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A07572 Summary:

BILL NOA07572
 
SAME ASNo Same As
 
SPONSORGonzalez-Rojas
 
COSPNSRKassay, Simon, Burdick, McMahon, Raga, Levenberg, Yeger, Shimsky, Glick, Hevesi, Burroughs, Cunningham, Ramos, Seawright
 
MLTSPNSR
 
Amd §§3221 & 4303, Ins L
 
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.
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A07572 Actions:

BILL NOA07572
 
04/01/2025referred to insurance
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A07572 Memo:

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.
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A07572 Text:



 
                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.
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