BILL NUMBER: S2917A
SPONSOR: CLEARE
 
PURPOSE OR GENERAL IDEA OF BILL:
To provide that where a patient has received notice that their mammogram
shows that the patient has dense breast tissue, such notice shall be
considered a determination of medical necessity for purposes of coverage
of breast ultrasounds.
 
SUMMARY OF PROVISIONS:
Section one adds a new subdivision 2 to section 2404c of the public
health law to provide that where a provider of mammography services has
provided notice to a patient that their mammogram detected dense breast
tissue, the notice shall be considered a determination of medical neces-
sity for purposes of coverage of breast ultrasounds.
Section two provide the effective date.
 
JUSTIFICATION:
Current New York State Law requires insurance companies to cover the
cost of mammograms. In addition, providers must give notice to a patient
when a mammogram shows that the patient has dense breast tissue. Having
dense breasts can make it more difficult to detect certain forms of
breast cancer, particularly some of the more aggressive forms, through a
mammogram alone. It also puts women at about a twofold risk for develop-
ing cancer as compared to those who do not have dense breasts. Conduct-
ing an ultrasound along with a regular mammogram is essential to improv-
ing cancer detection for women with dense breasts.
Ultrasounds for dense breasts are only covered by insurers if they are
found to be a medical necessity. This legislation amends the Public
Health Law to provide that the notice given by a provider to a patient
that the patient has dense breasts shall be considered a determination
of medical necessity for purposes of coverage of ultrasounds.
Early detection is key to preventing women from developing aggressive
forms of breast cancer and improving survival rates. This legislation
will prevent the unnecessary delay and stress imposed when an insurance
company denies coverage for this critical service. PRIOR LEGISLATIVE
 
PRIOR LEGISLATIVE HISTORY:
A.8814 of 2021 and 2022, referred to insurance / S.7647 reported and
committed to finance.
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
This act shall take effect immediately.

Statutes affected:
S2917: 2404-c public health law
S2917A: 2404-c public health law