract that provides coverage for hospital, surgical or medical care, 29 except for a grandfathered health plan under paragraph four of this 30 subsection, shall provide coverage for the following mammography screen- 31 ing services, and such coverage shall not be subject to annual deduct- 32 ibles or coinsurance: 33 (A) evidence-based items or services for mammography that have in 34 effect a rating of 'A' or 'B' in the current recommendations of the 35 United States preventive services task force; [and] 36 (B) with respect to women, such additional preventive care and screen- 37 ings for mammography not described in subparagraph (A) of this paragraph 38 and as provided for in comprehensive guidelines supported by the health 39 resources and services administration[.]; and 40 (C) an additional screening including a mammogram, which may be 41 provided by breast tomosynthesis, for covered persons whose mammogram, 42 which occurred in the previous one hundred and twenty days, showed 43 abnormalities due to dense breast, or when the provider deems another 44 mammogram is needed. 45 § 4. Subdivision 2 of section 365-a of the social services law is 46 amended by adding a new paragraph (nn) to read as follows: 47 (nn) a mammogram, which may be provided by breast tomosynthesis, for 48 covered persons whose mammogram, which occurred in the previous one 49 hundred twenty days, showed abnormalities due to dense breast or when 50 the provider deems another mammogram is needed. 51 § 5. This act shall take effect January 1, 2026 and shall apply to 52 all policies and contracts issued, renewed, modified, altered or amended 53 on or after such date.