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.
