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

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S6769-2011 Actions

• Jul 23, 2012: SIGNED CHAP.265
• Jul 20, 2012: DELIVERED TO GOVERNOR
• Jun 19, 2012: returned to senate
• Jun 19, 2012: passed assembly
• Jun 19, 2012: ordered to third reading rules cal.389
• Jun 19, 2012: substituted for a9586d
• Jun 19, 2012: referred to codes
• Jun 19, 2012: DELIVERED TO ASSEMBLY
• Jun 19, 2012: PASSED SENATE
• Jun 19, 2012: ORDERED TO THIRD READING CAL.1308
• Jun 19, 2012: COMMITTEE DISCHARGED AND COMMITTED TO RULES
• Jun 14, 2012: PRINT NUMBER 6769B
• Jun 14, 2012: AMEND (T) AND RECOMMIT TO INSURANCE
• May 11, 2012: PRINT NUMBER 6769A
• May 11, 2012: AMEND AND RECOMMIT TO INSURANCE
• Mar 20, 2012: REFERRED TO INSURANCE

S6769-2011 Votes

S6769-2011 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.

S6769-2011 Text

                      S T A T E   O F   N E W   Y O R K
  ________________________________________________________________________

      S. 6769                                                  A. 9586

                        SENATE - ASSEMBLY

                               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,

   EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                        [ ] is old law to be omitted.
                                                             LBD15074-01-2

 S. 6769                             2                            A. 9586

    (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]

 S. 6769                             3                            A. 9586

    (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

 S. 6769                             4                            A. 9586

  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.