Relates to coverage for the detection of breast cancer, requiring certified mammography facilities to provide extended hours and excused leave to undertake a breast cancer screening

*Section 1 would amend Ins. L. § 3216 (i)(11)(B) to prohibit cost-sharing for mammography screening for breast cancer in any policy that provides hospital, surgical or medical care coverage.

*Section 2 would add a new subparagraph (F) to Ins. L. § 3216 (i)(11) to prohibit cost-sharing for screening and diagnostic imaging for the detection of breast cancer, including diagnostic mammograms, breast ultrasounds, or magnetic resonance imaging otherwise covered under the policy.

*Section 3 would add a new paragraph 33 to Ins. L. § 3216(i) to specify that provisions requiring an insurer to provide benefits without cost-sharing apply only to: (i) participating providers in the insurer's network; and (ii) in cases where the insurer does not have an in-network participating provider with the appropriate training and experience to meet the health care needs of the insured, non-participating providers.

Sections 4, 5, and 6 of the bill would amend Ins. L. § 3221 to prohibit cost-sharing in blanket or commercial policies:

*Section 4 would amend Ins. L. § 3221(1)(11)(B) to prohibit cost-sharing for mammography screening for breast cancer in any policy that provides hospital, surgical or medical care coverage.

*Section 5 would add a new subparagraph (F) to Ins. L. § 3221(1)(11) to prohibit cost-sharing for screening and diagnostic imaging for the detection of breast cancer, including diagnostic mammograms, breast ultrasounds, or magnetic resonance imaging, covered under the policy.

*Section 6 of the bill would add a new paragraph 19 to Ins. L. § 3221(1) to specify that provisions requiring an insurer to provide benefits without cost-sharing apply only to: (i) participating providers in the insurer's network; and (ii) in cases where the insurer does not have an in-network participating provider with the appropriate training and experience to meet the health care needs of the insured, non-participating providers.

Sections 7, 8, and 9 of the bill would amend Ins. L. § 4303 to prohibit cost-sharing in coverage provided by health maintenance organizations and Article 43 corporations:

*Section 7 would amend Ins. L. § 4303(p)(1)(D) to prohibit cost-sharing for mammography screening for breast cancer in any contract that provides hospital, surgical or medical care coverage.

*Section 8 would add a new paragraph 5 of Ins. L. § 4303(p) to prohibit cost-sharing for screening and diagnostic imaging for the detection of breast cancer, including diagnostic mammograms, breast ultrasounds, or magnetic resonance imaging, covered under the contract.

*Section 9 would add a new subsection (qq) to Ins. L. § 4303 to specify that the provisions requiring a corporation to provide benefits without cost-sharing shall only apply to: (i) participating providers in the corporation's network; and (ii) in cases where the corporation does not have an in-network participating provider with the appropriate training and experience to meet the health care needs of the covered person, nonparticipating providers.

Section 10 of the bill would add a new section 2404-d to the Public Health L. to require any general hospital or extension clinic certified as a mammography facility under the federal Mammography Quality Standards Act (MQSA), to provide extended hours for screening mammography services. Such hours must be in the early morning, evening, or on the weekend, at least two days each week for at least two hours each day, for a total of at least four hours each week. Such hours must include the following times:

o Monday through Friday, between the hours of 7:00 AM and 9:00 AM; o Monday through Friday, between the hours of 5:00 PM and 7:00 PM; or o Saturday or Sunday, between the hours of 9:00 AM and 5:00 PM.

Section 10 would also allow the Department of Health to grant a waiver to facilities that: (i) have insufficient staff; (ii) are in the process of discontinuing screening mammography services; or (iii) are subject to hardships.

Section 11 of the bill would amend Civ. Serv. L. § 159-b to repeal a provision excluding public employees in cities having a population of one million or more from receiving up to four hours of paid leave to get a screening for breast cancer.

Section 12 would set forth the effective dates.

Statement in support

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer deaths among women in New York State. Each year, approximately 15,000 women are newly diagnosed with breast cancer, and approximately 2,640 die from the disease.

Screening for breast cancer, which includes mammography, can increase the detection of the disease at an early stage when treatment is most effective. In 2014, however, nearly 22% of women in New York aged 50-74 reported not having mammograms at least every other year.

Under current state law, insurers that provide coverage for mammography screening for breast cancer must also provide coverage for:

* mammograms for a covered person of any age that has a prior history of breast cancer, or a first degree relative with a prior history of breast cancer when a physician recommends the mammogram; * a single baseline mammogram for covered persons aged 35 to 39; and

* an annual mammogram for persons aged 40 and older.

However, individuals may still have to pay for such coverage. This bill would remove that financial barrier by prohibiting cost-sharing for mammograms and other screening and diagnostic imaging used to detect breast cancer, including diagnostic mammograms, breast ultrasounds, and breast MRIs. If an insurer does not have a participating in-network health provider with the appropriate training and experience to meet the health care needs of the insured or covered person, cost-sharing would also be prohibited for services provided by out of network providers.

This bill will also help individuals whose schedules prevent them from getting screened. All certified mammography facilities must now provide extended hours in the early morning, evening, or on the weekend for a total of at least four hours each week.

Finally, to ensure equity for all public employees throughout the state, this bill would eliminate a provision in the Civil Service Law that excludes New York City public employees from receiving up to four hours of paid leave to get a screening for breast cancer.

Budget implications

None.

Effective date

This bill is effective immediately and shall apply to all policies and contracts issued, renewed, modified, or amended on or after January 1, 2017; provided, however, that section 11 of this bill would take effect on the ninetieth day after it shall become law; and provided, further, that effective immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this bill on its effective date is authorized and directed to be made and completed on or before such effective date.