NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A5677
SPONSOR: Seawright
 
TITLE OF BILL: An act to amend the insurance law, in relation to
health insurance coverage for mammography by breast tomosynthesis
 
PURPOSE:
To require breast tomosyntheis (3-1) mammography) to covered by insur-
ance companies in New York State.
 
SUMMARY OF PROVISIONS:
Section 1 states that every policy providing coverage for hospital,
surgical or medical care shall include coverage for breast tomosynthesis
for mammography screening for occult breast cancer.
Section 2 stipulates that every insurer delivering a group or blanket
policy or issuing a group or blanket policy for delivery in this state
that provides coverage for hospital, surgical or medical care shall
include coverage for breast tomosynthesis for mammography screening for
occult breast cancer. Subparagraph (C) includes breast tomosynthesis in
the definition of mammography screening.
Section 3. Subparagraph (A) mandates breast tomosynthesis as an accepta-
ble form of breast cancer screening that is to be covered by insurance
plans for covered persons of any age who either have a prior history of
breast cancer or who have a first degree relative with a prior history
of breast cancer. Subparagraph (B) allows for breast tomosynthesis to be
utilized as a baseline mammography for covered persons aged thirty-five
through thirty-nine, and that it should be covered by the individual's
provider. Subparagraph (C) mandates annual mammograms for covered
persons forty and over shall have any breast tomosynthesis scan covered
by their provider.
Section 4 amends paragraph (2) of subsection (p) of section 4303 of the
insurance law to include breast tomosynthesis in its definition of
mammography.
Section 5 is the effective date.
 
JUSTIFICATION:
Tomosynthesis, or 3-D mammography, has proven to be a more consistent
and reliable way of detecting breast cancer. This type of breast cancer
screening has proven to be able to detect breast cancer earlier than
traditional mammography, as well as reduce the incidence of false-posi-
tives.
Unfortunately, most insurers do not cover breast tomosynthesis. This
bill would mandate that insurers provide this coverage to women who opt
to take advantage of this technology.
 
LEGISLATIVE HISTORY:
New Bill.
 
EFFECTIVE DATE:
This bill shall take effect on the sixtieth day after it shall have
become a law.
STATE OF NEW YORK
________________________________________________________________________
5677
2017-2018 Regular Sessions
IN ASSEMBLY
February 14, 2017
___________
Introduced by M. of A. SEAWRIGHT, BRINDISI -- read once and referred to
the Committee on Insurance
AN ACT to amend the insurance law, in relation to health insurance
coverage for mammography by breast tomosynthesis
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subparagraphs (A) and (C) of paragraph (11) of subsection
2 (i) of section 3216 of the insurance law, as amended by chapter 219 of
3 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
6 screening for occult breast cancer:
7 (i) upon the recommendation of a physician, a mammogram, which may be
8 provided by breast tomosynthesis, at any age for covered persons having
9 a prior history of breast cancer or who have a first degree relative
10 with a prior history of breast cancer;
11 (ii) a single baseline mammogram, which may be provided by breast
12 tomosynthesis, for covered persons aged thirty-five through thirty-nine,
13 inclusive; and
14 (iii) an annual mammogram, which may be provided by breast tomosynthe-
15 sis, for covered persons aged forty and older.
16 (C) For purposes of subparagraphs (A) and (B) of this paragraph,
17 mammography screening means an X-ray examination of the breast using
18 dedicated equipment, including X-ray tube, filter, compression device,
19 screens, films and cassettes, with an average glandular radiation dose
20 less than 0.5 rem per view per breast; provided, however, that mammogra-
21 phy screening shall also include breast tomosynthesis.
22 § 2. Subparagraphs (A) and (C) of paragraph (11) of subsection (l) of
23 section 3221 of the insurance law, as amended by chapter 219 of the laws
24 of 2011, are amended to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD07634-01-7
A. 5677 2
1 (A) Every insurer delivering a group or blanket policy or issuing a
2 group or blanket policy for delivery in this state that provides cover-
3 age for hospital, surgical or medical care shall provide the following
4 coverage for mammography screening for occult breast cancer:
5 (i) upon the recommendation of a physician, a mammogram, which may be
6 provided by breast tomosynthesis, at any age for covered persons having
7 a prior history of breast cancer or who have a first degree relative
8 with a prior history of breast cancer;
9 (ii) a single baseline mammogram, which may be provided by breast
10 tomosynthesis, for covered persons aged thirty-five through thirty-nine,
11 inclusive; and
12 (iii) an annual mammogram, which may be provided by breast tomosynthe-
13 sis, for covered persons aged forty and older.
14 (C) For purposes of subparagraphs (A) and (B) of this paragraph,
15 mammography screening means an X-ray examination of the breast using
16 dedicated equipment, including X-ray tube, filter, compression device,
17 screens, films and cassettes, with an average glandular radiation dose
18 less than 0.5 rem per view per breast; provided, however, that mammogra-
19 phy screening shall also include breast tomosynthesis.
20 § 3. Subparagraphs (A), (B) and (C) of paragraph (1) of subsection (p)
21 of section 4303 of the insurance law, as amended by chapter 219 of the
22 laws of 2011, are amended to read as follows:
23 (A) upon the recommendation of a physician, a mammogram, which may be
24 provided by breast tomosynthesis, at any age for covered persons having
25 a prior history of breast cancer or who have a first degree relative
26 with a prior history of breast cancer;
27 (B) a single baseline mammogram, which may be provided by breast tomo-
28 synthesis, for covered persons aged thirty-five through thirty-nine,
29 inclusive; and
30 (C) an annual mammogram, which may be provided by breast tomosythesis,
31 for covered persons aged forty and older.
32 § 4. Paragraph (2) of subsection (p) of section 4303 of the insurance
33 law, as amended by chapter 219 of the laws of 2011, is amended to read
34 as follows:
35 (2) For purposes of paragraph one of this subsection, mammography
36 screening means an X-ray examination of the breast using dedicated
37 equipment, including X-ray tube, filter, compression device, screens,
38 films and cassettes, with an average glandular radiation dose less than
39 0.5 rem per view per breast; provided, however, that mammography screen-
40 ing shall also include breast tomosythesis.
41 § 5. This act shall take effect on the sixtieth day after it shall
42 have become a law and shall apply to all policies and contracts issued,
43 renewed, modified, altered or amended on or after such date.