S 10480 NY

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Bill No.: Summary Actions Committee&nbspVotes Floor&nbspVotes Memo Text LFIN Chamber&nbspVideo/Transcript S10480 Summary: BILL NO S10480 &nbsp SAME AS No Same As &nbsp SPONSOR SCARCELLA-SPANTON &nbsp COSPNSR &nbsp MLTSPNSR &nbsp Amd §§3216, 3221 & 4303, Ins L &nbsp Provides for mandatory health insurance coverage for coronary artery calcium diagnostic testing upon the recommendation of a health care provider; makes related provisions.

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STATE OF NEW YORK ________________________________________________________________________

10480

IN SENATE

May 15, 2026 ___________

Introduced by Sen. SCARCELLA-SPANTON -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance

AN ACT to amend the insurance law, in relation to mandatory health insurance coverage for coronary artery calcium diagnostic testing

The People of the State of New York, represented in Senate and Assem- bly, do enact as follows:

1 Section 1. Subsection (i) of section 3216 of the insurance law is 2 amended by adding a new paragraph 42 to read as follows: 3 (42) (A) Every policy which provides medical, major medical, or simi- 4 lar comprehensive-type coverage shall provide coverage for coronary 5 artery calcium diagnostic testing upon the recommendation of a health 6 care provider acting within such provider's scope of practice pursuant 7 to title eight of the education law, and as recommended by nationally 8 recognized clinical practice guidelines for the prevention of cardiovas- 9 cular disease. 10 (B) Notwithstanding any other provision of law, any policy that 11 provides coverage required by this paragraph shall not impose patient 12 cost sharing for coronary artery calcium diagnostic testing. 13 (C) For the purposes of this paragraph, the term "nationally recog- 14 nized clinical practice guidelines" shall mean evidence-based, peer 15 reviewed clinical practice guidelines informed by a systematic review of 16 evidence and an assessment of the benefits, and risks of alternative 17 care options intended to optimize patient care developed by independent 18 organizations or medical professional societies utilizing a transparent 19 methodology and reporting structure and with a conflict of interest 20 policy. 21 (D) Nothing in this paragraph shall be construed to prevent medical 22 management or utilization review of the services, including preauthori- 23 zation, to ensure that such services are consistent with nationally 24 recognized clinical practice guidelines for the prevention of cardiovas- 25 cular disease. 26 (E) If the policy is a high deductible health plan as defined in 27 section 223(c)(2) of the Internal Revenue Code of 1986, such coverage

EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD15931-01-6

S. 10480 2

1 may be subject to the plan's annual deductible if application of this 2 requirement would result in ineligibility for a health savings account. 3 § 2. Subsection (l) of section 3221 of the insurance law is amended by 4 adding a new paragraph 24 to read as follows: 5 (24) (A) Every policy which provides medical, major medical, or simi- 6 lar comprehensive-type coverage shall provide coverage for coronary 7 artery calcium diagnostic testing upon the recommendation of a health 8 care provider acting within such provider's scope of practice pursuant 9 to title eight of the education law, and as recommended by nationally 10 recognized clinical practice guidelines for the prevention of cardiovas- 11 cular disease. 12 (B) Notwithstanding any other provision of law, any policy that 13 provides coverage required by this paragraph shall not impose patient 14 cost sharing for coronary artery calcium diagnostic testing. 15 (C) For the purposes of this paragraph, the term "nationally recog- 16 nized clinical practice guidelines" shall mean evidence-based, peer 17 reviewed clinical practice guidelines informed by a systematic review of 18 evidence and an assessment of the benefits, and risks of alternative 19 care options intended to optimize patient care developed by independent 20 organizations or medical professional societies utilizing a transparent 21 methodology and reporting structure and with a conflict of interest 22 policy. 23 (D) Nothing in this paragraph shall be construed to prevent medical 24 management or utilization review of the services, including preauthori- 25 zation, to ensure that such services are consistent with nationally 26 recognized clinical practice guidelines for the prevention of cardiovas- 27 cular disease. 28 (E) If the policy is a high deductible health plan as defined in 29 section 223(c)(2) of the Internal Revenue Code of 1986, such coverage 30 may be subject to the plan's annual deductible if application of this 31 requirement would result in ineligibility for a health savings account. 32 § 3. Section 4303 of the insurance law is amended by adding a new 33 subsection (yy) to read as follows: 34 (yy) (1) Every contract which provides medical, major medical, or 35 similar comprehensive-type coverage shall provide coverage for coronary 36 artery calcium diagnostic testing upon the recommendation of a health 37 care provider acting within such provider's scope of practice pursuant 38 to title eight of the education law, and as recommended by nationally 39 recognized clinical practice guidelines for the prevention of cardiovas- 40 cular disease. 41 (2) Notwithstanding any other provision of law, any contract that 42 provides coverage required by this subsection shall not impose patient 43 cost sharing for coronary artery calcium diagnostic testing. 44 (3) For the purposes of this subsection, the term "nationally recog- 45 nized clinical practice guidelines" shall mean evidence-based, peer 46 reviewed clinical practice guidelines informed by a systematic review of 47 evidence and an assessment of the benefits, and risks of alternative 48 care options intended to optimize patient care developed by independent 49 organizations or medical professional societies utilizing a transparent 50 methodology and reporting structure and with a conflict of interest 51 policy. 52 (4) Nothing in this subsection shall be construed to prevent medical 53 management or utilization review of the services, including preauthori- 54 zation, to ensure that such services are consistent with nationally 55 recognized clinical practice guidelines for the prevention of cardiovas- 56 cular disease.

S. 10480 3

1 (5) If the contract is a high deductible health plan as defined in 2 section 223(c)(2) of the Internal Revenue Code of 1986, such coverage 3 may be subject to the plan's annual deductible if application of this 4 requirement would result in ineligibility for a health savings account. 5 § 4. This act shall take effect January 1, 2027 and shall apply to all 6 policies and contracts issued, renewed, modified, altered or amended on 7 or after such date.

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