NY State Senate Bill 2025-S2395

Senate Bill S2395

2025-2026 Legislative Session

Requires health insurance coverage for mammography by either mammogram and breast ultrasound or breast tomosynthesis for persons with certain breast densities

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
Jan 17, 2025	referred to insurance

2025-S2395 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L

2025-S2395 (ACTIVE) - Summary

Requires health insurance coverage for mammography by either mammogram and breast ultrasound or breast tomosynthesis for persons with heterogeneously dense or extremely dense breasts.

2025-S2395 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S2395

SPONSOR: PERSAUD
 
TITLE OF BILL:

An act to amend the insurance law, in relation to requiring health
insurance coverage for mammography by either mammogram and breast ultra-
sound or breast tomosynthesis for persons with certain breast densities

 
PURPOSE OR GENERAL IDEA OF BILL:

This bill requires expanded health insurance coverage for mammography by
either mammogram and breast ultra-sound or breast tomosynthesis for
persons with certain breast densities.

 
SUMMARY OF PROVISIONS:

Section one, section two, section three, section four, section five, and
section six amend the insurance law to add an annual mammogram and
breast ultrasound; or breast tomosynthesis for covered persons with
heterogeneously dense or extremely dense breasts.

Section seven sets forth the effective date.

 
JUSTIFICATION:

Patients with heterogeneously dense or extremely dense breasts have a
higher risk of developing breast cancer compared to women with fatty
breasts. Due to the increased risk for these patients, annual screening
is necessary to ensure early detection. However, it can be more diffi-
cult to detect cancer in dense and extremely dense breasts from a stand-
ard mammogram. According to Yale Cancer Center, standard mammography can
have an accuracy of 98% when detecting cancer in fatty breast tissue,
however, this number can drop to as low as 30% for patients with
extremely dense breasts. Therefore, patients with dense breasts should
have access to co-imaging with mammogram and ultrasound or breast tomo-
synthesis. Breast tomosynthesis is a technologically advanced mammogram
that is much more effective at detecting cancer in patients with dense
and extremely dense breasts, with studies continuously showing breast
tomosynthesis significantly increasing cancer detection rates for women
with dense breasts.  Additionally, a mammogram paired with an ultrasound
is more effective at detecting breast cancer than a mammogram alone for
patients with dense breasts due to its more detailed imaging. This
legislation would ensure patients with dense and extremely dense breasts
have increased access to breast cancer detection services, covered by
health insurance, that could potentially save lives.

 
PRIOR LEGISLATIVE HISTORY:

None.

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

None.

 
EFFECTIVE DATE:
This act shall take effect on the sixtieth day after it shall have
become a law.

2025-S2395 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2395
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             January 17, 2025
                                ___________
 
 Introduced  by  Sen. PERSAUD -- 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  health
   insurance  coverage  for  mammography  by  either mammogram and breast
   ultrasound or breast tomosynthesis for  persons  with  certain  breast
   densities

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (A) of  paragraph  11  of  subsection  (i)  of
 section 3216 of the insurance law, as amended by chapter 414 of the laws
 of 2017, is amended to read as follows:
   (A)  Every  policy  that  provides  coverage for hospital, surgical or
 medical care  shall  provide  the  following  coverage  for  mammography
 screening for occult breast cancer:
   (i)  upon the recommendation of a physician, a mammogram, which may be
 provided by breast tomosynthesis, 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, which  may  be  provided  by  breast
 tomosynthesis, for covered persons aged thirty-five through thirty-nine,
 inclusive; [and]
   (iii) an annual mammogram, which may be provided by breast tomosynthe-
 sis, for covered persons aged forty and older; AND
   (IV)  EITHER:  A.  AN  ANNUAL  MAMMOGRAM  AND BREAST ULTRASOUND; OR B.
 BREAST TOMOSYNTHESIS FOR COVERED PERSONS WITH HETEROGENEOUSLY  DENSE  OR
 EXTREMELY DENSE BREASTS.
   §  2.  Subparagraph  (A)  of paragraph 11 of subsection (i) of section
 3216 of the insurance law, as amended by chapter  424  of  the  laws  of
 2024, is amended to read as follows:
   (A)  Every  policy  that  provides  coverage for hospital, surgical or
 medical care  shall  provide  the  following  coverage  for  mammography
 screening for occult breast cancer:
   (i)  upon the recommendation of a physician, a mammogram, which may be
 provided by breast tomosynthesis, at any age for covered persons  having

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD06157-01-5
 S. 2395                             2
 
 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,  which may be provided by breast
 tomosynthesis, for covered persons aged thirty-five through thirty-nine,
 inclusive;
   (iii) an annual mammogram, which may be provided by breast tomosynthe-
 sis, for covered persons aged forty and older; [and]
   (iv) upon the recommendation of a physician, screening and  diagnostic
 imaging, including diagnostic mammograms, breast ultrasounds, or magnet-
 ic  resonance  imaging,  recommended  by  nationally recognized clinical
 practice guidelines for the detection of breast cancer. For the purposes
 of this item, "nationally recognized clinical practice guidelines" means
 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; AND
   (V) EITHER: A. AN ANNUAL MAMMOGRAM AND BREAST ULTRASOUND; OR B. BREAST
 TOMOSYNTHESIS FOR COVERED PERSONS WITH HETEROGENEOUSLY DENSE OR EXTREME-
 LY DENSE BREASTS.
   §  3.  Subparagraph  (A)  of paragraph 11 of subsection (l) of section
 3221 of the insurance law, as amended by chapter  143  of  the  laws  of
 2019, is 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 screening for occult breast cancer:
   (i) upon the recommendation of a physician, a mammogram, which may  be
 provided  by breast tomosynthesis, 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,  which may be provided by breast
 tomosynthesis, for covered persons aged thirty-five through thirty-nine,
 inclusive;
   (iii) an annual mammogram, which may be provided by breast tomosynthe-
 sis, for covered persons aged forty and older; [and]
   (iv) for large group policies  that  provide  coverage  for  hospital,
 surgical  or  medical care, an annual mammogram for covered persons aged
 thirty-five through thirty-nine, inclusive, upon the recommendation of a
 physician, subject to the insurer's determination that the mammogram  is
 medically necessary; AND
   (V) EITHER: A. AN ANNUAL MAMMOGRAM AND BREAST ULTRASOUND; OR B. BREAST
 TOMOSYNTHESIS FOR COVERED PERSONS WITH HETEROGENEOUSLY DENSE OR EXTREME-
 LY DENSE BREASTS.
   §  4.  Subparagraph  (A)  of paragraph 11 of subsection (l) of section
 3221 of the insurance law, as amended by chapter  424  of  the  laws  of
 2024, is 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 screening for occult breast cancer:
   (i) upon the recommendation of a physician, a mammogram, which may  be
 provided  by breast tomosynthesis, 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;
 S. 2395                             3
 
   (ii)  a  single  baseline  mammogram,  which may be provided by breast
 tomosynthesis, for covered persons aged thirty-five through thirty-nine,
 inclusive;
   (iii) an annual mammogram, which may be provided by breast tomosynthe-
 sis, for covered persons aged forty and older;
   (iv)  for  large  group  policies  that provide coverage for hospital,
 surgical or medical care, an annual mammogram for covered  persons  aged
 thirty-five through thirty-nine, inclusive, upon the recommendation of a
 physician,  subject to the insurer's determination that the mammogram is
 medically necessary; [and]
   (v) upon the recommendation of a physician, screening  and  diagnostic
 imaging, including diagnostic mammograms, breast ultrasounds, or magnet-
 ic  resonance  imaging,  recommended  by  nationally recognized clinical
 practice guidelines for the detection of breast cancer. For the purposes
 of this item, "nationally recognized clinical practice guidelines" means
 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; AND
   (VI)  EITHER:  A.  AN  ANNUAL  MAMMOGRAM  AND BREAST ULTRASOUND; OR B.
 BREAST TOMOSYNTHESIS FOR COVERED PERSONS WITH HETEROGENEOUSLY  DENSE  OR
 EXTREMELY DENSE BREASTS.
   §  5.  Paragraph  1 of subsection (p) of section 4303 of the insurance
 law, as amended by chapter 219 of the laws of 2011, subparagraph (A)  as
 amended  by chapter 414 of the laws of 2017, and subparagraphs (B), (C),
 (D), and (E) as amended by chapter 143 of the laws of 2019,  is  amended
 to read as follows:
   (1) A medical expense indemnity corporation, a hospital service corpo-
 ration or a health service corporation that provides coverage for hospi-
 tal,  surgical  or medical care shall provide the following coverage for
 mammography screening for occult breast cancer:
   (A) upon the recommendation of a physician, a mammogram, which may  be
 provided  by breast tomosynthesis, 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, which may be provided by breast tomo-
 synthesis,  for  covered  persons  aged thirty-five through thirty-nine,
 inclusive;
   (C) an annual mammogram, which may be provided by breast tomosythesis,
 for covered persons aged forty and older;
   (D) for large group contracts offered by a medical  expense  indemnity
 corporation,  a  hospital service corporation or a health service corpo-
 ration that provide coverage for hospital, surgical or medical care,  an
 annual  mammogram  for  covered persons aged thirty-five through thirty-
 nine, inclusive, upon the recommendation of a physician, subject to  the
 corporation's  determination  that the mammogram is medically necessary;
 and
   (E) EITHER: (I) AN ANNUAL MAMMOGRAM AND  BREAST  ULTRASOUND;  OR  (II)
 BREAST  TOMOSYNTHESIS  FOR COVERED PERSONS WITH HETEROGENEOUSLY DENSE OR
 EXTREMELY DENSE BREASTS.
   (F) The coverage required in this paragraph or paragraph two  of  this
 subsection shall not be subject to annual deductibles or coinsurance.
 S. 2395                             4
 
   §  6.  Paragraph  1 of subsection (p) of section 4303 of the insurance
 law, as amended by chapter 424 of the laws of 2024, is amended  to  read
 as follows:
   (1) A medical expense indemnity corporation, a hospital service corpo-
 ration or a health service corporation that provides coverage for hospi-
 tal,  surgical  or medical care shall provide the following coverage for
 mammography screening for occult breast cancer:
   (A) upon the recommendation of a physician, a mammogram, which may  be
 provided  by breast tomosynthesis, 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, which may be provided by breast tomo-
 synthesis,  for  covered  persons  aged thirty-five through thirty-nine,
 inclusive;
   (C) an annual mammogram, which may be provided by breast tomosythesis,
 for covered persons aged forty and older;
   (D) for large group contracts offered by a medical  expense  indemnity
 corporation,  a  hospital service corporation or a health service corpo-
 ration that provide coverage for hospital, surgical or medical care,  an
 annual  mammogram  for  covered persons aged thirty-five through thirty-
 nine, inclusive, upon the recommendation of a physician, subject to  the
 corporation's determination that the mammogram is medically necessary;
   (E)  upon  the recommendation of a physician, screening and diagnostic
 imaging, including diagnostic mammograms, breast ultrasounds, or magnet-
 ic resonance imaging,  recommended  by  nationally  recognized  clinical
 practice guidelines for the detection of breast cancer. For the purposes
 of  this  subparagraph,  "nationally recognized clinical practice guide-
 lines" means 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; and
   (F) EITHER: (I) AN ANNUAL MAMMOGRAM AND  BREAST  ULTRASOUND;  OR  (II)
 BREAST  TOMOSYNTHESIS  FOR COVERED PERSONS WITH HETEROGENEOUSLY DENSE OR
 EXTREMELY DENSE BREASTS.
   (G) The coverage required in this paragraph or paragraph two  of  this
 subsection shall not be subject to annual deductibles or coinsurance. If
 under  federal  law,  application  of  this  requirement would result in
 health savings account ineligibility under 26 USC 223, this  requirement
 shall  apply for health savings account-qualified high deductible health
 plans with respect to the deductible of such a plan after  the  enrollee
 has  satisfied  the minimum deductible under 26 USC 223, except for with
 respect to items or services that are preventive care pursuant to 26 USC
 223(c)(2)(C), in which case the requirements  of  this  paragraph  shall
 apply  regardless of whether the minimum deductible under 26 USC 223 has
 been satisfied.
   § 7. This act shall take effect on the sixtieth  day  after  it  shall
 have  become a law and shall apply to all policies and contracts issued,
 renewed, modified, altered or amended on or after such  date;  provided,
 however,  sections  two,  four, and six of this act shall take effect on
 the same date and in the same manner as sections 1, 3 and 5, respective-
 ly, of chapter 424 of the laws of 2024, takes effect.

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