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S08093 Summary:

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S08093 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          8093
 
                    IN SENATE
 
                                      June 12, 2016
                                       ___________
 
        Introduced  by  Sens.  FLANAGAN,  HANNON,  SEWARD  -- (at request of the
          Governor) -- read twice and ordered printed, and when  printed  to  be
          committed to the Committee on Rules
 
        AN  ACT  to  amend  the  insurance  law, in relation to coverage for the
          detection of breast  cancer;  to  amend  the  public  health  law,  in
          relation  to  requiring  certified  mammography  facilities to provide
          extended hours; and to amend the civil service  law,  in  relation  to
          excused leave to undertake a screening for breast cancer
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Subparagraph (B) 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    (B) Such coverage required pursuant to subparagraph (A) or (C) of this
     5  paragraph  [may]  shall  not  be  subject to annual deductibles [and] or
     6  coinsurance [as may be deemed appropriate by the superintendent  and  as
     7  are  consistent with those established for other benefits within a given
     8  policy].
     9    § 2. Paragraph 11 of subsection (i) of section 3216 of  the  insurance
    10  law is amended by adding a new subparagraph (F) to read as follows:
    11    (F)  Screening  and  diagnostic  imaging  for  the detection of breast
    12  cancer, including diagnostic mammograms, breast ultrasounds, or magnetic
    13  resonance imaging, covered under the policy  shall  not  be  subject  to
    14  annual deductibles or coinsurance.
    15    § 3. Subsection (i) of section 3216 of the insurance law is amended by
    16  adding a new paragraph 33 to read as follows:
    17    (33)  Whenever in this section an insurer is required to provide bene-
    18  fits with no coinsurance or deductible,  the  requirement  only  applies
    19  with  respect  to  participating  providers in the insurer's network, or
    20  with respect to non-participating providers, if  the  insurer  does  not
    21  have  a participating provider in the in-network benefits portion of its
    22  network with the appropriate training and experience to meet the partic-
    23  ular health care needs of the insured  pursuant  to  subsection  (d)  of
    24  section three thousand two hundred seventeen-d of this article.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD12074-01-6
        S. 8093                             2
 
     1    §  4.  Subparagraph  (B)  of paragraph 11 of subsection (l) of section
     2  3221 of the insurance law, as amended by chapter  219  of  the  laws  of
     3  2011, is amended to read as follows:
     4    (B) Such coverage required pursuant to subparagraph (A) or (C) of this
     5  paragraph  [may]  shall  not  be  subject to annual deductibles [and] or
     6  coinsurance [as may be deemed appropriate by the superintendent  and  as
     7  are  consistent with those established for other benefits within a given
     8  policy].
     9    § 5. Paragraph 11 of subsection (l) of section 3221 of  the  insurance
    10  law is amended by adding a new subparagraph (F) to read as follows:
    11    (F)  Screening  and  diagnostic  imaging  for  the detection of breast
    12  cancer, including diagnostic mammograms, breast ultrasounds, or magnetic
    13  resonance imaging, covered under the policy  shall  not  be  subject  to
    14  annual deductibles or coinsurance.
    15    § 6. Subsection (l) of section 3221 of the insurance law is amended by
    16  adding a new paragraph 19 to read as follows:
    17    (19)  Whenever in this section an insurer is required to provide bene-
    18  fits with no coinsurance or deductible,  the  requirement  only  applies
    19  with  respect  to  participating  providers in the insurer's network, or
    20  with respect to non-participating providers, if  the  insurer  does  not
    21  have  a participating provider in the in-network benefits portion of its
    22  network with the appropriate training and experience to meet the partic-
    23  ular health care needs of the insured  pursuant  to  subsection  (d)  of
    24  section three thousand two hundred seventeen-d of this article.
    25    § 7. Subparagraph (D) of paragraph 1 of subsection (p) of section 4303
    26  of  the insurance law, as amended by chapter 219 of the laws of 2011, is
    27  amended to read as follows:
    28    (D) The coverage required in this paragraph or paragraph two  of  this
    29  subsection  [may]  shall  not  be subject to annual deductibles [and] or
    30  coinsurance [as may be deemed appropriate by the superintendent  and  as
    31  are  consistent with those established for other benefits within a given
    32  contract].
    33    § 8. Subsection (p) of section 4303 of the insurance law is amended by
    34  adding a new paragraph 5 to read as follows:
    35    (5) Screening and diagnostic  imaging  for  the  detection  of  breast
    36  cancer, including diagnostic mammograms, breast ultrasounds, or magnetic
    37  resonance  imaging,  covered  under the contract shall not be subject to
    38  annual deductibles or coinsurance.
    39    § 9. Section 4303 of the insurance law is  amended  by  adding  a  new
    40  subsection (qq) to read as follows:
    41    (qq)  Whenever  in  this  section a corporation is required to provide
    42  benefits with no coinsurance or deductible, the requirement only applies
    43  with respect to participating providers in the corporation's network, or
    44  with respect to non-participating providers, if the corporation does not
    45  have a participating provider in the in-network benefits portion of  its
    46  network with the appropriate training and experience to meet the partic-
    47  ular  health care needs of the covered person pursuant to subsection (d)
    48  of section four thousand three hundred six-c  of  this  article,  or  as
    49  applicable,  pursuant  to  paragraph  (a)  of subdivision six of section
    50  forty-four hundred three of the public health law.
    51    § 10. The public health law is amended by adding a new section  2404-d
    52  to read as follows:
    53    §  2404-d.  Breast cancer; duty to provide extended hours. 1. Applica-
    54  bility. This section shall apply to any general  hospital  or  extension
    55  clinic  that  is  certified  as  a  mammography facility pursuant to the
    56  federal mammography quality standards act (MQSA).
        S. 8093                             3
 
     1    2. Extended service hours. Any general hospital  or  extension  clinic
     2  certified  as  a mammography facility pursuant to the MQSA shall provide
     3  extended hours, i.e. in the early morning, evening,  or  weekend  hours,
     4  for screening mammography services. Extended hours for screening mammog-
     5  raphy  services shall be provided on at least two days each week, for at
     6  least two hours each day offered, for a total of  at  least  four  hours
     7  each week, including but not limited to the following times:
     8    (a) Monday through Friday, between the hours of 7:00 AM and 9:00 AM;
     9    (b)  Monday  through Friday, between the hours of 5:00 PM and 7:00 PM;
    10  or
    11    (c) Saturday or Sunday, between the hours of 9:00 AM and 5:00 PM.
    12    3. Waiver. (a) A facility may submit an application for a waiver  from
    13  the  requirements of this section, in whole or in part, if it can demon-
    14  strate, to the department's satisfaction, that the facility:
    15    (i) does not have sufficient  staff  to  provide  extended  hours  for
    16  screening mammography services in accordance with this section, and that
    17  it  is  making  diligent  efforts  to  obtain  staffing such that it can
    18  provide extended hours;
    19    (ii)  is  in  the  process  of  discontinuing  screening   mammography
    20  services, as part of a consolidation or similar change; or
    21    (iii)  is  subject  to  such  other  hardships as the department deems
    22  appropriate.
    23    (b) The department may deny, grant or  extend  a  waiver  pursuant  to
    24  paragraph  (a)  of  this  subdivision  for  ninety  days, or more if the
    25  department determines appropriate, in its sole discretion.
    26    § 11. Subdivision 3 of section 159-b of  the  civil  service  law,  as
    27  added by chapter 566 of the laws of 2006, is amended to read as follows:
    28    [3.  The provisions of this section shall not apply to any employee of
    29  a city having a population of one million or more.]
    30    § 12. This act shall take effect immediately and shall apply to  poli-
    31  cies  and  contracts  issued,  renewed, modified or amended  on or after
    32  January 1, 2017; provided, however, that  section  eleven  of  this  act
    33  shall take effect on the ninetieth day after it shall have become a law;
    34  and  provided, further, that effective immediately, the addition, amend-
    35  ment and/or repeal of any rule or regulation necessary for the implemen-
    36  tation of this act on its effective date is authorized and  directed  to
    37  be made and completed on or before such effective date.