Mandated Health Coverage – Detection of Breast Cancer

On June 27, 2016, New York Governor Andrew Cuomo signed legislation (S.B. 8093) relating to coverage for the detection of breast cancer. According to the Governor’s press release, Senate Bill 8093:

  • Requires 210 hospitals and hospital extension clinics to offer extended hours of screening for at least four hours per week to help women who have difficulty scheduling mammograms during the typical 9 a.m. to 5 p.m. workday. These hours include 7 a.m. to 9 a.m. and 5 p.m. to 7 p.m. Monday through Friday, and 9 a.m. to 5 p.m. Saturday or Sunday.
  • Eliminates annual deductibles, co-payments, and co-insurance payments (“cost-sharing”) for all screening mammograms, including those provided to women more frequently than current federal screening guidelines such as annual mammograms for women in their forties.
  • Eliminates cost-sharing for diagnostic imaging for breast cancer, including diagnostic mammograms, breast ultrasounds, and breast MRIs for women at high risk for breast cancer. As a result, women in need of tests other than standard mammograms will not have to pay any additional out-of-pocket expenses for these most common diagnostic tests.
  • Adds public employees of cities with a population of one million or more to the population of public employees in New York State who are currently allowed four hours of leave for screening for breast cancer each year. Current state law requires all public employers to provide their employees with four hours of leave each year for breast cancer screening. Now public employees in New York City will receive the same benefit as all other public employees statewide.

The New York State Department Financial Services will issue a circular letter to set forth insurers’ legal obligations to cover breast cancer screening and treatment. The circular letter reminds insurers that cost sharing for mammography screenings, diagnostic imaging, genetic screening, and medication is prohibited. The letter also provides guidance on the department’s view that insurers must cover certain medically necessary treatments, such as prophylactic mastectomies and reconstruction surgery and prostheses when the BRCA 1 or 2 gene is discovered or for those who have a strong family history of breast cancer. This will help prevent insurance companies from charging women additional out-of-pocket expenses for common screenings and diagnostic tests, and ensure that women are covered for all medically necessary services.

Read NY S.B. 8093
Read the Governor’s Press Release

New York State Human Rights Act

On June 2, 2016, the New York State Division of Human Rights issued new regulations clarifying that the state’s Human Rights Law prohibits discrimination against an individual because of the individual’s known relationship or association with members of a protected class.

Read the Regulations