New York Provides Coverage for Prostate Screening

On December 21, 2000, Governor Pataki of New York signed legislation requiring health insurance coverage for routine prostate screening.  Both DRE and PSA are provided for.  The provisions become effective January 1, 2001.

New York joins Texas, New Jersey, and Alaska as states providing coverage for routine prostate cancer screening.

The text of the bill is followed by the bill summary and voting record.

Text of New York State Bill A05037

S T A T E  O F  N E W  Y O R K

1999-2000 Regular Sessions

I N  A S S E M B L Y

February 22, 1999
___________
  
Introduced  by  M.  of  A.  DiNAPOLI,  HARENBERG,  HOCHBERG, WEISENBERG, COLMAN, PERRY, SWEENEY -- Multi-Sponsored  by  --  M.  of  A.  ABBATE, D. BUTLER,  CARROZZA,  COLTON, CONNELLY, CYMBROWITZ, ESPAILLAT, GALEF, GLICK, HILL, JOHN, LOPEZ,  MATUSOW,  MAZZARELLI,  PHEFFER,  SEMINERIO, SIDIKMAN,  SMITH,  WEINSTEIN,  WRIGHT -- read once and referred to the Committee on Insurance  
  
AN ACT to amend the insurance law, in relation to providing  for  health
insurance coverage for diagnostic screening for prostate cancer
  
THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:  
  
  1  Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
  2  amended by adding a new paragraph 11-a to read as follows:  
  3  (11-A) (A) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
  4  WHICH  PROVIDES  MEDICAL  COVERAGE  THAT INCLUDES COVERAGE FOR PHYSICIAN
  5  SERVICES IN A PHYSICIAN`S OFFICE AND EVERY POLICY WHICH  PROVIDES  MAJOR
  6  MEDICAL  OR  SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE, UPON THE
  7  PRESCRIPTION OF A HEALTH CARE PROVIDER LEGALLY AUTHORIZED  TO  PRESCRIBE
  8  UNDER TITLE EIGHT OF THE EDUCATION LAW, THE FOLLOWING COVERAGE FOR DIAG-
  9  NOSTIC SCREENING FOR PROSTATIC CANCER:  
  10  (I)  STANDARD  DIAGNOSTIC  TESTING  INCLUDING,  BUT  NOT LIMITED TO, A
  11  DIGITAL RECTAL EXAMINATION AND A PROSTATE-SPECIFIC ANTIGEN TEST  AT  ANY
  12  AGE FOR MEN HAVING A PRIOR HISTORY OF PROSTATE CANCER; AND  
  13  (II)  AN  ANNUAL  STANDARD  DIAGNOSTIC  EXAMINATION INCLUDING, BUT NOT
  14  LIMITED TO, A DIGITAL RECTAL EXAMINATION AND A PROSTATE-SPECIFIC ANTIGEN
  15  TEST FOR MEN AGE FIFTY AND OVER WHO ARE ASYMPTOMATIC  AND  FOR  MEN  AGE
  16  FORTY  AND  OVER  WITH  A  FAMILY  HISTORY  OF  PROSTATE CANCER OR OTHER
  17  PROSTATE CANCER RISK FACTORS.  
  18  (B) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE
  19  AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT
  20  WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.  
  
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets { } is old law to be omitted.
LBD01500-01-9
  
A. 5037  2
  
  1  S 2. Subsection (l) of section 3221 of the insurance law is amended by
  2  adding a new paragraph 11-a to read as follows:  
  3  (11-A) (A) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
  4  WHICH  PROVIDES  MEDICAL  COVERAGE  THAT INCLUDES COVERAGE FOR PHYSICIAN
  5  SERVICES IN A PHYSICIAN`S OFFICE AND EVERY POLICY WHICH  PROVIDES  MAJOR
  6  MEDICAL  OR  SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE, UPON THE
  7  PRESCRIPTION OF A HEALTH CARE PROVIDER LEGALLY AUTHORIZED  TO  PRESCRIBE
  8  UNDER TITLE EIGHT OF THE EDUCATION LAW, THE FOLLOWING COVERAGE FOR DIAG-
  9  NOSTIC SCREENING FOR PROSTATIC CANCER:  
  10  (I)  STANDARD  DIAGNOSTIC  TESTING  INCLUDING,  BUT  NOT LIMITED TO, A
  11  DIGITAL RECTAL EXAMINATION AND A PROSTATE-SPECIFIC ANTIGEN TEST  AT  ANY
  12  AGE FOR MEN HAVING A PRIOR HISTORY OF PROSTATE CANCER; AND  
  13  (II)  AN  ANNUAL  STANDARD  DIAGNOSTIC  EXAMINATION INCLUDING, BUT NOT
  14  LIMITED TO, A DIGITAL RECTAL EXAMINATION AND A PROSTATE-SPECIFIC ANTIGEN
  15  TEST FOR MEN AGE FIFTY AND OVER WHO ARE ASYMPTOMATIC  AND  FOR  MEN  AGE
  16  FORTY  AND  OVER  WITH  A  FAMILY  HISTORY  OF  PROSTATE CANCER OR OTHER
  17  PROSTATE CANCER RISK FACTORS.  
  18  (B) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE
  19  AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT
  20  WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.  
  21  S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
  22  subsection (z-1) to read as follows:  
  23  (Z-1)  (1) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
  24  WHICH PROVIDES MEDICAL COVERAGE THAT  INCLUDES  COVERAGE  FOR  PHYSICIAN
  25  SERVICES  IN  A PHYSICIAN`S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR
  26  MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE,  UPON  THE
  27  PRESCRIPTION  OF  A HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE
  28  UNDER TITLE EIGHT OF THE EDUCATION LAW, THE FOLLOWING COVERAGE FOR DIAG-
  29  NOSTIC SCREENING FOR PROSTATIC CANCER:  
  30  (A) STANDARD DIAGNOSTIC TESTING  INCLUDING,  BUT  NOT  LIMITED  TO,  A
  31  DIGITAL  RECTAL  EXAMINATION AND A PROSTATE-SPECIFIC ANTIGEN TEST AT ANY
  32  AGE FOR MEN HAVING A PRIOR HISTORY OF PROSTATE CANCER; AND  
  33  (B) AN ANNUAL  STANDARD  DIAGNOSTIC  EXAMINATION  INCLUDING,  BUT  NOT
  34  LIMITED TO, A DIGITAL RECTAL EXAMINATION AND A PROSTATE-SPECIFIC ANTIGEN
  35  TEST  FOR  MEN  AGE  FIFTY AND OVER WHO ARE ASYMPTOMATIC AND FOR MEN AGE
  36  FORTY AND OVER WITH  A  FAMILY  HISTORY  OF  PROSTATE  CANCER  OR  OTHER
  37  PROSTATE CANCER RISK FACTORS.  
  38  (2) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE
  39  AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT
  40  WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.  
  41  S  4.  This  act  shall  take  effect on the first day of January next
  42  succeeding the date on which it shall have become a law.
  
.SO DOC A 5037  *END*  BTXT  1999  

Summary of A 5037

Summary of Bill A05037
BILL NO  A05037  
  
SPONSOR  DiNapoli  
  
COSPNSR  Harenberg, Hochberg, Weisenberg, Colman, Perry, Sweeney  
  
MLTSPNSR  Abbate, Butler D, Carrozza, Cohen M, Colton, Connelly, Cymbrowitz, Espaillat, Galef, Glick, Hill Hooper, John, Lopez, Matusow, Mazzarelli, McEneny, Pheffer, Seminerio, Sidikman, Smith, Weinstein, Wright  
  
Amd SS3216, 3221 & 4303, Ins L  
Requires health insurance contracts and policies to include coverage for prostrate cancer screening.  

Actions on Bill A05037
BILL NO  A05037  
  
02/22/1999referred to insurance  
03/30/1999reported referred to ways and means  
04/20/1999reported  
04/22/1999advanced to third reading cal.320  
04/26/1999passed assembly  
04/26/1999delivered to senate  
04/26/1999REFERRED TO INSURANCE  
01/05/2000DIED IN SENATE  
01/05/2000RETURNED TO ASSEMBLY  
01/05/2000committed to rules  
04/17/2000rules report cal.424  
04/17/2000ordered to third reading rules cal.424  
04/17/2000passed assembly  
04/17/2000delivered to senate  
04/17/2000REFERRED TO INSURANCE  
06/22/2000SUBSTITUTED FOR S976  
06/22/20003RD READING CAL.1715  
06/22/2000PASSED SENATE  
06/22/2000RETURNED TO ASSEMBLY  
12/08/2000delivered to governor  

Votes on Bill A05037
BILL: A05037  DATE: 04/17/2000  MOTION:  YEA/NAY: 144/000 
  
Abbate  Y  Christe Y  Espaill Y  Hill Ho Y  Mazzare Y  Ravitz  Y  Tocci  Y  
Acampor Y  Clark  ER Eve  Y  Hochber Y  McEneny Y  Rhodd-C Y  Tokasz  Y  
Alfano  Y  Cohe A  Y  Farrell Y  Hoyt  Y  McLaugh Y  Rivera  Y  Tonko  Y  
Arroyo  Y  Cohe M  Y  Faso  Y  Jacobs  Y  Miller  Y  Robach  Y  Towns  Y  
Aubry  Y  Colman  Y  Ferrara Y  John  Y  Millman Y  Sanders Y  Townsen Y  
Bacalle Y  Colton  Y  Finch  Y  Kaufman Y  Mills  Y  Scarbor Y  Vann  Y  
Barraga Y  Connell Y  Flanaga Y  Kirwan  Y  Morelle Y  Schimmi Y  Vitalia Y  
Bea  Y  Conte  Y  Galef  Y  Klein  Y  Murray  Y  Scozzaf Y  Warner  Y  
Boyland Y  Cook  Y  Gantt  ER Kolb  Y  Nesbitt Y  Seaman  Y  Weinste Y  
Boyle  Y  Crouch  Y  Glick  Y  Koon  Y  Nolan  Y  Seddio  ER Weisenb Y  
Bragman Y  Cymbrow Y  Gottfri Y  Labriol Y  Norman  Y  Seminer Y  Weprin  Y  
Brennan Y  Daly  Y  Grannis Y  Lafayet Y  Nortz  Y  Sidikma Y  Wertz  Y  
Brodsky Y  D`Andre Y  Green  Y  Lentol  Y  Oaks  Y  Smith  Y  Winner  Y  
Brown  Y  Darcy  Y  Greene  ER Little  Y  O`Conne Y  Spano  Y  Wirth  Y  
Burling Y  Davis  Y  Griffit Y  Lopez  Y  Ortiz  Y  Stephen Y  Wright  Y  
Butl DJ Y  Denis  Y  Gromack Y  Luster  Y  Ortloff Y  Stranie Y  Young  Y  
Butl MW Y  Destito Y  Gunther Y  Magee  Y  Parment Y  Stringe Y  Mr Spkr Y  
Cahill  Y  Diaz  Y  Harenbe Y  Magnare Y  Perry  Y  Sull EC Y  
Calhoun Y  DiNapol Y  Hayes  Y  Manning Y  Pheffer Y  Sull F  Y  
Canestr Y  Dinga  Y  Herbst  Y  Markey  Y  Prentis Y  Sweeney Y  
Carrozz Y  Dinowit Y  Higgins Y  Matusow Y  Pretlow Y  Tedisco Y  
Casale  Y  Englebr Y  Hikind  ER Mayerso Y  Ramirez Y  Thiele  Y  

Memo on Bill A05037
BILL NUMBER: A5037  
  
PURPOSE OF BILL:  By requiring health insurance contracts and policies to  include  cancer  screening men would be encouraged to have regular annual screenings for the early detection of this disease.  
  
SUMMARY OF SPECIFIC PROVISIONS:  Sections 3216, 3221 and 4303  of  the Insurance  Law  are  amended to require health insurance contracts and policies to cover prostate cancer screening for:  
  
-- any male with a prior history of prostate cancer; and  
  
-- males aged fifty and over who are asymptomatic and males aged forty and over with a family history of prostate cancer  or  other  prostate cancer risk factors on an annual basis.  
  
JUSTIFICATION:  
Prostate  cancer  is  the  second  most  common  type  of cancer among American men, after skin cancer.  It is second only to lung cancer  as a  cause  of  death  in  men over the age of 50. By 1992, the American Cancer Society (ACS)  estimated  there  would  be  132,000  new  cases diagnosed  in the United States with approximately 34,000 resulting in death.  
  
As our population ages, the incidence of prostate cancer  is  expected to  increase  significantly.  The  risk  of developing prostate cancer greatly increases with age with 80% of diagnosed cases being men  over the age of 65. For reasons not currently known, African-Americans have the highest incidence rate in the world.  
  
Due  to  the  current  inability  to  prevent  prostate  cancer, early detection offers the most practical method of reducing  morbidity  and mortality.  Every  male  aged 50 and over and every male aged 40 and over with a family history of prostate cancer or  other  risk  factors should have a digital rectal examination as part of his regular annual physical  checkup.  Almost all prostate cancers begin in a part of the prostate that can be palpated by such  examination.  The  current  ACS recommendation is that diagnostic testing be done with the DRE.  
  
Standard  health insurance coverage for diagnostic screenings will not only induce more  men  to  regularly  scheduled  checkups,  but  early detection  and  treatment  in  the  short  run will undoubtedly reduce medical costs associated with latent discovery.  
  
PRIOR LEGISLATIVE HISTORY:  
1992: A.1183  - Referred to Insurance.  
1994: A.517A  - Referred to Insurance.  
1996: A.5886  - Referred to Insurance.  
1998: A.4678-B  - Passed Assembly.  
  
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENT:  Minimal insurance premium increase for State health insurance plan.  
  
EFFECTIVE DATE:  The first day of January next succeeding the date on which it shall have become law.  

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