NY State Senate Bill 2023-S5579A

Senate Bill S5579A

2023-2024 Legislative Session

Requires insurance policies to provide coverage for transvaginal ultrasounds during pregnancy

download bill text pdf

Current Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 22, 2024	print number 5579a
May 22, 2024	amend and recommit to insurance
Jan 03, 2024	referred to insurance
Mar 08, 2023	referred to insurance

Bill Amendments

Original

A (Active)

co-Sponsors

2023-S5579 - Details

See Assembly Version of this Bill:: A6042
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2021-2022 Legislative Session:: S7146, A7741

2023-S5579 - Summary

Requires insurance policies to provide coverage for transvaginal ultrasounds during pregnancy.

2023-S5579 - Sponsor Memo

                                 
BILL NUMBER: S5579

SPONSOR: SCARCELLA-SPANTON
 
TITLE OF BILL:

An act to amend the insurance law, in relation to requiring insurance
policies to provide coverage for transvaginal ultrasounds during preg-
nancy

 
PURPOSE:

The purpose of this bill is to ensure that testing for an incompetent
cervix is covered by insurance.

 
SUMMARY OF PROVISIONS:

Section 1. Amends Paragraph 10 of subsection (i) of section 3216 of the
insurance law (Individual accident and health insurance policy
provisions) by adding a new subparagraph ( C); Section 2 - amends para-
graph 5 of subsection (k) of section 3221 (Group or blanket accident and
health insurance policies; standard provisions) of the insurance law by
adding a new subparagraph ( C); and,

Section 3 amends Paragraph 1 of subsection (c) of section 4303 (Bene-
fits) of the insurance law by adding a new subparagraph (D), as follows:

Coverage provided under this paragraph for care and treatment during
pregnancy shall include:

A. A transvaginal ultrasound once between 16 and 24 weeks;

B. A transvaginal ultrasound every two weeks from 16 through 24 weeks
for patients with a history of:

C. Early delivery in any prior pregnancy (between 13 and 37 weeks);

D. A history of any surgical (including office procedures) procedure
done on their cervix (such as LEEP and cone biopsy);

E. All multifetal pregnancies (twins and more);

F. Uterine unification defect or any congenital structural defect of a
kidney; and,

G. Any patient whose prior delivery occurred at or near term by cesarean
after obstructed labor.

Section 4 provides for a 60-day effective date.

 
JUSTIFICATION:

An incompetent cervix, also called a cervical insufficiency, is a condi-
tion that occurs when weak cervical tissue causes or contributes to
premature birth or the loss of an otherwise healthy pregnancy.

Before pregnancy, a woman's cervix - the lower part of the uterus that
connects to the vagina - is normally closed and rigid. As pregnancy
progresses and a woman prepares to give birth, the cervix gradually

softens, decreases in length and opens. If a woman has an incompetent
cervix, the cervix might begin to open too soon causing premature birth.

Performing a test and an examination on all expecting women helps to
ensure better birth outcomes. Cervical incompetence is a known risk
factor for preterm birth and is considered responsible for 5% of
extremely preterm deliveries (<28weeks).

The United States is one of the most dangerous developed nations for
pregnant mothers and their babies. Nearly 10% of all babies in the US
are born prematurely. Premature birth (birth before 37 weeks) and its
complications is the leading cause of death in babies in the US; of
babies who survive, many have longstanding health problems, including
cerebral palsy, developmental disabilities, chronic lung disease, and
issues with vision and hearing.

 
LEGISLATIVE HISTORY:

2022 - Referred to Insurance

 
FISCAL IMPLICATIONS:

Minimal.

 
EFFECTIVE DATE:
On the sixtieth day after it shall have become a law. Effective imme-
diately the addition, amendment and/or repeal of any rule or regulation
necessary for the implementation of this act on its effective date are
authorized to be made and completed on or before such date.

2023-S5579 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5579
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               March 8, 2023
                                ___________
 
 Introduced  by Sen. SCARCELLA-SPANTON -- read twice and ordered printed,
   and when printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law, in relation  to  requiring  insurance
   policies to provide coverage for transvaginal ultrasounds during preg-
   nancy

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph 10 of subsection  (i)  of  section  3216  of  the
 insurance  law  is  amended  by adding a new subparagraph (C) to read as
 follows:
   (C) COVERAGE PROVIDED UNDER THIS  PARAGRAPH  FOR  CARE  AND  TREATMENT
 DURING PREGNANCY SHALL INCLUDE PROVISION FOR PAYMENTS FOR NOT LESS THAN:
   (I) A TRANSVAGINAL ULTRASOUND ONCE BETWEEN SIXTEEN THROUGH TWENTY-FOUR
 WEEKS; AND
   (II)  A  TRANSVAGINAL  ULTRASOUND EVERY TWO WEEKS FROM SIXTEEN THROUGH
 TWENTY-FOUR WEEKS FOR PREGNANT INDIVIDUALS WITH ANY  OF  THE  FOLLOWING:
 (I)  A HISTORY OF EARLY DELIVERY BETWEEN THIRTEEN AND THIRTY-SEVEN WEEKS
 IN ANY PRIOR PREGNANCY;  (II)  A  HISTORY  OF  ANY  SURGICAL  PROCEDURE,
 INCLUDING  OFFICE  PROCEDURES,  PERFORMED ON THEIR CERVIX, INCLUDING BUT
 NOT LIMITED TO LEEP AND CONE BIOPSY; (III) MULTIFETAL PREGNANCIES;  (IV)
 A  PREGNANT  INDIVIDUAL WITH A UTERINE UNIFICATION DEFECT, INCLUDING BUT
 NOT LIMITED TO BICORNUATE, SEPTATE OR UNICORNUATE UTERUS, OR ANY CONGEN-
 ITAL STRUCTURAL DEFECT OF A KIDNEY; AND (V) A HISTORY OF PRIOR  DELIVERY
 OCCURRING AT OR NEAR TERM BY CESAREAN AFTER OBSTRUCTED LABOR.
   §  2.  Paragraph  5 of subsection (k) of section 3221 of the insurance
 law is amended by adding a new subparagraph (C) to read as follows:
   (C) COVERAGE PROVIDED UNDER THIS  PARAGRAPH  FOR  CARE  AND  TREATMENT
 DURING PREGNANCY SHALL INCLUDE PROVISION FOR PAYMENTS FOR NOT LESS THAN:
   (I) A TRANSVAGINAL ULTRASOUND ONCE BETWEEN SIXTEEN THROUGH TWENTY-FOUR
 WEEKS; AND
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01169-01-3
 S. 5579                             2

 
   (II)  A  TRANSVAGINAL  ULTRASOUND EVERY TWO WEEKS FROM SIXTEEN THROUGH
 TWENTY-FOUR WEEKS FOR PREGNANT INDIVIDUALS WITH ANY  OF  THE  FOLLOWING:
 (I)  A HISTORY OF EARLY DELIVERY BETWEEN THIRTEEN AND THIRTY-SEVEN WEEKS
 IN ANY PRIOR PREGNANCY;  (II)  A  HISTORY  OF  ANY  SURGICAL  PROCEDURE,
 INCLUDING  OFFICE  PROCEDURES,  PERFORMED ON THEIR CERVIX, INCLUDING BUT
 NOT LIMITED TO LEEP AND CONE BIOPSY; (III) MULTIFETAL PREGNANCIES;  (IV)
 A  PREGNANT  INDIVIDUAL WITH A UTERINE UNIFICATION DEFECT, INCLUDING BUT
 NOT LIMITED TO BICORNUATE, SEPTATE OR UNICORNUATE UTERUS, OR ANY CONGEN-
 ITAL STRUCTURAL DEFECT OF A KIDNEY; AND (V) A HISTORY OF PRIOR  DELIVERY
 OCCURRING AT OR NEAR TERM BY CESAREAN AFTER OBSTRUCTED LABOR.
   §  3.  Paragraph  1 of subsection (c) of section 4303 of the insurance
 law is amended by adding a new subparagraph (D) to read as follows:
   (D) COVERAGE PROVIDED UNDER THIS  PARAGRAPH  FOR  CARE  AND  TREATMENT
 DURING PREGNANCY SHALL INCLUDE PROVISION FOR PAYMENTS FOR NOT LESS THAN:
   (I) A TRANSVAGINAL ULTRASOUND ONCE BETWEEN SIXTEEN THROUGH TWENTY-FOUR
 WEEKS; AND
   (II)  A  TRANSVAGINAL  ULTRASOUND EVERY TWO WEEKS FROM SIXTEEN THROUGH
 TWENTY-FOUR WEEKS FOR PREGNANT INDIVIDUALS WITH ANY  OF  THE  FOLLOWING:
 (I)  A HISTORY OF EARLY DELIVERY BETWEEN THIRTEEN AND THIRTY-SEVEN WEEKS
 IN ANY PRIOR PREGNANCY;  (II)  A  HISTORY  OF  ANY  SURGICAL  PROCEDURE,
 INCLUDING  OFFICE  PROCEDURES,  PERFORMED ON THEIR CERVIX, INCLUDING BUT
 NOT LIMITED TO LEEP AND CONE BIOPSY; (III) MULTIFETAL PREGNANCIES;  (IV)
 A  PREGNANT  INDIVIDUAL WITH A UTERINE UNIFICATION DEFECT, INCLUDING BUT
 NOT LIMITED TO BICORNUATE, SEPTATE OR UNICORNUATE UTERUS, OR ANY CONGEN-
 ITAL STRUCTURAL DEFECT OF A KIDNEY; AND (V) A HISTORY OF PRIOR  DELIVERY
 OCCURRING AT OR NEAR TERM BY CESAREAN AFTER OBSTRUCTED LABOR.
   §  4.  This  act  shall take effect on the sixtieth day after it shall
 have become a law.  Effective immediately the addition, amendment and/or
 repeal of any rule or regulation necessary  for  the  implementation  of
 this  act  on its effective date are authorized to be made and completed
 on or before such date.

co-Sponsors

2023-S5579A (ACTIVE) - Details

See Assembly Version of this Bill:: A6042
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2021-2022 Legislative Session:: S7146, A7741

2023-S5579A (ACTIVE) - Summary

Requires insurance policies to provide coverage for transvaginal ultrasounds during pregnancy.

2023-S5579A (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S5579A

SPONSOR: SCARCELLA-SPANTON
 
TITLE OF BILL:

An act to amend the insurance law, in relation to requiring insurance
policies to provide coverage for transvaginal ultrasounds during preg-
nancy

 
PURPOSE:

The purpose of this bill is to require commercial health insurance
coverage of medically necessary transvaginal ultrasounds when recom-
mended by nationally recognized clinical practice guidelines.

 
SUMMARY OF SPECIFIC PROVISIONS:

This bill would require individual, group, and Article 43 commercial
health insurance policies provide coverage of medically necessary tran-
svaginal ultrasounds when recommended by nationally recognized clinical
practice guidelines. For the purposes of this legislation, nationally
recognized clinical practice guidelines mean evidence-based clinical.

practice guidelines informed by a systematic review of evidence and an
assessment of the benefits, and risks of alternative care options
intended to optimize patient care developed by independent organizations
or medical professional societies utilizing a transparent methodology
and reporting structure and with a conflict-of-interest policy.

 
JUSTIFICATION:

Carolyn Spiro Levitt and her husband, Josh, lost their son Eli Parker
Levitt, when he was born at 23 weeks in 2020. At 20 weeks, Carolyn was
told during a routine appointment that she was three centimeters dilat-
ed, fully effaced, and about to go into labor due to a condition cruelly
named an "incompetent cervix". Prior to that, the Levitt's were led to
believe that everything was fine with their pregnancy.  The condition
Carolyn developed can be treated and addressed if caught in time through
easy-to-conduct testing. Because Carolyn was not tested for the condi-
tion earlier in her pregnancy, their son, Eli Levitt, passed away after
being born early.

An incompregnancy. Before so called cervical insufficiency, is a condi-
tion that occurs when weak cervical tissue causes or contributes to
premature birth or the loss of an otherwise healthy pregnancy.  Before
pregnancy, a woman's cervix - the lower part of the uterus that connects
to the vagina - is normally closed and rigid. As pregnancy progresses
and a woman prepares to give birth, the cervix gradually softens,
decreases in length, and opens. If a woman has an incompetent cervix,
the cervix might begin to open too soon causing premature birth.
Submitted in accordance with Assembly Rule III, Sec 1(f)

Performing a test and an examination on all expecting women helps to
ensure better birth outcomes. Cervical incompetence is a known risk
factor for preterm birth and is considered responsible for 5% of extreme
preterm deliveries (<28 weeks).

The United States is one of the most dangerous developed nations for
pregnant mothers and their babies. Ten percent of all babies in the US
are born prematurely. Premature birth (birth before 37 weeks) and its
complications is the leading cause of death in babies in the US; of
babies who survive, many have longstanding health problems, including
cerebral palsy, developmental disabilities, chronic lung disease, and
issues with vision and hearing.

 
LEGISLATIVE HISTORY:

2021-22: A7741 - referred to insurance

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
January 1, 2026.

2023-S5579A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5579--A
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               March 8, 2023
                                ___________
 
 Introduced  by Sens. SCARCELLA-SPANTON, BROUK, SALAZAR -- read twice and
   ordered printed, and when printed to be committed to the Committee  on
   Insurance  --  recommitted to the Committee on Insurance in accordance
   with Senate Rule 6, sec. 8  --  committee  discharged,  bill  amended,
   ordered reprinted as amended and recommitted to said committee

 AN  ACT  to  amend the insurance law, in relation to requiring insurance
   policies to provide coverage for transvaginal ultrasounds during preg-
   nancy
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph  10  of  subsection  (i) of section 3216 of the
 insurance law is amended by adding a new subparagraph  (C)  to  read  as
 follows:
   (C)  COVERAGE  PROVIDED  UNDER  THIS  PARAGRAPH FOR CARE AND TREATMENT
 DURING PREGNANCY SHALL INCLUDE MEDICALLY NECESSARY  TRANSVAGINAL  ULTRA-
 SOUNDS  WHEN  RECOMMENDED  BY  NATIONALLY  RECOGNIZED  CLINICAL PRACTICE
 GUIDELINES. FOR THE PURPOSES OF THIS  SUBPARAGRAPH,  "NATIONALLY  RECOG-
 NIZED  CLINICAL PRACTICE GUIDELINES" MEANS EVIDENCE-BASED CLINICAL PRAC-
 TICE GUIDELINES INFORMED BY A  SYSTEMATIC  REVIEW  OF  EVIDENCE  AND  AN
 ASSESSMENT  OF  THE  BENEFITS,  AND  RISKS  OF  ALTERNATIVE CARE OPTIONS
 INTENDED TO OPTIMIZE PATIENT CARE DEVELOPED BY INDEPENDENT ORGANIZATIONS
 OR MEDICAL PROFESSIONAL SOCIETIES UTILIZING  A  TRANSPARENT  METHODOLOGY
 AND REPORTING STRUCTURE AND WITH A CONFLICT OF INTEREST POLICY.
   §  2.  Paragraph  5 of subsection (k) of section 3221 of the insurance
 law is amended by adding a new subparagraph (C) to read as follows:
   (C) COVERAGE PROVIDED UNDER THIS  PARAGRAPH  FOR  CARE  AND  TREATMENT
 DURING  PREGNANCY  SHALL INCLUDE MEDICALLY NECESSARY TRANSVAGINAL ULTRA-
 SOUNDS WHEN  RECOMMENDED  BY  NATIONALLY  RECOGNIZED  CLINICAL  PRACTICE
 GUIDELINES.  FOR  THE  PURPOSES OF THIS SUBPARAGRAPH, "NATIONALLY RECOG-
 NIZED CLINICAL PRACTICE GUIDELINES" MEANS EVIDENCE-BASED CLINICAL  PRAC-
 TICE  GUIDELINES  INFORMED  BY  A  SYSTEMATIC  REVIEW OF EVIDENCE AND AN
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01169-05-4

 S. 5579--A                          2
 
 ASSESSMENT OF THE  BENEFITS,  AND  RISKS  OF  ALTERNATIVE  CARE  OPTIONS
 INTENDED TO OPTIMIZE PATIENT CARE DEVELOPED BY INDEPENDENT ORGANIZATIONS
 OR  MEDICAL  PROFESSIONAL  SOCIETIES UTILIZING A TRANSPARENT METHODOLOGY
 AND REPORTING STRUCTURE AND WITH A CONFLICT OF INTEREST POLICY.
   §  3.  Paragraph  1 of subsection (c) of section 4303 of the insurance
 law is amended by adding a new subparagraph (D) to read as follows:
   (D) COVERAGE PROVIDED UNDER THIS  PARAGRAPH  FOR  CARE  AND  TREATMENT
 DURING  PREGNANCY  SHALL INCLUDE MEDICALLY NECESSARY TRANSVAGINAL ULTRA-
 SOUNDS WHEN  RECOMMENDED  BY  NATIONALLY  RECOGNIZED  CLINICAL  PRACTICE
 GUIDELINES.  FOR  THE  PURPOSES OF THIS SUBPARAGRAPH, "NATIONALLY RECOG-
 NIZED CLINICAL PRACTICE GUIDELINES" MEANS EVIDENCE-BASED CLINICAL  PRAC-
 TICE  GUIDELINES  INFORMED  BY  A  SYSTEMATIC  REVIEW OF EVIDENCE AND AN
 ASSESSMENT OF THE  BENEFITS,  AND  RISKS  OF  ALTERNATIVE  CARE  OPTIONS
 INTENDED TO OPTIMIZE PATIENT CARE DEVELOPED BY INDEPENDENT ORGANIZATIONS
 OR  MEDICAL  PROFESSIONAL  SOCIETIES UTILIZING A TRANSPARENT METHODOLOGY
 AND REPORTING STRUCTURE AND WITH A CONFLICT OF INTEREST POLICY.
   § 4. This act shall take effect January 1, 2026 and shall apply to any
 policy or contract issued, renewed, modified, altered, or amended on  or
 after such date.

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Senate Bill S5579A

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Sponsored By

Jessica Scarcella-Spanton

Current Bill Status - In Senate Committee Insurance Committee

Bill Amendments

co-Sponsors

Samra G. Brouk

Julia Salazar

2023-S5579 - Details

2023-S5579 - Summary

2023-S5579 - Sponsor Memo

2023-S5579 - Bill Text download pdf

co-Sponsors

Samra G. Brouk

Julia Salazar

2023-S5579A (ACTIVE) - Details

2023-S5579A (ACTIVE) - Summary

2023-S5579A (ACTIVE) - Sponsor Memo

2023-S5579A (ACTIVE) - Bill Text download pdf

Comments