A 6561: Includes image-guided biopsies under mandatory insurance coverage for breast cancer screening.

  
  STATE OF NEW YORK ________________________________________________________________________ 6561 2025-2026 Regular Sessions  IN ASSEMBLY March 6, 2025 ___________ Introduced by M. of A. WEPRIN -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to including image-guided biopsies under certain insurance coverage for breast cancer screening and providing for mandatory health insurance coverage for lung cancer screening The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Item (iv) of subparagraph (A) of paragraph 11 of subsection 2 (i) of section 3216 of the insurance law, as amended by chapter 424 of 3 the laws of 2024, is amended to read as follows: 4 (iv) upon the recommendation of a physician, screening and diagnostic 5 imaging, including diagnostic mammograms, breast ultrasounds, image- 6 guided breast biopsies, or magnetic resonance imaging, recommended by 7 nationally recognized clinical practice guidelines for the detection of 8 breast cancer. For the purposes of this item, "nationally recognized 9 clinical practice guidelines" means evidence-based clinical practice 10 guidelines informed by a systematic review of evidence and an assessment 11 of the benefits, and risks of alternative care options intended to opti- 12 mize patient care developed by independent organizations or medical 13 professional societies utilizing a transparent methodology and reporting 14 structure and with a conflict of interest policy. 15 § 2. Item (v) of subparagraph (A) of paragraph 11 of subsection (l) of 16 section 3221 of the insurance law, as amended by chapter 424 of the laws 17 of 2024, is amended to read as follows: 18 (v) upon the recommendation of a physician, screening and diagnostic 19 imaging, including diagnostic mammograms, breast ultrasounds, image- 20 guided breast biopsies, or magnetic resonance imaging, recommended by 21 nationally recognized clinical practice guidelines for the detection of 22 breast cancer. For the purposes of this item, "nationally recognized 23 clinical practice guidelines" means evidence-based clinical practice EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD10190-02-5 
 A. 6561 2 1 guidelines informed by a systematic review of evidence and an assessment 2 of the benefits, and risks of alternative care options intended to opti- 3 mize patient care developed by independent organizations or medical 4 professional societies utilizing a transparent methodology and reporting 5 structure and with a conflict of interest policy. 6 § 3. Subparagraph (E) of paragraph 1 of subsection (p) of section 4303 7 of the insurance law, as amended by chapter 424 of the laws of 2024, is 8 amended to read as follows: 9 (E) upon the recommendation of a physician, screening and diagnostic 10 imaging, including diagnostic mammograms, breast ultrasounds, image- 11 guided breast biopsies, or magnetic resonance imaging, recommended by 12 nationally recognized clinical practice guidelines for the detection of 13 breast cancer. For the purposes of this subparagraph, "nationally recog- 14 nized clinical practice guidelines" means evidence-based clinical prac- 15 tice guidelines informed by a systematic review of evidence and an 16 assessment of the benefits, and risks of alternative care options 17 intended to optimize patient care developed by independent organizations 18 or medical professional societies utilizing a transparent methodology 19 and reporting structure and with a conflict of interest policy; and 20 § 4. Subsection (i) of section 3216 of the insurance law is amended by 21 adding a new paragraph 41 to read as follows: 22 (41) (A) Every policy which provides medical, major medical, or simi- 23 lar comprehensive-type coverage shall provide coverage for lung cancer 24 screening or follow-up diagnostic imaging to assist in the diagnosis of 25 lung cancer when recommended by a health care provider acting within the 26 provider's scope of practice pursuant to title eight of the education 27 law. 28 (B) Notwithstanding any other provision of law, any policy that 29 provides coverage required by this paragraph shall not impose a copay- 30 ment, coinsurance, or deductible requirement for lung cancer screening 31 or follow-up diagnostic imaging to assist in the diagnosis of lung 32 cancer and shall not require prior authorization for such coverage. 33 § 5. Subsection (l) of section 3221 of the insurance law is amended by 34 adding a new paragraph 23 to read as follows: 35 (23) (A) Every policy which provides medical, major medical, or simi- 36 lar comprehensive-type coverage shall provide coverage for lung cancer 37 screening or follow-up diagnostic imaging to assist in the diagnosis of 38 lung cancer when recommended by a health care provider acting within the 39 provider's scope of practice pursuant to title eight of the education 40 law. 41 (B) Notwithstanding any other provision of law, any policy that 42 provides coverage required by this paragraph shall not impose a copay- 43 ment, coinsurance, or deductible requirement for lung cancer screening 44 or follow-up diagnostic imaging to assist in the diagnosis of lung 45 cancer and shall not require prior authorization for such coverage. 46 § 6. Section 4303 of the insurance law is amended by adding a new 47 subsection (ww) to read as follows: 48 (ww) (1) Every policy which provides medical, major medical, or simi- 49 lar comprehensive-type coverage shall provide coverage for lung cancer 50 screening or follow-up diagnostic imaging to assist in the diagnosis of 51 lung cancer when recommended by a health care provider acting within the 52 provider's scope of practice pursuant to title eight of the education 53 law. 54 (2) Notwithstanding any other provision of law, any policy that 55 provides coverage required by this subsection shall not impose a copay- 56 ment, coinsurance, or deductible requirement for lung cancer screening 
 A. 6561 3 1 or follow-up diagnostic imaging to assist in the diagnosis of lung 2 cancer and shall not require prior authorization for such coverage. 3 § 7. This act shall take effect January 1, 2026 and shall apply to all 4 policies and contracts issued, renewed, modified, altered or amended on 5 or after such date; provided, however, that if chapter 424 of the laws 6 of 2024 shall not have taken effect on or before such date then sections 7 one, two and three of this act shall take effect on the same date and in 8 the same manner as such chapter of the laws of 2024 takes effect.