BILL NUMBER: S2465C Revised 7/22/24
SPONSOR: PERSAUD
TITLE OF BILL:
An act to amend the insurance law, in relation to requiring certain
insurance policies allow patients additional screenings for breast
cancer when the provider deems such screening is necessary under
nationally recognized clinical practice guidelines; and to repeal
certain provisions of such law relating thereto
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill is to require commercial health insurance
coverage of screening and diagnostic imaging, including diagnostic
mammograms, breast ultrasounds, or magnetic resonance imaging, recom-
mended by nationally recognized clinical practice guidelines for the
detection of breast cancer.
SUMMARY OF SPECIFIC PROVISIONS:
Sections 1, and 3 of the bill requires individual, group, and Article 43
health insurance policies provide coverage of screening and diagnostic
imaging, including diagnostic mammograms, breast ultrasounds, or magnet-
ic resonance imaging, recommended by nationally recognized clinical
practice guidelines for the detection of breast cancer. For the purposes
of this legislation, nationally recognized clinical practice guidelines
mean evidence-based clinical practice guidelines informed by a systemat-
ic review of evidence and an assessment of the benefits, and risks of
alternative care options intended to optimize patient care, developed by
independent organizations or medical professional societies utilizing a
transparent methodology and reporting structure and with a conflict of
interest policy.
Sections 1, 3 and 5: Amends the bill to carve out insureds with high
deductible health plans from cost sharing elimination if their HEMP
deductibles are not met. This language would apply to all mammograms and
the new covered services (ultrasound, diagnostic mammogram, and MRIs).
However, because breast cancer screenings are considered preventive care
by the IRS, HDHPs provide coverage for these services before the deduct-
ible is met. Adding this language would protect insureds' HSA eligibil-
ity in the event that these services are removed from the preventive
care category by the IRS.
Sections 2, 4 and 6: Repeal language exempting ultrasounds, diagnostic
mammogram, and MRIs from cost sharing. This bill adds these services to
a subparagraph where coverage is already exempt from cost-sharing,
making this old language unnecessary.
Section 7 of the bill sets the effective date.
JUSTIFICATION:
Many individuals that identify as women end up with breast cancer
despite completing a routine mammogram. Women in the United States have
a higher breast cancer mortality rate than other cancers. A publication
done by the University of Rochester Medical Center showed approximately
67 percent of women aged 40 and older receive a screening mammogram
every one or two years. 16 percent of those screened will require addi-
tional screening by their providers if it is their first mammogram, and
10 percent will be called to undergo further mammography exams.
In 2015, the American Association for Cancer Research reported that
women who have a history of false-positives screening for mammogram
exams or negative biopsies are at greater risk of getting breast cancer
for at least a decade. False-positive mammogram screening helps provid-
ers to detect early breast cancer. Allowing women to get an additional
mammogram is an early intervention method that can save many lives, and
this legislation aims to do just that.
PRIOR LEGISLATIVE HISTORY:
2022: S8156 - Passed Senate
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
The act shall take effect on January 1, 2026.
Statutes affected: S2465: 3216 insurance law, 3216(i) insurance law
S2465A: 3216 insurance law, 3216(i) insurance law, 4303 insurance law, 4303(p) insurance law
S2465B: 3216 insurance law, 3216(i) insurance law
S2465C: 4303 insurance law, 4303(p) insurance law