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Bill

A 580

Allows a notice of dense breast tissue to be determination of medical necessity for coverage of a breast ultrasound

2025 Regular Session Introduced by Anil Beephan and 4 co-sponsors

Allows a dense breast tissue notice to qualify as medical necessity for coverage of a breast ultrasound.

REFERRED TO INSURANCE
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WeVote Research Nonpartisan
Bill Summary · A 580

Summary of Bill A 580

Overview

Bill A 580 would allow a notice indicating that a person has dense breast tissue to be treated as a determination of medical necessity for coverage of a breast ultrasound. If enacted, insurers would recognize a dense-breast-tissue notice as a basis for covering breast ultrasound imaging.

Key Provisions

  • Establishes that a notice of dense breast tissue can serve as evidence of medical necessity for coverage of a breast ultrasound.
  • Applies to insurance coverage standards under the bill’s scope (specific provisions on exemptions, copays, or deductibles are not detailed in the information provided).
  • Aims to reduce barriers to ultrasound imaging for individuals with dense breast tissue, potentially enabling earlier or additional evaluation when indicated.

Who Is Affected

  • Individuals who have been issued a notice stating they have dense breast tissue.
  • Health insurers subject to the bill’s requirements (under New York State law).
  • Healthcare providers who order or perform breast ultrasounds.

Legislative Status and Timeline

  • Introduced: January 8, 2025.
  • Status: Referred to the Assembly Insurance Committee, with the Legislative Actions listing the same referral on January 8, 2025.
  • The bill currently has no further committee action listed beyond the referral.
  • Related legislation includes companion and prior-session bills:
    • A 8814 (prior-session)
    • A 2516 (prior-session)
    • S 3559 (companion)

Sponsors

  • Primary sponsor: Amy Paulin
  • Cosponsors: Demond Meeks, Rebecca Seawright, Anil Beephan Jr., Karen McMahon

Potential Impact

  • Access and coverage: Could improve access to diagnostic breast ultrasound for individuals with dense breasts by providing a clear pathway for medical-necessity coverage based on a dense-tissue notice.
  • Detection and care: May support earlier detection or additional evaluation, particularly for women with dense breast tissue who are at higher risk or who require supplemental imaging.
  • Administrative considerations: Insurers would need to recognize the dense-breast-tissue notice as sufficient for coverage decisions; potential administrative changes in processing claims and notices.

Note: The information provided here reflects the bill text and actions available, and does not reflect final passage or potential amendments.

Compiled from official sources — confirm details with the bill’s official record.

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