A10747 — Requires health insurance plans to cover a medically necessary peripheral artery disease screening test for any at-risk individual

Summary

Requires health insurance plans to cover a medically necessary peripheral artery disease screening test for any at-risk individual; prohibits imposition of patient cost sharing for follow-up screenings or diagnostics.

Bill Text

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Compared against the New York Consolidated Laws as published AI-generated reading aid — verify against the official bill.

This bill amends 1 section(s) of the New York Consolidated Laws: Section 3216 of the insurance law.

• Section 3216 of the insurance law

  (42) (A) Every policy which provides medical, major medical, or simi- lar comprehensive-type coverage shall provide medically necessary cover- age for a peripheral artery disease screening test for any at-risk indi- vidual, as defined by the American College of Cardiology and the American Heart Association's joint committee on clinical practice guide- lines. (B) Notwithstanding any other provision of law, any policy that provides coverage required by this paragraph shall not impose patient cost sharing for follow-up screening or diagnostic services for periph- eral artery disease. (C) (i) Nothing in this paragraph shall be construed to prevent medical management or utilization review of the services, including preauthorization, to ensure that such services are consistent with nationally recognized clinical practice guidelines for the detection of peripheral artery disease. (ii) For the purposes of this subparagraph, the term "nationally recognized clinical practice guidelines" means evidence-based, peer reviewed clinical practice guidelines informed by a systematic review of evidence and an assessment of the benefits, and risks of alternative care options intended to optimize patient care developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict of interest policy. (D) If the policy is a high deductible health plan as defined in section 223(c)(2) of the Internal Revenue Code of 1986, such coverage italics may be subject to the plan's annual deductible if application of this requirement would result in ineligibility for a health savings account. (24) (A) Every policy which provides medical, major medical, or simi- lar comprehensive-type coverage shall provide medically necessary cover- age for a peripheral artery disease screening test for any at-risk indi- vidual, as defined by the American College of Cardiology and the American Heart Association's joint committee on clinical practice guide- lines. (B) Notwithstanding any other provision of law, any policy that provides coverage required by this paragraph shall not impose patient cost sharing for follow-up screening or diagnostic services for periph- eral artery disease. (C) (i) Nothing in this paragraph shall be construed to prevent medical management or utilization review of the services, including preauthorization, to ensure that such services are consistent with nationally recognized clinical practice guidelines for the detection of peripheral artery disease. (ii) For the purposes of this subparagraph, the term "nationally recognized clinical practice guidelines" means evidence-based, peer reviewed clinical practice guidelines informed by a systematic review of evidence and an assessment of the benefits, and risks of alternative care options intended to optimize patient care developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict of interest policy. (D) If the policy is a high deductible health plan as defined in section 223(c)(2) of the Internal Revenue Code of 1986, such coverage may be subject to the plan's annual deductible if application of this requirement would result in ineligibility for a health savings account. (yy) (1) Every contract under this section which provides medical, major medical, or similar comprehensive-type coverage shall provide medically necessary coverage for a peripheral artery disease screening test for any at-risk individual, as defined by the American College of Cardiology and the American Heart Association's joint committee on clin- ical practice guidelines. (2) Notwithstanding any other provision of law, any contract under this section that provides coverage required by this subsection shall not impose patient cost sharing for follow-up screening or diagnostic services for peripheral artery disease. (3) (A) Nothing in this subsection shall be construed

  amended

Action History

1. March 27, 2026

   REFERRED TO INSURANCE

Sponsors

• Karines Reyes · Primary

Subjects