Requires health insurance plans to cover a medically necessary peripheral artery disease screening test for any at-risk individual
Summary
This bill would require New York health insurance policies and contracts that provide medical, major medical, or similar comprehensive coverage to cover medically necessary peripheral artery disease (PAD) screening tests for any “at-risk individual,” as defined by clinical guidelines from the American College of Cardiology and the American Heart Association. The mandate applies to individual, group, and nonprofit health plans through amendments to the Insurance Law sections governing those products.
The bill also prohibits patient cost sharing for follow-up screening or diagnostic services related to PAD when coverage is required under the bill. At the same time, it preserves insurer medical management tools, including utilization review and preauthorization, so long as they are used consistently with nationally recognized clinical practice guidelines. For high-deductible health plans, the bill allows the screening coverage to remain subject to the annual deductible if necessary to preserve health savings account eligibility. The bill would take effect January 1, 2027, and would apply to policies and contracts issued, renewed, modified, altered, or amended on or after that date.
Impact
The bill would amend multiple provisions of the New York Insurance Law, including sections 3216, 3221, and 4303, to create a new mandated benefit for PAD screening and related diagnostic follow-up. It would expand required coverage across most comprehensive health insurance products in the state, while carving out an exception for high-deductible health plans where applying the mandate would jeopardize HSA eligibility. Insurers would need to update benefit designs, claims processing, and utilization review practices to comply with the new mandate once effective.
Sentiment
No committee transcript or vote record is available in the provided materials, so there is no documented floor or committee debate to assess. Based on the bill text, the measure appears framed as a preventive-care coverage expansion with guardrails for evidence-based use and insurer management, suggesting a policy approach that balances access and cost control. The absence of recorded opposition or support in the supplied context means the overall sentiment cannot be measured beyond the bill’s stated consumer-health orientation.
Contention
The main policy tension is between expanding access to PAD screening and limiting insurance costs. Supporters would likely emphasize earlier detection and prevention for at-risk patients, while insurers or cost-conscious lawmakers could question the breadth of the mandate, the use of external clinical guidelines to define eligibility, and the requirement to waive cost sharing for follow-up services. The bill addresses some of those concerns by allowing utilization review and by preserving deductible treatment for certain high-deductible plans, but those provisions may still be points of debate.
Requires health insurers to cover colorectal cancer screenings for covered persons aged 33 or over and covered persons under the age of 33 if deemed medically necessary.
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