A 10747: Requires health insurance plans to cover a medically necessary peripheral artery disease screening test for any at-risk individual; prohibits imposition of patient cost sharing for follow-up screenings or diagnostics.

  
  STATE OF NEW YORK ________________________________________________________________________ 10747  IN ASSEMBLY March 27, 2026 ___________ Introduced by M. of A. REYES -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to requiring health insurance plans to cover a medically necessary peripheral artery disease screening test for any at-risk individual The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subsection (i) of section 3216 of the insurance law is 2 amended by adding a new paragraph 42 to read as follows: 3 (42) (A) Every policy which provides medical, major medical, or simi- 4 lar comprehensive-type coverage shall provide medically necessary cover- 5 age for a peripheral artery disease screening test for any at-risk indi- 6 vidual, as defined by the American College of Cardiology and the 7 American Heart Association's joint committee on clinical practice guide- 8 lines. 9 (B) Notwithstanding any other provision of law, any policy that 10 provides coverage required by this paragraph shall not impose patient 11 cost sharing for follow-up screening or diagnostic services for periph- 12 eral artery disease. 13 (C) (i) Nothing in this paragraph shall be construed to prevent 14 medical management or utilization review of the services, including 15 preauthorization, to ensure that such services are consistent with 16 nationally recognized clinical practice guidelines for the detection of 17 peripheral artery disease. 18 (ii) For the purposes of this subparagraph, the term "nationally 19 recognized clinical practice guidelines" means evidence-based, peer 20 reviewed clinical practice guidelines informed by a systematic review of 21 evidence and an assessment of the benefits, and risks of alternative 22 care options intended to optimize patient care developed by independent 23 organizations or medical professional societies utilizing a transparent 24 methodology and reporting structure and with a conflict of interest 25 policy. 26 (D) If the policy is a high deductible health plan as defined in 27 section 223(c)(2) of the Internal Revenue Code of 1986, such coverage EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD15315-01-6 
 A. 10747 2 1 may be subject to the plan's annual deductible if application of this 2 requirement would result in ineligibility for a health savings account. 3 § 2. Subsection (l) of section 3221 of the insurance law is amended by 4 adding a new paragraph (24) to read as follows: 5 (24) (A) Every policy which provides medical, major medical, or simi- 6 lar comprehensive-type coverage shall provide medically necessary cover- 7 age for a peripheral artery disease screening test for any at-risk indi- 8 vidual, as defined by the American College of Cardiology and the 9 American Heart Association's joint committee on clinical practice guide- 10 lines. 11 (B) Notwithstanding any other provision of law, any policy that 12 provides coverage required by this paragraph shall not impose patient 13 cost sharing for follow-up screening or diagnostic services for periph- 14 eral artery disease. 15 (C) (i) Nothing in this paragraph shall be construed to prevent 16 medical management or utilization review of the services, including 17 preauthorization, to ensure that such services are consistent with 18 nationally recognized clinical practice guidelines for the detection of 19 peripheral artery disease. 20 (ii) For the purposes of this subparagraph, the term "nationally 21 recognized clinical practice guidelines" means evidence-based, peer 22 reviewed clinical practice guidelines informed by a systematic review of 23 evidence and an assessment of the benefits, and risks of alternative 24 care options intended to optimize patient care developed by independent 25 organizations or medical professional societies utilizing a transparent 26 methodology and reporting structure and with a conflict of interest 27 policy. 28 (D) If the policy is a high deductible health plan as defined in 29 section 223(c)(2) of the Internal Revenue Code of 1986, such coverage 30 may be subject to the plan's annual deductible if application of this 31 requirement would result in ineligibility for a health savings account. 32 § 3. Section 4303 of the insurance law is amended by adding a new 33 subsection (yy) to read as follows: 34 (yy) (1) Every contract under this section which provides medical, 35 major medical, or similar comprehensive-type coverage shall provide 36 medically necessary coverage for a peripheral artery disease screening 37 test for any at-risk individual, as defined by the American College of 38 Cardiology and the American Heart Association's joint committee on clin- 39 ical practice guidelines. 40 (2) Notwithstanding any other provision of law, any contract under 41 this section that provides coverage required by this subsection shall 42 not impose patient cost sharing for follow-up screening or diagnostic 43 services for peripheral artery disease. 44 (3) (A) Nothing in this subsection shall be construed to prevent 45 medical management or utilization review of the services, including 46 preauthorization, to ensure that such services are consistent with 47 nationally recognized clinical practice guidelines for the detection of 48 peripheral artery disease. 49 (B) For the purposes of this paragraph, the term "nationally recog- 50 nized clinical practice guidelines" means evidence-based, peer reviewed 51 clinical practice guidelines informed by a systematic review of evidence 52 and an assessment of the benefits, and risks of alternative care options 53 intended to optimize patient care developed by independent organizations 54 or medical professional societies utilizing a transparent methodology 55 and reporting structure and with a conflict of interest policy. 
 A. 10747 3 1 (4) If the contract is a high deductible health plan as defined in 2 section 223(c)(2) of the Internal Revenue Code of 1986, such coverage 3 may be subject to the plan's annual deductible if application of this 4 requirement would result in ineligibility for a health savings account. 5 § 4. This act shall take effect January 1, 2027, and shall apply to 6 all policies and contracts issued, renewed, modified, altered or amended 7 on or after such date.