| Memorandum in Opposition |
| For Immediate Release: March 1, 2024 Re: S.2465 (Persaud)/A.1696 (Hunter) — AN ACT to amend the insurance law and social services law, in relation to requiring certain insurance policies and Medicaid to allow patients a one hundred twenty-day window for additional breast exams when the provider deems another exam is needed. |
This legislation, S.2465/A.1696, would require health plans to cover additional mammograms for persons having a prior history of breast cancer or dense breast tissue, which would be deemed a determination of medical necessity. New York’s health plans support early detection and early treatment of breast cancer — and all cancers. While this bill is well intended, the New York Health Plan Association (HPA) opposes the legislation for several reasons.
Health plans support appropriate use of mammography as a method of detecting breast cancer, and plans cover a variety of mammography methods. However, plans support and promote the use of evidence-based, best practices as it relates to cancer screenings, and develop coverage criteria of which modalities are “medically necessary” based on these best practices. This is aligned with the recently issued FDA rule[1] that requires the inclusion of breast density assessments in mammography reports for all women in the U.S., starting September 10, 2024, which requires mammography facilities to notify patients about the density of their breasts and encourages supplemental screening.
The United States Preventive Services Task Force, an independent, volunteer panel of national experts in disease prevention and evidence-based medicine, is widely recognized for its efforts to develop evidence-based recommendations about clinical preventive services. When questions arise as to coverage of a particular preventive screening, the Affordable Care Act determined only those receiving a rating of “A” or “B” in the current recommendations of the USPSTF should be required. Breast ultrasounds do not meet this standard. According to its latest recommendations for breast cancer screening, “[t]he USPSTF found insufficient evidence to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, MRI, DBT, or other methods in women identified to have dense breasts on an otherwise negative
[1] https://www.federalregister.gov/documents/2023/03/10/2023-04550/mammography-quality-standards-act