Bill Text: NY A03760 | 2013-2014 | General Assembly | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Requires health insurance policies to cover comprehensive screening for ovarian cancer.
Spectrum: Moderate Partisan Bill (Democrat 25-4)
Status: (Introduced - Dead) 2013-11-20 - enacting clause stricken [A03760 Detail]
Download: New_York-2013-A03760-Introduced.html
Bill Title: Requires health insurance policies to cover comprehensive screening for ovarian cancer.
Spectrum: Moderate Partisan Bill (Democrat 25-4)
Status: (Introduced - Dead) 2013-11-20 - enacting clause stricken [A03760 Detail]
Download: New_York-2013-A03760-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
3760
2013-2014 Regular Sessions
I N A S S E M B L Y
January 29, 2013
___________
Introduced by M. of A. ESPINAL -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law, in relation to requiring health
insurance policies to cover comprehensive ultrasound screening, genet-
ic testing, magnetic resonance imaging and/or other screening tests
for breast cancer in certain cases, requiring the provision of certain
information relating to breast density to patients; and requiring
health insurance policies to cover comprehensive tests for ovarian
cancer in certain cases
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Paragraph 11 of subsection (i) of section 3216 of the
2 insurance law is amended by adding a new subparagraph (F) to read as
3 follows:
4 (F) (I) SUCH POLICY SHALL PROVIDE ADDITIONAL COVERAGE FOR COMPREHEN-
5 SIVE ULTRASOUND SCREENING, GENETIC TESTING, MAGNETIC RESONANCE IMAGING
6 (MRI), AND/OR OTHER SCREENING TESTS APPROVED BY THE AMERICAN COLLEGE OF
7 RADIOLOGY OF AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
8 (I) A MAMMOGRAM DEMONSTRATES HETEROGENEOUS OR DENSE BREAST TISSUE
9 BASED ON THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY THE
10 AMERICAN COLLEGE OF RADIOLOGY; OR
11 (II) A WOMAN IS BELIEVED TO BE AT INCREASED RISK FOR BREAST CANCER DUE
12 TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER, POSITIVE
13 GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH WOMAN'S
14 PHYSICIAN OR NURSE PRACTITIONER.
15 (II) SUCH ADDITIONAL COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND
16 COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS
17 ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN
18 POLICY.
19 (III) EACH MAMMOGRAPHY REPORT PROVIDED TO A PATIENT SHALL INCLUDE
20 INFORMATION ABOUT BREAST DENSITY, BASED ON THE BREAST IMAGING REPORTING
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06910-02-3
A. 3760 2
1 AND DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY. WHERE
2 APPLICABLE, SUCH REPORT SHALL INCLUDE THE FOLLOWING NOTICE: "IF YOUR
3 MAMMOGRAM DEMONSTRATES THAT YOU HAVE DENSE BREAST TISSUE, WHICH COULD
4 HIDE SMALL ABNORMALITIES, YOU MIGHT BENEFIT FROM SUPPLEMENTARY SCREENING
5 TESTS, DEPENDING ON YOUR INDIVIDUAL RISK FACTORS AND THE RECOMMENDATION
6 OF YOUR INTERPRETING PHYSICIAN. A REPORT OF YOUR MAMMOGRAPHY RESULTS,
7 WHICH CONTAINS INFORMATION ABOUT YOUR BREAST DENSITY, HAS BEEN SENT TO
8 YOUR TREATING PHYSICIAN'S OFFICE AND YOU SHOULD CONTACT YOUR TREATING
9 PHYSICIAN IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR REPORT."
10 S 2. Paragraph 11 of subsection (l) of section 3221 of the insurance
11 law is amended by adding a new subparagraph (F) to read as follows:
12 (F) (I) SUCH POLICY SHALL PROVIDE ADDITIONAL COVERAGE FOR COMPREHEN-
13 SIVE ULTRASOUND SCREENING, GENETIC TESTING, MAGNETIC RESONANCE IMAGING
14 (MRI), AND/OR OTHER SCREENING TESTS APPROVED BY THE AMERICAN COLLEGE OF
15 RADIOLOGY OF AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
16 (I) A MAMMOGRAM DEMONSTRATES HETEROGENEOUS OR DENSE BREAST TISSUE
17 BASED ON THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY THE
18 AMERICAN COLLEGE OF RADIOLOGY; OR
19 (II) A WOMAN IS BELIEVED TO BE AT AN INCREASED RISK FOR BREAST CANCER
20 DUE TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER, POSI-
21 TIVE GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH WOMAN'S
22 PHYSICIAN OR NURSE PRACTITIONER.
23 (II) SUCH ADDITIONAL COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND
24 COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS
25 ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN
26 POLICY.
27 (III) EACH MAMMOGRAPHY REPORT PROVIDED TO A PATIENT SHALL INCLUDE
28 INFORMATION ABOUT BREAST DENSITY, BASED ON THE BREAST IMAGING REPORTING
29 AND DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY. WHERE
30 APPLICABLE, SUCH REPORT SHALL INCLUDE THE FOLLOWING NOTICE: "IF YOUR
31 MAMMOGRAM DEMONSTRATES THAT YOU HAVE DENSE BREAST TISSUE, WHICH COULD
32 HIDE SMALL ABNORMALITIES, YOU MIGHT BENEFIT FROM SUPPLEMENTARY SCREENING
33 TESTS, DEPENDING ON YOUR INDIVIDUAL RISK FACTORS AND THE RECOMMENDATION
34 OF YOUR INTERPRETING PHYSICIAN. A REPORT OF YOUR MAMMOGRAPHY RESULTS,
35 WHICH CONTAINS INFORMATION ABOUT YOUR BREAST DENSITY, HAS BEEN SENT TO
36 YOUR TREATING PHYSICIAN'S OFFICE AND YOU SHOULD CONTACT YOUR TREATING
37 PHYSICIAN IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR REPORT."
38 S 3. Subsection (p) of section 4303 of the insurance law is amended by
39 adding a new paragraph 5 to read as follows:
40 (5) (A) SUCH COVERAGE SHALL PROVIDE ADDITIONAL COVERAGE FOR COMPREHEN-
41 SIVE ULTRASOUND SCREENING, GENETIC TESTING, MAGNETIC RESONANCE IMAGING
42 (MRI), AND/OR OTHER SCREENING TESTS APPROVED BY THE AMERICAN COLLEGE OF
43 RADIOLOGY OF AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
44 (I) A MAMMOGRAM DEMONSTRATES HETEROGENEOUS OR DENSE BREAST TISSUE
45 BASED ON THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY THE
46 AMERICAN COLLEGE OF RADIOLOGY; OR
47 (II) A WOMAN IS BELIEVED TO BE AT INCREASED RISK FOR BREAST CANCER DUE
48 TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER, POSITIVE
49 GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH WOMAN'S
50 PHYSICIAN OR NURSE PRACTITIONER.
51 THE ADDITIONAL COVERAGE REQUIRED IN THIS SUBPARAGRAPH MAY BE SUBJECT
52 TO ANNUAL DEDUCTIBLES AND COINSURANCE AS MAY BE DEEMED APPROPRIATE BY
53 THE SUPERINTENDENT AND AS ARE CONSISTENT WITH THOSE ESTABLISHED FOR
54 OTHER BENEFITS WITHIN A GIVEN POLICY.
55 (B) EACH MAMMOGRAPHY REPORT PROVIDED TO A PATIENT SHALL INCLUDE INFOR-
56 MATION ABOUT BREAST DENSITY, BASED ON THE BREAST IMAGING REPORTING AND
A. 3760 3
1 DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY. WHERE
2 APPLICABLE, SUCH REPORT SHALL INCLUDE THE FOLLOWING NOTICE: "IF YOUR
3 MAMMOGRAM DEMONSTRATES THAT YOU HAVE DENSE BREAST TISSUE, WHICH COULD
4 HIDE SMALL ABNORMALITIES, YOU MIGHT BENEFIT FROM SUPPLEMENTARY SCREENING
5 TESTS, DEPENDING ON YOUR INDIVIDUAL RISK FACTORS AND THE RECOMMENDATION
6 OF YOUR INTERPRETING PHYSICIAN. A REPORT OF YOUR MAMMOGRAPHY RESULTS,
7 WHICH CONTAINS INFORMATION ABOUT YOUR BREAST DENSITY, HAS BEEN SENT TO
8 YOUR TREATING PHYSICIAN'S OFFICE AND YOU SHOULD CONTACT YOUR TREATING
9 PHYSICIAN IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR REPORT."
10 S 4. Paragraph 7 of subsection (d) of section 4326 of the insurance
11 law, as added by chapter 1 of the laws of 1999, is amended to read as
12 follows:
13 (7) adult preventive health services consisting of mammography screen-
14 ing, AS PROVIDED IN SUBSECTION (P) OF SECTION FOUR THOUSAND THREE
15 HUNDRED THREE OF THIS ARTICLE; OVARIAN CANCER SCREENING AS PROVIDED IN
16 SUBSECTION (P-1) OF SECTION FOUR THOUSAND THREE HUNDRED THREE OF THIS
17 ARTICLE; cervical cytology screening; periodic physical examinations no
18 more than once every three years; and adult immunizations;
19 S 5. Subsection (i) of section 3216 of the insurance law is amended by
20 adding a new paragraph 11-b to read as follows:
21 (11-B) (A) EVERY POLICY THAT PROVIDES COVERAGE FOR HOSPITAL, SURGICAL
22 OR MEDICAL CARE SHALL PROVIDE THE FOLLOWING COVERAGE FOR SCREENING FOR
23 OVARIAN CANCER:
24 (I) UPON THE RECOMMENDATION OF A PHYSICIAN, A PELVIC EXAM, GENETIC
25 TESTING, ULTRASOUND AND BLOOD TESTING AT ANY AGE FOR COVERED PERSONS
26 HAVING A HIGH RISK OF DEVELOPING OVARIAN CANCER OR WHO HAVE A FIRST
27 DEGREE RELATIVE WITH A PRIOR HISTORY OF OVARIAN CANCER;
28 (II) A SINGLE BASELINE ULTRASOUND FOR COVERED PERSONS AGED THIRTY-FIVE
29 THROUGH THIRTY-NINE, INCLUSIVE; AND
30 (III) AN ANNUAL ULTRASOUND FOR COVERED PERSONS AGED FORTY AND OLDER.
31 (B) SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
32 GRAPH MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS MAY BE
33 DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT WITH
34 THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
35 (C) (I) SUCH POLICY SHALL PROVIDE FOR ADDITIONAL COVERAGE FOR COMPUTED
36 TOMOGRAPHY, BARIUM ENEMA X-RAYS, MAGNETIC RESONANCE IMAGING (MRI), POSI-
37 TRON EMISSION TOMOGRAPHY, LAPAROSCOPY, COLONOSCOPY AND BIOPSY IF A
38 PERSON IS BELIEVED TO BE AT INCREASED RISK FOR OVARIAN CANCER DUE TO
39 FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF OVARIAN CANCER, POSITIVE
40 GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH PERSON'S
41 PHYSICIAN OR NURSE PRACTITIONER.
42 (II) SUCH ADDITIONAL COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND
43 COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS
44 ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN
45 POLICY.
46 S 6. Subsection (1) of section 3221 of the insurance law is amended by
47 adding a new paragraph 11-b to read as follows:
48 (11-B) (A) EVERY INSURER DELIVERING A GROUP OR BLANKET POLICY OR ISSU-
49 ING A GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE THAT PROVIDES
50 COVERAGE FOR HOSPITAL, SURGICAL OR MEDICAL CARE SHALL PROVIDE THE
51 FOLLOWING COVERAGE FOR SCREENING FOR OVARIAN CANCER:
52 (I) UPON THE RECOMMENDATION OF A PHYSICIAN, A PELVIC EXAM, GENETIC
53 TESTING, ULTRASOUND AND BLOOD TESTING AT ANY AGE FOR COVERED PERSONS
54 HAVING A HIGH RISK OF DEVELOPING OVARIAN CANCER OR WHO HAVE A FIRST
55 DEGREE RELATIVE WITH A PRIOR HISTORY OF OVARIAN CANCER;
A. 3760 4
1 (II) A SINGLE BASELINE ULTRASOUND FOR COVERED PERSONS AGED THIRTY-FIVE
2 THROUGH THIRTY-NINE, INCLUSIVE; AND
3 (III) AN ANNUAL ULTRASOUND FOR COVERED PERSONS AGED FORTY AND OLDER.
4 (B) SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
5 GRAPH MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS MAY BE
6 DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT WITH
7 THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
8 (C) (I) SUCH POLICY SHALL PROVIDE FOR ADDITIONAL COVERAGE FOR COMPUTED
9 TOMOGRAPHY, BARIUM ENEMA X-RAYS, MAGNETIC RESONANCE IMAGING (MRI), POSI-
10 TRON EMISSION TOMOGRAPHY, LAPAROSCOPY, COLONOSCOPY AND BIOPSY IF A
11 PERSON IS BELIEVED TO BE AT INCREASED RISK FOR OVARIAN CANCER DUE TO
12 FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF OVARIAN CANCER, POSITIVE
13 GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH PERSON'S
14 PHYSICIAN OR NURSE PRACTITIONER.
15 (II) SUCH ADDITIONAL COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND
16 COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS
17 ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN
18 POLICY.
19 S 7. Section 4303 of the insurance law is amended by adding a new
20 subsection (p-1) to read as follows:
21 (P-1) (1) A MEDICAL EXPENSE INDEMNITY CORPORATION, A HOSPITAL SERVICE
22 CORPORATION OR A HEALTH SERVICE CORPORATION THAT PROVIDES COVERAGE FOR
23 HOSPITAL, SURGICAL OR MEDICAL CARE SHALL PROVIDE THE FOLLOWING COVERAGE
24 FOR SCREENING FOR OVARIAN CANCER:
25 (A) UPON THE RECOMMENDATION OF A PHYSICIAN, A PELVIC EXAM, GENETIC
26 TESTING, ULTRASOUND AND BLOOD TESTING AT ANY AGE FOR COVERED PERSONS
27 HAVING A HIGH RISK OF DEVELOPING OVARIAN CANCER OR WHO HAVE A FIRST
28 DEGREE RELATIVE WITH A PRIOR HISTORY OF OVARIAN CANCER;
29 (B) A SINGLE BASELINE ULTRASOUND FOR COVERED PERSONS AGED THIRTY-FIVE
30 THROUGH THIRTY-NINE, INCLUSIVE; AND
31 (C) AN ANNUAL ULTRASOUND FOR COVERED PERSONS AGED FORTY AND OLDER.
32 (2) SUCH COVERAGE REQUIRED PURSUANT TO SUBPARAGRAPH (A) OF THIS PARA-
33 GRAPH MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS MAY BE
34 DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT WITH
35 THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
36 (3) (A) SUCH POLICY SHALL PROVIDE FOR ADDITIONAL COVERAGE FOR COMPUTED
37 TOMOGRAPHY, BARIUM ENEMA X-RAYS, MAGNETIC RESONANCE IMAGING (MRI), POSI-
38 TRON EMISSION TOMOGRAPHY, LAPAROSCOPY, COLONOSCOPY AND BIOPSY IF A
39 PERSON IS BELIEVED TO BE AT INCREASED RISK FOR OVARIAN CANCER DUE TO
40 FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF OVARIAN CANCER, POSITIVE
41 GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY SUCH PERSON'S
42 PHYSICIAN OR NURSE PRACTITIONER.
43 (B) SUCH ADDITIONAL COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND
44 COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS
45 ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN
46 POLICY.
47 S 8. This act shall take effect on the sixtieth day after it shall
48 have become a law.
