A.6042.B – Transvaginal Ultrasounds Mandate

This legislation, A.6042-B, would mandate coverage for medically necessary transvaginal ultrasounds during pregnancy when recommended by nationally recognized clinical practice guidelines. While this bill is well intended, the New York Health Plan Association (HPA) opposes the legislation for several reasons.

Health plans have long provided comprehensive services that focus on preventive and primary care, including coverage of prenatal, maternity and postnatal care. As part of comprehensive maternity benefits, New York’s health plans support a variety of screenings and services, including prenatal ultrasounds. Given existing health plan practices, this legislation is unnecessary.

Health plans also support and promote the use of evidence-based best practices, and develop coverage criteria of which modalities are “medically necessary” based on these criteria. As new information becomes available, best practices and clinical criteria change over time. Health plans must be able to use set criteria based on evidence and unique circumstance of the patient to determine the best screening modality. They must also be able to adapt as clinical practices and criteria change. Setting treatment requirements in statute interferes with these processes.

Plans are among the many stakeholders currently working on maternal health and maternal mortality issues, including best practices for pre-natal and post-partum care, and remain committed to advancing quality in maternal health.

For these reasons, HPA opposes A.6042-B.