Amd SS3216, 3221 & 4303, Ins L; amd S2404-c, Pub Health L
Relates to coverage for mammography and other image screening for occult breast cancer and providing notification of test results to patient's physician.
STATE OF NEW YORK
________________________________________________________________________
8319
2013-2014 Regular Sessions
IN ASSEMBLY
December 18, 2013
___________
Introduced by M. of A. JAFFEE -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law and the public health law, in relation
to authorizing coverage for mammography and other imaging screening
for occult breast cancer and to provide notification of dense breast
tissue results to the patient's physician
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subparagraphs (A), (C) and (D) of paragraph 11 of
2 subsection (i) of section 3216 of the insurance law, as amended by chap-
3 ter 219 of the laws of 2011, are amended to read as follows:
4 (A) Every policy that provides coverage for hospital, surgical or
5 medical care shall provide the following coverage for mammography and
6 other imaging screening for occult breast cancer:
7 (i) upon the recommendation of a physician, a mammogram at any age for
8 covered persons having a prior history of breast cancer or who have a
9 first degree relative with a prior history of breast cancer;
10 (ii) a single baseline mammogram for covered persons aged thirty-five
11 through thirty-nine, inclusive; [and]
12 (iii) an annual mammogram for covered persons aged forty and older[.];
13 and
14 (iv) upon recommendation of a physician, supplemental screening for a
15 covered person using other imaging modalities as deemed appropriate by
16 the American College of Radiology or the American Cancer Society of an
17 entire breast or the entirety of both breasts if:
18 (a) a mammogram performed pursuant to this subparagraph demonstrates
19 that the covered person has dense breast tissue; or
20 (b) a covered person is believed to be at increased risk for breast
21 cancer due to family history or prior personal history of breast cancer,
22 positive genetic testing or other indications as determined by a physi-
23 cian.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13128-01-3
A. 8319 2
1 For the purposes of this subparagraph dense breast tissue shall mean
2 heterogeneously dense or extremely dense tissue as defined in nationally
3 recognized guidelines or systems for breast imaging reporting of mammog-
4 raphy screening, including, but not limited to, the breast imaging
5 reporting and data system of the American College of Radiology, and any
6 equivalent new terms, as such guidelines or systems are updated.
7 (C) (i) For purposes of subparagraphs (A) and (B) of this paragraph,
8 mammography screening means an X-ray examination of the breast using
9 dedicated equipment, including X-ray tube, filter, compression device,
10 screens, films and cassettes, with an average glandular radiation dose
11 less than 0.5 rem per view per breast.
12 (ii) For purposes of subparagraphs (A) and (B) of this paragraph,
13 imaging modalities are modalities used to screen for, or diagnose,
14 occult breast cancer.
15 (D) In addition to subparagraph (A), (B) or (C) of this paragraph,
16 every policy that provides coverage for hospital, surgical or medical
17 care, except for a grandfathered health plan under subparagraph (E) of
18 this paragraph, shall provide coverage for the following mammography
19 screening services and for the following comprehensive ultrasound
20 screenings of an entire breast or the entirety of both breasts, and such
21 coverage shall not be subject to annual deductibles or coinsurance:
22 (i) evidence-based items or services for mammography that have in
23 effect a rating of 'A' or 'B' in the current recommendations of the
24 United States preventive services task force; [and]
25 (ii) with respect to women, such additional preventive care and
26 screenings for mammography not described in item (i) of this subpara-
27 graph and as provided for in comprehensive guidelines supported by the
28 health resources and services administration[.]; and
29 (iii) comprehensive ultrasound screenings as long as deemed appropri-
30 ate by the American College of Radiology or the American Cancer Society
31 of an entire breast or the entirety of both breasts if:
32 (a) a mammogram demonstrates that a woman has dense breast tissue; or
33 (b) a woman is believed to be at increased risk for breast cancer due
34 to family history or prior personal history of breast cancer, positive
35 genetic testing or other indications as determined by a physician.
36 For the purposes of this subparagraph dense breast tissue shall mean
37 heterogeneously dense or extremely dense tissue as defined in nationally
38 recognized guidelines or systems for breast imaging reporting of mammog-
39 raphy screening, including, but not limited to, the breast imaging
40 reporting and data system of the American College of Radiology, and any
41 equivalent new terms, as such guidelines or systems are updated.
42 § 2. Subparagraphs (A), (C) and (D) of paragraph 11 of subsection (1)
43 of section 3221 of the insurance law, as amended by chapter 219 of the
44 laws of 2011, are amended to read as follows:
45 (A) Every insurer delivering a group or blanket policy or issuing a
46 group or blanket policy for delivery in this state that provides cover-
47 age for hospital, surgical or medical care shall provide the following
48 coverage for mammography and other imaging screening for occult breast
49 cancer:
50 (i) upon the recommendation of a physician, a mammogram at any age for
51 covered persons having a prior history of breast cancer or who have a
52 first degree relative with a prior history of breast cancer;
53 (ii) a single baseline mammogram for covered persons aged thirty-five
54 through thirty-nine, inclusive; [and]
55 (iii) an annual mammogram for covered persons aged forty and older[.];
56 and
A. 8319 3
1 (iv) upon recommendation of a physician, supplemental screening for a
2 covered person using other imaging modalities as deemed appropriate by
3 the American College of Radiology or the American Cancer Society of an
4 entire breast or the entirety of both breasts if:
5 (a) a mammogram performed pursuant to this subparagraph demonstrates
6 that the covered person has dense breast tissue; or,
7 (b) a covered person is believed to be at increased risk for breast
8 cancer due to family history or prior personal history of breast cancer,
9 positive genetic testing or other indications as determined by a physi-
10 cian.
11 For the purposes of this subparagraph dense breast tissue shall mean
12 heterogeneously dense or extremely dense tissue as defined in nationally
13 recognized guidelines or systems for breast imaging reporting of mammog-
14 raphy screening, including, but not limited to, the breast imaging
15 reporting and data system of the American College of Radiology, and any
16 equivalent new terms, as such guidelines or systems are updated.
17 (C) (i) For purposes of subparagraphs (A) and (B) of this paragraph,
18 mammography screening means an X-ray examination of the breast using
19 dedicated equipment, including X-ray tube, filter, compression device,
20 screens, films and cassettes, with an average glandular radiation dose
21 less than 0.5 rem per view per breast.
22 (ii) For purposes of subparagraphs (A) and (B) of this paragraph,
23 imaging modalities are modalities used to screen for, or diagnose,
24 occult breast cancer.
25 (D) In addition to subparagraph (A), (B) or (C) of this paragraph,
26 every group or blanket policy that provides coverage for hospital,
27 surgical or medical care, except for a grandfathered health plan under
28 subparagraph (E) of this paragraph, shall provide coverage for the
29 following mammography screening services and for comprehensive ultra-
30 sound screenings of an entire breast or the entirety of both breasts,
31 and such coverage shall not be subject to annual deductibles or coinsu-
32 rance:
33 (i) 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 (ii) with respect to women, such additional preventive care and
37 screenings for mammography not described in item (i) of this subpara-
38 graph and as provided for in comprehensive guidelines supported by the
39 health resources and services administration[.]; and
40 (iii) comprehensive ultrasound screenings as long as deemed appropri-
41 ate by the American College of Radiology or the American Cancer Society
42 of an entire breast or the entirety of both breasts if:
43 (a) a mammogram demonstrates that a woman has dense breast tissue; or
44 (b) a woman is believed to be at increased risk for breast cancer due
45 to family history or prior personal history of breast cancer, positive
46 genetic testing or other indications as determined by a physician.
47 For the purposes of this subparagraph dense breast tissue shall mean
48 heterogeneously dense or extremely dense tissue as defined in nationally
49 recognized guidelines or systems for breast imaging reporting of mammog-
50 raphy screening, including, but not limited to, the breast imaging
51 reporting and data system of the American College of Radiology, and any
52 equivalent new terms, as such guidelines or systems are updated.
53 § 3. Subsection (p) of section 4303 of the insurance law, as amended
54 by chapter 219 of the laws of 2011, is amended to read as follows:
55 (p) (1) A medical expense indemnity corporation, a hospital service
56 corporation or a health service corporation that provides coverage for
A. 8319 4
1 hospital, surgical or medical care shall provide the following coverage
2 for mammography and other imaging screening for occult breast cancer:
3 (A) upon the recommendation of a physician, a mammogram at any age for
4 covered persons having a prior history of breast cancer or who have a
5 first degree relative with a prior history of breast cancer;
6 (B) a single baseline mammogram for covered persons aged thirty-five
7 through thirty-nine, inclusive; [and]
8 (C) an annual mammogram for covered persons aged forty and older[.];
9 and
10 (D) upon recommendation of a physician, supplemental screening for a
11 covered person using other imaging modalities as deemed appropriate by
12 the American College of Radiology or the American Cancer Society of an
13 entire breast or the entirety of both breasts if:
14 (a) a mammogram performed pursuant to this subparagraph demonstrates
15 that the covered person has dense breast tissue; or
16 (b) a covered person is believed to be at increased risk for breast
17 cancer due to family history or prior personal history of breast cancer,
18 positive genetic testing or other indications as determined by a physi-
19 cian.
20 For the purposes of this subparagraph dense breast tissue shall mean
21 heterogeneously dense or extremely dense tissue as defined in nationally
22 recognized guidelines or systems for breast imaging reporting of mammog-
23 raphy screening, including, but not limited to, the breast imaging
24 reporting and data system of the American College of Radiology, and any
25 equivalent new terms, as such guidelines or systems are updated.
26 (E) The coverage required in this paragraph or paragraph two of this
27 subsection may be subject to annual deductibles and coinsurance as may
28 be deemed appropriate by the superintendent and as are consistent with
29 those established for other benefits within a given contract.
30 (2) (A) For purposes of paragraph one of this subsection, mammography
31 screening means an X-ray examination of the breast using dedicated
32 equipment, including X-ray tube, filter, compression device, screens,
33 films and cassettes, with an average glandular radiation dose less than
34 0.5 rem per view per breast.
35 (B) For purposes of paragraph one of this subsection, imaging modali-
36 ties are modalities used to screen for, or diagnose, occult breast
37 cancer.
38 (3) In addition to paragraph one or two of this subsection, every
39 contract that provides coverage for hospital, surgical or medical care,
40 except for a grandfathered health plan under paragraph four of this
41 subsection, shall provide coverage for the following mammography screen-
42 ing services and for comprehensive ultrasound screenings of an entire
43 breast or the entirety of both breasts, and such coverage shall not be
44 subject to annual deductibles or coinsurance:
45 (A) evidence-based items or services for mammography that have in
46 effect a rating of 'A' or 'B' in the current recommendations of the
47 United States preventive services task force; [and]
48 (B) with respect to women, such additional preventive care and screen-
49 ings for mammography not described in subparagraph (A) of this paragraph
50 and as provided for in comprehensive guidelines supported by the health
51 resources and services administration[.]; and
52 (C) Comprehensive ultrasound screenings as long as deemed appropriate
53 by the American College of Radiology or the American Cancer Society of
54 an entire breast or the entirety of both breasts if:
55 (i) a mammogram demonstrates that a woman has dense breast tissue; or
A. 8319 5
1 (ii) a woman is believed to be at increased risk for breast cancer due
2 to family history or prior personal history of breast cancer, positive
3 genetic testing or other indications as determined by a physician.
4 For the purposes of this subparagraph dense breast tissue shall mean
5 heterogeneously dense or extremely dense tissue as defined in nationally
6 recognized guidelines or systems for breast imaging reporting of mammog-
7 raphy screening, including, but not limited to, the breast imaging
8 reporting and data system of the American College of Radiology, and any
9 equivalent new terms, as such guidelines or systems are updated.
10 (4) For purposes of this subsection, "grandfathered health plan" means
11 coverage provided by a corporation in which an individual was enrolled
12 on March twenty-third, two thousand ten for as long as the coverage
13 maintains grandfathered status in accordance with section 1251(e) of the
14 Affordable Care Act, 42 U.S.C. § 18011(e).
15 § 4. Section 2404-c of the public health law, as added by chapter 265
16 of the laws of 2012, is amended to read as follows:
17 § 2404-c. Breast cancer; duty of providers of mammography services to
18 notify and inform. Every provider of mammography services shall, if a
19 patient's mammogram demonstrates dense breast tissue, provide notifica-
20 tion to such patient that shall include, but not be limited to, the
21 following information, in any summary of the mammography report sent,
22 pursuant to the federal mammography quality standards act, to the
23 patient and the patient's physician:
24 Your mammogram shows that your breast tissue is dense. Dense breast
25 tissue is very common and is not abnormal. However, dense breast tissue
26 can make it harder to find cancer on a mammogram and may also be associ-
27 ated with an increased risk of breast cancer.
28 This information about the result of your mammogram is given to you to
29 raise your awareness. Use this information to talk to your doctor about
30 your own risks for breast cancer. At that time, ask your doctor if more
31 screening tests might be useful, based on your risk. A report of your
32 results was sent to your physician.
33 For the purposes of this section dense breast tissue shall mean heter-
34 ogeneously dense or extremely dense tissue as defined in nationally
35 recognized guidelines or systems for breast imaging reporting of mammog-
36 raphy screening, including, but not limited to, the breast imaging
37 reporting and data system of the American College of Radiology, and any
38 equivalent new terms, as such guidelines or systems are updated.
39 § 5. This act shall take effect on the one hundred eightieth day after
40 it shall have become a law.
