A. 8319 2
FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE SHALL MEAN
HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS DEFINED IN NATIONALLY
RECOGNIZED GUIDELINES OR SYSTEMS FOR BREAST IMAGING REPORTING OF MAMMOG-
RAPHY SCREENING, INCLUDING, BUT NOT LIMITED TO, THE BREAST IMAGING
REPORTING AND DATA SYSTEM OF THE AMERICAN COLLEGE OF RADIOLOGY, AND ANY
EQUIVALENT NEW TERMS, AS SUCH GUIDELINES OR SYSTEMS ARE UPDATED.
(C) (I) For purposes of subparagraphs (A) and (B) of this paragraph,
mammography screening means an X-ray examination of the breast using
dedicated equipment, including X-ray tube, filter, compression device,
screens, films and cassettes, with an average glandular radiation dose
less than 0.5 rem per view per breast.
(II) FOR PURPOSES OF SUBPARAGRAPHS (A) AND (B) OF THIS PARAGRAPH,
IMAGING MODALITIES ARE MODALITIES USED TO SCREEN FOR, OR DIAGNOSE,
OCCULT BREAST CANCER.
(D) In addition to subparagraph (A), (B) or (C) of this paragraph,
every policy that provides coverage for hospital, surgical or medical
care, except for a grandfathered health plan under subparagraph (E) of
this paragraph, shall provide coverage for the following mammography
screening services AND FOR THE FOLLOWING COMPREHENSIVE ULTRASOUND
SCREENINGS OF AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS, and such
coverage shall not be subject to annual deductibles or coinsurance:
(i) evidence-based items or services for mammography that have in
effect a rating of 'A' or 'B' in the current recommendations of the
United States preventive services task force; [and]
(ii) with respect to women, such additional preventive care and
screenings for mammography not described in item (i) of this subpara-
graph and as provided for in comprehensive guidelines supported by the
health resources and services administration[.]; AND
(III) COMPREHENSIVE ULTRASOUND SCREENINGS AS LONG AS DEEMED APPROPRI-
ATE BY THE AMERICAN COLLEGE OF RADIOLOGY OR THE AMERICAN CANCER SOCIETY
OF AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
(A) A MAMMOGRAM DEMONSTRATES THAT A WOMAN HAS DENSE BREAST TISSUE; OR
(B) A WOMAN IS BELIEVED TO BE AT INCREASED RISK FOR BREAST CANCER DUE
TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER, POSITIVE
GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY A PHYSICIAN.
FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE SHALL MEAN
HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS DEFINED IN NATIONALLY
RECOGNIZED GUIDELINES OR SYSTEMS FOR BREAST IMAGING REPORTING OF MAMMOG-
RAPHY SCREENING, INCLUDING, BUT NOT LIMITED TO, THE BREAST IMAGING
REPORTING AND DATA SYSTEM OF THE AMERICAN COLLEGE OF RADIOLOGY, AND ANY
EQUIVALENT NEW TERMS, AS SUCH GUIDELINES OR SYSTEMS ARE UPDATED.
S 2. Subparagraphs (A), (C) and (D) of paragraph 11 of subsection (1)
of section 3221 of the insurance law, as amended by chapter 219 of the
laws of 2011, are amended to read as follows:
(A) Every insurer delivering a group or blanket policy or issuing a
group or blanket policy for delivery in this state that provides cover-
age for hospital, surgical or medical care shall provide the following
coverage for mammography AND OTHER IMAGING screening for occult breast
cancer:
(i) upon the recommendation of a physician, a mammogram at any age for
covered persons having a prior history of breast cancer or who have a
first degree relative with a prior history of breast cancer;
(ii) a single baseline mammogram for covered persons aged thirty-five
through thirty-nine, inclusive; [and]
(iii) an annual mammogram for covered persons aged forty and older[.];
AND
A. 8319 3
(IV) UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING FOR A
COVERED PERSON USING OTHER IMAGING MODALITIES AS DEEMED APPROPRIATE BY
THE AMERICAN COLLEGE OF RADIOLOGY OR THE AMERICAN CANCER SOCIETY OF AN
ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
(A) A MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DEMONSTRATES
THAT THE COVERED PERSON HAS DENSE BREAST TISSUE; OR,
(B) A COVERED PERSON IS BELIEVED TO BE AT INCREASED RISK FOR BREAST
CANCER DUE TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER,
POSITIVE GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY A PHYSI-
CIAN.
FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE SHALL MEAN
HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS DEFINED IN NATIONALLY
RECOGNIZED GUIDELINES OR SYSTEMS FOR BREAST IMAGING REPORTING OF MAMMOG-
RAPHY SCREENING, INCLUDING, BUT NOT LIMITED TO, THE BREAST IMAGING
REPORTING AND DATA SYSTEM OF THE AMERICAN COLLEGE OF RADIOLOGY, AND ANY
EQUIVALENT NEW TERMS, AS SUCH GUIDELINES OR SYSTEMS ARE UPDATED.
(C) (I) For purposes of subparagraphs (A) and (B) of this paragraph,
mammography screening means an X-ray examination of the breast using
dedicated equipment, including X-ray tube, filter, compression device,
screens, films and cassettes, with an average glandular radiation dose
less than 0.5 rem per view per breast.
(II) FOR PURPOSES OF SUBPARAGRAPHS (A) AND (B) OF THIS PARAGRAPH,
IMAGING MODALITIES ARE MODALITIES USED TO SCREEN FOR, OR DIAGNOSE,
OCCULT BREAST CANCER.
(D) In addition to subparagraph (A), (B) or (C) of this paragraph,
every group or blanket policy that provides coverage for hospital,
surgical or medical care, except for a grandfathered health plan under
subparagraph (E) of this paragraph, shall provide coverage for the
following mammography screening services AND FOR COMPREHENSIVE ULTRA-
SOUND SCREENINGS OF AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS,
and such coverage shall not be subject to annual deductibles or coinsu-
rance:
(i) evidence-based items or services for mammography that have in
effect a rating of 'A' or 'B' in the current recommendations of the
United States preventive services task force; [and]
(ii) with respect to women, such additional preventive care and
screenings for mammography not described in item (i) of this subpara-
graph and as provided for in comprehensive guidelines supported by the
health resources and services administration[.]; AND
(III) COMPREHENSIVE ULTRASOUND SCREENINGS AS LONG AS DEEMED APPROPRI-
ATE BY THE AMERICAN COLLEGE OF RADIOLOGY OR THE AMERICAN CANCER SOCIETY
OF AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
(A) A MAMMOGRAM DEMONSTRATES THAT A WOMAN HAS DENSE BREAST TISSUE; OR
(B) A WOMAN IS BELIEVED TO BE AT INCREASED RISK FOR BREAST CANCER DUE
TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER, POSITIVE
GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY A PHYSICIAN.
FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE SHALL MEAN
HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS DEFINED IN NATIONALLY
RECOGNIZED GUIDELINES OR SYSTEMS FOR BREAST IMAGING REPORTING OF MAMMOG-
RAPHY SCREENING, INCLUDING, BUT NOT LIMITED TO, THE BREAST IMAGING
REPORTING AND DATA SYSTEM OF THE AMERICAN COLLEGE OF RADIOLOGY, AND ANY
EQUIVALENT NEW TERMS, AS SUCH GUIDELINES OR SYSTEMS ARE UPDATED.
S 3. Subsection (p) of section 4303 of the insurance law, as amended
by chapter 219 of the laws of 2011, is amended to read as follows:
(p) (1) A medical expense indemnity corporation, a hospital service
corporation or a health service corporation that provides coverage for
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hospital, surgical or medical care shall provide the following coverage
for mammography AND OTHER IMAGING screening for occult breast cancer:
(A) upon the recommendation of a physician, a mammogram at any age for
covered persons having a prior history of breast cancer or who have a
first degree relative with a prior history of breast cancer;
(B) a single baseline mammogram for covered persons aged thirty-five
through thirty-nine, inclusive; [and]
(C) an annual mammogram for covered persons aged forty and older[.];
AND
(D) UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING FOR A
COVERED PERSON USING OTHER IMAGING MODALITIES AS DEEMED APPROPRIATE BY
THE AMERICAN COLLEGE OF RADIOLOGY OR THE AMERICAN CANCER SOCIETY OF AN
ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
(A) A MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DEMONSTRATES
THAT THE COVERED PERSON HAS DENSE BREAST TISSUE; OR
(B) A COVERED PERSON IS BELIEVED TO BE AT INCREASED RISK FOR BREAST
CANCER DUE TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER,
POSITIVE GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY A PHYSI-
CIAN.
FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE SHALL MEAN
HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS DEFINED IN NATIONALLY
RECOGNIZED GUIDELINES OR SYSTEMS FOR BREAST IMAGING REPORTING OF MAMMOG-
RAPHY SCREENING, INCLUDING, BUT NOT LIMITED TO, THE BREAST IMAGING
REPORTING AND DATA SYSTEM OF THE AMERICAN COLLEGE OF RADIOLOGY, AND ANY
EQUIVALENT NEW TERMS, AS SUCH GUIDELINES OR SYSTEMS ARE UPDATED.
(E) The coverage required in this paragraph or paragraph two of this
subsection may be subject to annual deductibles and coinsurance as may
be deemed appropriate by the superintendent and as are consistent with
those established for other benefits within a given contract.
(2) (A) For purposes of paragraph one of this subsection, mammography
screening means an X-ray examination of the breast using dedicated
equipment, including X-ray tube, filter, compression device, screens,
films and cassettes, with an average glandular radiation dose less than
0.5 rem per view per breast.
(B) FOR PURPOSES OF PARAGRAPH ONE OF THIS SUBSECTION, IMAGING MODALI-
TIES ARE MODALITIES USED TO SCREEN FOR, OR DIAGNOSE, OCCULT BREAST
CANCER.
(3) In addition to paragraph one or two of this subsection, every
contract that provides coverage for hospital, surgical or medical care,
except for a grandfathered health plan under paragraph four of this
subsection, shall provide coverage for the following mammography screen-
ing services AND FOR COMPREHENSIVE ULTRASOUND SCREENINGS OF AN ENTIRE
BREAST OR THE ENTIRETY OF BOTH BREASTS, and such coverage shall not be
subject to annual deductibles or coinsurance:
(A) evidence-based items or services for mammography that have in
effect a rating of 'A' or 'B' in the current recommendations of the
United States preventive services task force; [and]
(B) with respect to women, such additional preventive care and screen-
ings for mammography not described in subparagraph (A) of this paragraph
and as provided for in comprehensive guidelines supported by the health
resources and services administration[.]; AND
(C) COMPREHENSIVE ULTRASOUND SCREENINGS AS LONG AS DEEMED APPROPRIATE
BY THE AMERICAN COLLEGE OF RADIOLOGY OR THE AMERICAN CANCER SOCIETY OF
AN ENTIRE BREAST OR THE ENTIRETY OF BOTH BREASTS IF:
(I) A MAMMOGRAM DEMONSTRATES THAT A WOMAN HAS DENSE BREAST TISSUE; OR
A. 8319 5
(II) A WOMAN IS BELIEVED TO BE AT INCREASED RISK FOR BREAST CANCER DUE
TO FAMILY HISTORY OR PRIOR PERSONAL HISTORY OF BREAST CANCER, POSITIVE
GENETIC TESTING OR OTHER INDICATIONS AS DETERMINED BY A PHYSICIAN.
FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE SHALL MEAN
HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS DEFINED IN NATIONALLY
RECOGNIZED GUIDELINES OR SYSTEMS FOR BREAST IMAGING REPORTING OF MAMMOG-
RAPHY SCREENING, INCLUDING, BUT NOT LIMITED TO, THE BREAST IMAGING
REPORTING AND DATA SYSTEM OF THE AMERICAN COLLEGE OF RADIOLOGY, AND ANY
EQUIVALENT NEW TERMS, AS SUCH GUIDELINES OR SYSTEMS ARE UPDATED.
(4) For purposes of this subsection, "grandfathered health plan" means
coverage provided by a corporation in which an individual was enrolled
on March twenty-third, two thousand ten for as long as the coverage
maintains grandfathered status in accordance with section 1251(e) of the
Affordable Care Act, 42 U.S.C. S 18011(e).
S 4. Section 2404-c of the public health law, as added by chapter 265
of the laws of 2012, is amended to read as follows:
S 2404-c. Breast cancer; duty of providers of mammography services to
notify and inform. Every provider of mammography services shall, if a
patient's mammogram demonstrates dense breast tissue, provide notifica-
tion to such patient that shall include, but not be limited to, the
following information, in any summary of the mammography report sent,
pursuant to the federal mammography quality standards act, to the
patient AND THE PATIENT'S PHYSICIAN:
Your mammogram shows that your breast tissue is dense. Dense breast
tissue is very common and is not abnormal. However, dense breast tissue
can make it harder to find cancer on a mammogram and may also be associ-
ated with an increased risk of breast cancer.
This information about the result of your mammogram is given to you to
raise your awareness. Use this information to talk to your doctor about
your own risks for breast cancer. At that time, ask your doctor if more
screening tests might be useful, based on your risk. A report of your
results was sent to your physician.
For the purposes of this section dense breast tissue shall mean heter-
ogeneously dense or extremely dense tissue as defined in nationally
recognized guidelines or systems for breast imaging reporting of mammog-
raphy screening, including, but not limited to, the breast imaging
reporting and data system of the American College of Radiology, and any
equivalent new terms, as such guidelines or systems are updated.
S 5. This act shall take effect on the one hundred eightieth day after
it shall have become a law.