Bill Text: NY A06820 | 2013-2014 | General Assembly | Amended


Bill Title: Requires mandatory health insurance coverage for certain individuals with prosthetic limbs; requires coverage where the model is determined to adequately meet the medical needs of the policy holder.

Spectrum: Slight Partisan Bill (Democrat 31-14)

Status: (Engrossed - Dead) 2014-06-19 - REFERRED TO RULES [A06820 Detail]

Download: New_York-2013-A06820-Amended.html
                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                        6820--C
                              2013-2014 Regular Sessions
                                 I N  A S S E M B L Y
                                    April 19, 2013
                                      ___________
       Introduced  by  M.  of  A.  CRESPO,  MILLER,  GUNTHER,  SCHIMEL, MOSLEY,
         BARRETT, COLTON, COOK, MAGNARELLI, TITONE, DiPIETRO, FINCH, MONTESANO,
         GRAF, DUPREY, RIVERA, HOOPER, CAHILL, ROBINSON, JAFFEE, OTIS, SCARBOR-
         OUGH, SALADINO, CERETTO, RA, LALOR, BENEDETTO,  JOHNS  --  Multi-Spon-
         sored by -- M. of A.  ARROYO, BRENNAN, GIGLIO, HIKIND, JACOBS, KEARNS,
         MARKEY,  McLAUGHLIN,  PALMESANO, PEOPLES-STOKES, PERRY, STEC, SWEENEY,
         THIELE, WEISENBERG -- read once  and  referred  to  the  Committee  on
         Insurance  --  recommitted to the Committee on Insurance in accordance
         with Assembly Rule 3, sec. 2 -- committee  discharged,  bill  amended,
         ordered  reprinted  as  amended  and  recommitted to said committee --
         again reported from said committee with amendments, ordered  reprinted
         as  amended and recommitted to said committee -- reported and referred
         to the Committee on Ways  and  Means  --  committee  discharged,  bill
         amended,  ordered reprinted as amended and recommitted to said commit-
         tee
       AN ACT to amend the insurance  law,  in  relation  to  mandatory  health
         insurance coverage for prosthetic devices
         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 30 to read as follows:
    3    (30)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
    4  COMPREHENSIVE TYPE COVERAGE AND PROVIDES COVERAGE  FOR  DURABLE  MEDICAL
    5  EQUIPMENT  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC  DEVICES  THAT  ARE
    6  INTENDED  FOR  MEDICALLY  NECESSARY  REHABILITATIVE   AND   HABILITATIVE
    7  PURPOSES  AS  REQUIRED  BY  42  U.S.C. S 18022 THAT IS EQUIVALENT TO THE
    8  COVERAGE PROVIDED FOR DURABLE MEDICAL EQUIPMENT.  COVERAGE SHALL NOT  BE
    9  DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC DEVICE
   10  IS THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL NEEDS OF
   11  THE  POLICY  HOLDER.  THE TERM "PROSTHETIC DEVICE" AS USED IN THIS PARA-
   12  GRAPH INCLUDES AN ARTIFICIAL LIMB BUT SHALL NOT  INCLUDE  SHOES  OR  ANY
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD10223-08-4
       A. 6820--C                          2
    1  OTHER  ARTICLE  CONSIDERED  AS  ORDINARY WEARING APPAREL, WHETHER OR NOT
    2  SPECIALLY CONSTRUCTED.  THE TERM "POLICY HOLDER" AS USED IN  THIS  PARA-
    3  GRAPH  SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES IN THE STATE
    4  OF  NEW  YORK AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE RESULTED
    5  FROM AN INJURY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN  THE  ARMED
    6  FORCES.
    7    S 2. Subsection (l) of section 3221 of the insurance law is amended by
    8  adding a new paragraph 19 to read as follows:
    9    (19)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
   10  COMPREHENSIVE TYPE COVERAGE AND PROVIDES COVERAGE  FOR  DURABLE  MEDICAL
   11  EQUIPMENT  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC  DEVICES  THAT  ARE
   12  INTENDED  FOR  MEDICALLY  NECESSARY  REHABILITATIVE   AND   HABILITATIVE
   13  PURPOSES  AS  REQUIRED  BY  42  U.S.C. S 18022 THAT IS EQUIVALENT TO THE
   14  COVERAGE PROVIDED FOR DURABLE MEDICAL EQUIPMENT.  COVERAGE SHALL NOT  BE
   15  DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC DEVICE
   16  IS THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL NEEDS OF
   17  THE  POLICY  HOLDER.  THE TERM "PROSTHETIC DEVICE" AS USED IN THIS PARA-
   18  GRAPH INCLUDES AN ARTIFICIAL LIMB BUT SHALL NOT  INCLUDE  SHOES  OR  ANY
   19  OTHER  ARTICLE  CONSIDERED  AS  ORDINARY WEARING APPAREL, WHETHER OR NOT
   20  SPECIALLY CONSTRUCTED. THE TERM "POLICY HOLDER" AS USED  IN  THIS  PARA-
   21  GRAPH  SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES IN THE STATE
   22  OF NEW YORK AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC  DEVICE  RESULTED
   23  FROM  AN  INJURY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN THE ARMED
   24  FORCES.
   25    S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
   26  subsection (oo) to read as follows:
   27    (OO)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
   28  COMPREHENSIVE TYPE COVERAGE AND PROVIDES COVERAGE  FOR  DURABLE  MEDICAL
   29  EQUIPMENT  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC  DEVICES  THAT  ARE
   30  INTENDED  FOR  MEDICALLY  NECESSARY  REHABILITATIVE   AND   HABILITATIVE
   31  PURPOSES  AS  REQUIRED  BY  42  U.S.C. S 18022 THAT IS EQUIVALENT TO THE
   32  COVERAGE PROVIDED FOR DURABLE MEDICAL EQUIPMENT.  COVERAGE SHALL NOT  BE
   33  DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC DEVICE
   34  IS THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL NEEDS OF
   35  THE  POLICY  HOLDER.    THE  TERM  "PROSTHETIC  DEVICE"  AS USED IN THIS
   36  SUBSECTION INCLUDES AN ARTIFICIAL LIMB BUT SHALL NOT  INCLUDE  SHOES  OR
   37  ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL, WHETHER OR NOT
   38  SPECIALLY  CONSTRUCTED.    THE  TERM  "POLICY  HOLDER"  AS  USED IN THIS
   39  SUBSECTION SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES  IN  THE
   40  STATE  OF  NEW  YORK  AND  WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE
   41  RESULTED FROM AN INJURY SUFFERED IN THE LINE OF DUTY  WHILE  SERVING  IN
   42  THE ARMED FORCES.
   43    S  4.  This  act  shall take effect May 1, 2015 and shall apply to all
   44  policies and contracts issued, renewed, altered, or amended on or  after
   45  such effective date.
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