Requires insurance coverage of sonograms and other diagnostic procedures used to detect breast cancer for covered persons with a prior history of breast cancer or who have a first degree relative with a prior history of breast cancer.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7572
SPONSOR: Gonzalez-Rojas TITLE OF BILL:
An act to amend the insurance law, in relation to coverage of certain
procedures to detect breast cancer
PURPOSE:
This purpose of this bill is expand breast cancer screenings for covered
persons who have a prior history of breast cancer or who have a first
degree relative with a prior history of breast cancer, or have had any
sonogram or other diagnostic procedure used to detect breast cancer.
SUMMARY OF PROVISIONS:
Section 1 of this bill would require a group or blanket policy insurer
to expand breast cancer screenings for covered persons who have a prior
history of breast cancer or who have a first degree relative with a
prior history of breast cancer, or have had any sonogram or other diag-
nostic procedure used to detect breast cancer.
Section 2 of this bill would require a medical expense indemnity corpo-
ration, a hospital service corporation or a health service corporation
that offers large group contracts to offer breast cancer screenings for
covered persons who have a prior history of breast cancer or who have a
first degree relative with a prior history of breast cancer, or have had
any sonogram or other diagnostic procedure used to detect breast cancer.
Section 3 of this bill would establish an effective date that shall take
effect on the same date and in the same manner as chapter 424 of the
laws of 2024, takes effect.
JUSTIFICATION:
New Yorkers are suffering from an increase in breast cancer. Breast
Cancer is the most diagnosed form of cancer among U.S. women. Each year,
about 30% of all newly diagnosed cancers in women are breast cancer.
According to the data from Breatcancer.org, approximately 13% (about one
in eight) of U.S. women are going to develop invasive breast cancer
during their life. This pattern is replicated in New York State. Accord-
ing to data from Department of Health, breast cancer is one of the most
common cancers among women. Specifically, each year approximately 16,700
women are diagnosed with breast cancer, and about 2,500 women die from
the disease.
On Long Island, incidents of breast cancer are thirteen to eighteen
percent higher than the statewide average, according to The Department
of Health and Human Services, National Institutes of Health National
Cancer Institute, National Institute of Environmental Health Sciences,
as released in the November 2004 "Report to the U.S. Congress: The Long
Island Breast Cancer Study Project."
Cancer is an insidious malignancy that thrives when hidden. Providing
additional viable detection options at an earlier age for diagnostic
testing, as determined appropriate by a patient's own physicians, will
lead to earlier diagnosis based upon each patient's unique situation.
New Yorkers should have a fighting chance against this malicious disease
by bringing more health information to light.
This bill would expand breast cancer screenings for covered persons who
have a prior history of breast cancer or who have a first degree rela-
tive with a prior history of breast cancer, or have had any sonogram or
other diagnostic procedure used to detect breast cancer.
LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS:
To be determined.
EFFECTIVE DATE:
This act shall take effect on the same date and in the same manner as
chapter 424 of the laws of 2024, takes effect.
STATE OF NEW YORK
________________________________________________________________________
7572
2025-2026 Regular Sessions
IN ASSEMBLY
April 1, 2025
___________
Introduced by M. of A. GONZALEZ-ROJAS -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to coverage of certain
procedures to detect breast cancer
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subparagraph (A) of paragraph 11 of subsection (l) of
2 section 3221 of the insurance law, as amended by chapter 424 of the laws
3 of 2024, is amended to read as follows:
4 (A) Every insurer delivering a group or blanket policy or issuing a
5 group or blanket policy for delivery in this state that provides cover-
6 age for hospital, surgical or medical care shall provide the following
7 coverage for mammography screening for occult breast cancer:
8 (i) upon the recommendation of a physician, a mammogram, which may be
9 provided by breast tomosynthesis, at any age for covered persons having
10 a prior history of breast cancer or who have a first degree relative
11 with a prior history of breast cancer;
12 (ii) a single baseline mammogram, which may be provided by breast
13 tomosynthesis[, for covered persons aged thirty-five through thirty-
14 nine, inclusive];
15 (iii) [an annual mammogram, which may be provided by breast tomosyn-
16 thesis, for covered persons aged forty and older;
17 (iv)] for large group policies that provide coverage for hospital,
18 surgical or medical care, [an annual mammogram] mammograms for covered
19 persons [aged thirty-five through thirty-nine, inclusive] having a prior
20 history of breast cancer or who have a first degree relative with a
21 prior history of breast cancer, or any sonogram or other diagnostic
22 procedure used to detect breast cancer, upon the recommendation of a
23 physician, subject to the insurer's determination that the mammogram is
24 medically necessary; and
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01242-01-5
A. 7572 2
1 [(v)] (iv) upon the recommendation of a physician, screening and diag-
2 nostic imaging, including diagnostic mammograms, breast ultrasounds, or
3 magnetic resonance imaging, recommended by nationally recognized clin-
4 ical practice guidelines for the detection of breast cancer. For the
5 purposes of this item, "nationally recognized clinical practice guide-
6 lines" means evidence-based clinical practice guidelines informed by a
7 systematic review of evidence and an assessment of the benefits, and
8 risks of alternative care options intended to optimize patient care
9 developed by independent organizations or medical professional societies
10 utilizing a transparent methodology and reporting structure and with a
11 conflict of interest policy.
12 § 2. Subparagraph (D) of paragraph 1 of subsection (p) of section 4303
13 of the insurance law, as amended by chapter 424 of the laws of 2024, is
14 amended to read as follows:
15 (D) for large group contracts offered by a medical expense indemnity
16 corporation, a hospital service corporation or a health service corpo-
17 ration that provide coverage for hospital, surgical or medical care, [an
18 annual mammogram] mammograms for covered persons [aged thirty-five
19 through thirty-nine, inclusive] having a prior history of breast cancer
20 or who have a first degree relative with a prior history of breast
21 cancer, or any sonogram or other diagnostic procedure used to detect
22 breast cancer, upon the recommendation of a physician, subject to the
23 corporation's determination that the mammogram is medically necessary;
24 § 3. This act shall take effect on the same date and in the same
25 manner as chapter 424 of the laws of 2024, takes effect.
