NY State Senate Bill 2025-S3559

Senate Bill S3559

2025-2026 Legislative Session

Allows a notice of dense breast tissue to be determination of medical necessity for coverage of a breast ultrasound

download bill text pdf

Current Bill Status - In Senate Committee Health 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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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 28, 2025	referred to health

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2025-S3559 (ACTIVE) - Details

See Assembly Version of this Bill:: A580
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §2404-c, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2021-2022: S7647, A8814
2023-2024: S2917, A2516

2025-S3559 (ACTIVE) - Summary

Allows a notice of dense breast tissue to be considered a determination of medical necessity for purposes of coverage of breast ultrasounds as recommended by a provider of mammography services.

2025-S3559 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S3559

SPONSOR: CLEARE
 
TITLE OF BILL:

An act to amend the public health law, in relation to allowing a notice
of dense breast tissue to be considered a determination of medical
necessity for coverage of a breast ultrasound

 
PURPOSE OR GENERAL IDEA OF BILL:

To provide that where a patient has received notice that their mammogram
shows that the patient has dense breast tissue, such notice shall be
considered a determination of medical necessity for purposes of coverage
of breast ultrasounds.

 
SUMMARY OF PROVISIONS:

Section one adds a new subdivision 2 to section 2404c of the public
health law to provide that where a provider of mammography services has
provided notice to a patient that their mammogram detected dense breast
tissue, the notice shall be considered a determination of medical neces-

sity for purposes of coverage of breast ultrasounds.

Section two provide the effective date.

 
JUSTIFICATION:

Current New York State Law requires insurance companies to cover the
cost of mammograms. In addition, providers must give notice to a patient
when a mammogram shows that the patient has dense breast tissue. Having
dense breasts can make it more difficult to detect certain forms of
breast cancer, particularly some of the more aggressive forms, through a
mammogram alone. It also puts women at about a twofold risk for develop-
ing cancer as compared to those who do not have dense breasts. Conduct-
ing an ultrasound along with a regular mammogram is essential to improv-
ing cancer detection for women with dense breasts.

Ultrasounds for dense breasts are only covered by insurers if they are
found to be a medical necessity. This legislation amends the Public
Health Law to provide that the notice given by a provider to a patient
that the patient has dense breasts shall be considered a determination
of medical necessity for purposes of coverage of ultrasounds.

Early detection is key to preventing women from developing aggressive
forms of breast cancer and improving survival rates. This legislation
will prevent the unnecessary delay and stress imposed when an insurance
company denies coverage for this critical service. PRIOR

 
LEGISLATIVE

 
PRIOR LEGISLATIVE HISTORY:

A.8814 of 2021 and 2022, referred to insurance / S.7647 reported and
committed to finance.

 
FISCAL IMPLICATIONS:

None.
 
EFFECTIVE DATE:
This act shall take effect immediately.

2025-S3559 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3559
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             January 28, 2025
                                ___________
 
 Introduced   by  Sens.  CLEARE,  ASHBY,  CANZONERI-FITZPATRICK,  COMRIE,
   FERNANDEZ, HOYLMAN-SIGAL, PALUMBO, PARKER -- read  twice  and  ordered
   printed, and when printed to be committed to the Committee on Health
 
 AN  ACT to amend the public health law, in relation to allowing a notice
   of dense breast tissue to be considered  a  determination  of  medical
   necessity for coverage of a breast ultrasound
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 2404-c of the public health law, as added by  chap-
 ter 265 of the laws of 2012, is amended to read as follows:
   §  2404-c. Breast cancer; duty of providers of mammography services to
 notify and inform. 1. Every provider of mammography services shall, if a
 patient's mammogram demonstrates dense breast tissue, provide  notifica-
 tion  to  such  patient  that  shall include, but not be limited to, the
 following information, in any summary of the  mammography  report  sent,
 pursuant  to  the  federal  mammography  quality  standards  act, to the
 patient:
   Your mammogram shows that your breast tissue is  dense.  Dense  breast
 tissue  is very common and is not abnormal. However, dense breast tissue
 can make it harder to find cancer on a mammogram and may also be associ-
 ated with an increased risk of breast cancer.
   This information about the result of your mammogram is given to you to
 raise your awareness. Use this information to talk to your doctor  about
 your  own risks for breast cancer. At that time, ask your doctor if more
 screening tests might be useful, based on your risk. A  report  of  your
 results was sent to your physician.
   For the purposes of this section dense breast tissue shall mean heter-
 ogeneously  dense  or  extremely  dense  tissue as defined in nationally
 recognized guidelines or systems for breast imaging reporting of mammog-
 raphy screening, including, but  not  limited  to,  the  breast  imaging

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02130-01-5
 S. 3559                             2

 
 reporting  and data system of the American College of Radiology, and any
 equivalent new terms, as such guidelines or systems are updated.
   2.  WHERE  A PROVIDER OF MAMMOGRAPHY SERVICES HAS PROVIDED NOTICE TO A
 PATIENT UNDER SUBDIVISION ONE OF  THIS  SECTION,  THE  NOTICE  SHALL  BE
 CONSIDERED A DETERMINATION OF MEDICAL NECESSITY FOR PURPOSES OF COVERAGE
 OF A BREAST ULTRASOUND.
   § 2.  This act shall take effect immediately.

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