This bill has been amended

Bill S6769-2011

Relates to insurance coverage for supplemental screenings for breast cancer under certain circumstances

Relates to duties of providers of mammography services to notify and inform patients if a mammogram demonstrates dense breast tissue.

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  • Mar 20, 2012: REFERRED TO INSURANCE

Memo

BILL NUMBER:S6769

TITLE OF BILL: An act to amend the insurance law and the public health law, in relation to supplemental screenings

PURPOSE: This bill requires health insurance policies to provide additional coverage for supplementary screening tests for breast cancer when a mammography indicates dense breast tissue. It also requires specific written notification to the patient and the patient's physician of a finding of dense tissue and the need to consult with the physician about additional screening.

SUMMARY OF PROVISIONS: Section one amends subparagraphs (A) and (C) of paragraph 11 of subsection (i) of section 3216 of the insurance law, as amended by chapter 219 of the laws of 2011, to require insurance Coverage for Supplementary screening tests to detect occult breast cancer Upon recommendation of a physician in those cases where a mammography indicates the presence of dense breast tissue as defined by the breast imaging reporting and data system established by the American College of Radiology, or a physician determines that the covered person is potentially at high risk for breast cancer according to such guidelines. Other imaging modalities are defined as modalities used to screen for, or diagnose, breast cancer.

Section two amends subparagraphs (A) and (C) of paragraph 11 of subsection (1) of section 3221 of the insurance law, as amended by chapter 219 of the laws of 2011, in exactly the same way as section one above.

Section three amends subsection (p) of section 4303 of the insurance law, as amended by chapter 219 of the laws of 2011, in exactly the same way as section one above.

Section four amends paragraph 7 of subsection (d) of section 4326 of the insurance law, as added by chapter 1 of the laws of 1999, by adding a cross reference to subsection (p) of section 4303 of the insurance law.

Section five amends the public health law by adding a new section 2404-c which requires the commissioner to develop a written notification informing patients who have dense tissue: that their mammography found dense tissue, that they have dense tissue, that dense tissue may reduce the sensitivity of mammography screening and interfere with the detection of abnormalities, that their physician has been notified, and that they should consult with their physician about further screening options. The notification will be included

with the federally required mammography report sent to the patient and patient's physician.

Section six sets forth the effective date on the ninetieth day after it shall have become a law.

EXISTING LAW: Current law requires coverage for mammography screening for individuals, based upon personal or family history and the age of the individual. Mammography screening is defined as X-ray examination under current law. There are no requirements for patients to be alerted to breast density.

JUSTIFICATION: One woman is diagnosed with breast cancer every three minutes, and one woman dies of breast cancer every 13 minutes in the United States. Cancer is four to six times more likely in women with dense breast tissue and 40 percent of women have dense tissue. 71 percent of all breast cancers occur in women with dense breast tissue (as stated in a 2010 study published in the Annals of Surgical Oncology). Mammograms fail to detect about half the tumors present in dense breast tissue as dense tissue obscures the presence of the tumors. Follow-up studies after a similar dense breast tissue law passed in Connecticut in 2009 show that for women with dense tissue, the addition of a screening ultrasound nearly doubles the number of cancers found by mammography alone. In New York State, that number extrapolates to at least 2000 cancers a year in women who are told their mammogram results are "normal/negative," but who, in actuality, have invasive breast cancer. Missed cancers, growing undetected until at a later stage, are less treatable, least survivable and most expensive to treat.

Over 20 years ago, elected officials and medical experts reached a consensus that early breast cancer detection saved lives and states began requiring insurance coverage for mammograms. In order to ensure that patients received information about relevant mammographic findings, a federal law was enacted requiring a mammography report be issued to patients to help them partner with their physician in their health care vigilance.

A woman's breast density is determined through the mammography exam. Breast density not only dramatically compromises the effectiveness of a mammogram, but is, in and of itself, a risk factor for developing breast cancer. Women with dense breasts have a greater risk of developing breast cancer than those who have a first degree relative who have had the disease. Unfortunately, there is currently no protocol for density information to be shared with patients. The mammography reports to patients, citing a "normal" finding when the radiologist does not know, with any reasonable certainty what is lurking behind dense tissue - gives women a false sense of security.

Now, twenty years later, states are recognizing that, for a significant percentage of women, the mammography insurance coverage and notification requirements are not sufficient. The report a woman receives after her mammogram is required to be a summary, in lay language, of her mammographic findings. Information about breast density is a material medical finding which must be shared with patients. This legislation will give women with dense tissue the information and opportunity to get adequate baseline and follow-up screening. Without it, women with dense tissue are effectively denied equal access to early cancer detection.

LEGISLATIVE HISTORY: New bill.

FISCAL IMPLICATIONS: None.

LOCAL FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: This bill takes effect on the ninetieth day after it shall have become a law.


Text

STATE OF NEW YORK ________________________________________________________________________ S. 6769 A. 9586 S E N A T E - A S S E M B L Y March 20, 2012 ___________
IN SENATE -- Introduced by Sen. FLANAGAN -- read twice and ordered printed, and when printed to be committed to the Committee on Insur- ance IN ASSEMBLY -- Introduced by M. of A. JAFFEE -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law and the public health law, in relation to supplemental screenings THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subparagraphs (A) and (C) of paragraph 11 of subsection (i) of section 3216 of the insurance law, as amended by chapter 219 of the laws of 2011, are amended to read as follows: (A) Every policy that provides coverage 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 (IV) UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING FOR A COVERED PERSON USING OTHER IMAGING MODALITIES DEEMED APPROPRIATE FOR ADJUVANT SCREENING BY AMERICAN COLLEGE OF RADIOLOGY GUIDELINES TO DETECT OCCULT BREAST CANCER IF: (A) A MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DOES NOT PROVIDE ADEQUATE SCREENING BECAUSE OF THE NATURE OF THE BREAST TISSUE, INCLUDING, BUT NOT LIMITED TO, THE PRESENCE OF HETEROGENEOUSLY OR EXTREMELY DENSE BREAST TISSUE, AS DEFINED BY THE BREAST IMAGING REPORT- ING AND DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY, THAT MAY LOWER THE SENSITIVITY OF MAMMOGRAPHY; OR,
(B) IT IS DETERMINED BY A PHYSICIAN THAT THE COVERED PERSON IS POTEN- TIALLY AT HIGH RISK FOR BREAST CANCER ACCORDING TO SUCH GUIDELINES. (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. S 2. Subparagraphs (A) and (C) of paragraph 11 of subsection (l) 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 (IV) UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING FOR A COVERED PERSON USING OTHER IMAGING MODALITIES DEEMED APPROPRIATE FOR ADJUVANT SCREENING BY AMERICAN COLLEGE OF RADIOLOGY GUIDELINES TO DETECT OCCULT BREAST CANCER IF: (A) A MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DOES NOT PROVIDE ADEQUATE SCREENING BECAUSE OF THE NATURE OF THE BREAST TISSUE, INCLUDING, BUT NOT LIMITED TO, THE PRESENCE OF HETEROGENEOUSLY OR EXTREMELY DENSE BREAST TISSUE, AS DEFINED BY THE BREAST IMAGING REPORT- ING AND DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY, THAT MAY LOWER THE SENSITIVITY OF MAMMOGRAPHY; OR, (B) IT IS DETERMINED BY A PHYSICIAN THAT THE COVERED PERSON IS POTEN- TIALLY AT HIGH RISK FOR BREAST CANCER ACCORDING TO SUCH GUIDELINES. (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. 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 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 DEEMED APPROPRIATE FOR ADJUVANT SCREENING BY AMERICAN COLLEGE OF RADIOLOGY GUIDELINES TO DETECT OCCULT BREAST CANCER IF: (A) A MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DOES NOT PROVIDE ADEQUATE SCREENING BECAUSE OF THE NATURE OF THE BREAST TISSUE, INCLUDING, BUT NOT LIMITED TO, THE PRESENCE OF HETEROGENEOUSLY OR EXTREMELY DENSE BREAST TISSUE, AS DEFINED BY THE BREAST IMAGING REPORT- ING AND DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY, THAT MAY LOWER THE SENSITIVITY OF MAMMOGRAPHY; OR, (B) IT IS DETERMINED BY A PHYSICIAN THAT THE COVERED PERSON IS POTEN- TIALLY AT HIGH RISK FOR BREAST CANCER ACCORDING TO SUCH GUIDELINES. (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 such coverage shall not be subject to annual deduct- ibles 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. (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. Paragraph 7 of subsection (d) of section 4326 of the insurance law, as added by chapter 1 of the laws of 1999, is amended to read as follows: (7) adult preventive health services consisting of mammography screen- ing, AS PROVIDED IN SUBSECTION (P) OF SECTION FOUR THOUSAND THREE HUNDRED THREE OF THIS ARTICLE; cervical cytology screening; periodic physical examinations no more than once every three years; and adult immunizations; S 5. The public health law is amended by adding a new section 2404-c to read as follows: S 2404-C. BREAST CANCER; DUTY OF PROVIDERS OF MAMMOGRAPHY SERVICES TO NOTIFY AND INFORM. 1. THE COMMISSIONER SHALL DEVELOP A STANDARD WRITTEN
NOTIFICATION IN PLAIN NON-TECHNICAL LANGUAGE FOR PATIENTS, WHO RECEIVE MAMMOGRAPHY SERVICES THAT DEMONSTRATE THE PATIENT HAS HETEROGENEOUSLY OR EXTREMELY DENSE BREAST TISSUE BASED ON THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY, WHICH SHALL EXPLAIN THAT: (A) THE PATIENT'S MAMMOGRAPHY RESULTS DEMONSTRATE THAT THE PATIENT HAS DENSE BREAST TISSUE WHICH MAY REDUCE THE SENSITIVITY OF MAMMOGRAPHY SCREENING AND INTERFERE WITH THE DETECTION OF ABNORMALITIES; (B) THE NOTIFICATION HAS ALSO BEEN SENT TO THE PATIENT'S PHYSICIAN; AND, (C) THE NOTIFICATION IS PROVIDED TO ENCOURAGE THE PATIENT TO DISCUSS WITH THE PATIENT'S PHYSICIAN THE OPTION OF ADDITIONAL METHODS OF SCREEN- ING FOR BREAST CANCER DEPENDING ON THE PATIENT'S RISK FACTORS. 2. EVERY PROVIDER OF MAMMOGRAPHY SERVICES SHALL, IF A PATIENT HAS HETEROGENEOUSLY DENSE OR EXTREMELY DENSE BREAST TISSUE, INCLUDE SUCH NOTIFICATION IN ANY MAMMOGRAPHY REPORT SENT, PURSUANT TO THE FEDERAL MAMMOGRAPHY QUALITY STANDARDS ACT, TO THE PATIENT AND THE PATIENT'S PHYSICIAN. S 6. This act shall take effect on the ninetieth day after it shall have become a law.

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