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S T A T E O F N E W Y O R K
________________________________________________________________________
6561
2025-2026 Regular Sessions
I N A S S E M B L Y
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.