Bill Text: NY A01619 | 2019-2020 | General Assembly | Introduced


Bill Title: Relates to coverage for eating disorders; requires comparable coverage for adults and children with eating disorders; defines eating disorder.

Spectrum: Moderate Partisan Bill (Democrat 31-8)

Status: (Introduced) 2019-02-11 - reported [A01619 Detail]

Download: New_York-2019-A01619-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                          1619
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                    January 16, 2019
                                       ___________
        Introduced  by  M.  of A. ROZIC, BLAKE, BRONSON, COLTON, CRESPO, D'URSO,
          DE LA ROSA, ENGLEBRIGHT, BARRETT,  FAHY,  FERNANDEZ,  GUNTHER,  ORTIZ,
          L. ROSENTHAL,  D. ROSENTHAL,  RIVERA, SIMON, SOLAGES, ABINANTI, JOHNS,
          RAIA -- Multi-Sponsored by -- M. of A. COOK,  CROUCH,  GALEF,  GIGLIO,
          M. L. MILLER,  NOLAN, RA -- read once and referred to the Committee on
          Insurance
        AN ACT to amend the insurance law, in relation to  coverage  for  eating
          disorders
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Subparagraph (B)  of  paragraph  5  of  subsection  (1)  of
     2  section 3221 of the insurance law, as amended by chapter 502 of the laws
     3  of 2007, is amended to read as follows:
     4    (B)  (i)  Every insurer delivering a group or school blanket policy or
     5  issuing a group or school blanket policy for delivery,  in  this  state,
     6  which  provides  coverage  for  inpatient  hospital care or coverage for
     7  physician services, shall provide comparable  coverage  for  adults  and
     8  children  with  biologically  based  mental illness. Such group policies
     9  issued or delivered in this state shall  also  provide  such  comparable
    10  coverage for children with serious emotional disturbances. Such coverage
    11  shall  be  provided  under the terms and conditions otherwise applicable
    12  under the policy, including network limitations  or  variations,  exclu-
    13  sions,  co-pays, coinsurance, deductibles or other specific cost sharing
    14  mechanisms. Provided further, where a policy  provides  both  in-network
    15  and  out-of-network  benefits,  the  out-of-network  benefits  may  have
    16  different coinsurance, co-pays,  or  deductibles,  than  the  in-network
    17  benefits,  regardless of whether the policy is written under one license
    18  or two licenses.
    19    (ii) For purposes of this  paragraph,  the  term  "biologically  based
    20  mental  illness" means a mental, nervous, or emotional condition that is
    21  caused by a biological disorder of the brain and results in a clinically
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01128-01-9

        A. 1619                             2
     1  significant, psychological syndrome or pattern that substantially limits
     2  the functioning of the person with the illness. Such biologically  based
     3  mental illnesses are defined as schizophrenia/psychotic disorders, major
     4  depression,  bipolar  disorder,  delusional  disorders,  panic disorder,
     5  obsessive compulsive disorders[, bulimia, and  anorexia]  or  an  eating
     6  disorder.
     7    (iii) For purposes of this paragraph, the term "eating disorder" means
     8  pica,  rumination  disorder,  avoidant/restrictive food intake disorder,
     9  anorexia nervosa, bulimia nervosa, binge eating disorder,  other  speci-
    10  fied feeding or eating disorder, and any other eating disorder contained
    11  in  the  most recent version of the Diagnostic and Statistical Manual of
    12  Mental Disorders published by the American Psychiatric Association.
    13    § 2. Paragraph 2 of subsection (g) of section 4303  of  the  insurance
    14  law,  as  amended by chapter 502 of the laws of 2007, is amended to read
    15  as follows:
    16    (2) (A) A hospital service corporation  or  a  health  service  corpo-
    17  ration,  which provides group, group remittance or school blanket cover-
    18  age for inpatient hospital care, shall provide comparable  coverage  for
    19  adults  and children with biologically based mental illness. Such hospi-
    20  tal service corporation or health service corporation shall also provide
    21  such comparable coverage for children with  serious  emotional  disturb-
    22  ances.  Such  coverage  shall be provided under the terms and conditions
    23  otherwise applicable under the contract, including  network  limitations
    24  or  variations,  exclusions,  co-pays, coinsurance, deductibles or other
    25  specific cost sharing mechanisms. Provided  further,  where  a  contract
    26  provides both in-network and out-of-network benefits, the out-of-network
    27  benefits  may  have different coinsurance, co-pays, or deductibles, than
    28  the in-network benefits, regardless of whether the contract  is  written
    29  under one license or two licenses.
    30    (B)  For  purposes  of  this  subsection, the term "biologically based
    31  mental illness" means a mental, nervous, or emotional condition that  is
    32  caused by a biological disorder of the brain and results in a clinically
    33  significant, psychological syndrome or pattern that substantially limits
    34  the  functioning of the person with the illness. Such biologically based
    35  mental illnesses are defined as schizophrenia/psychotic disorders, major
    36  depression, bipolar  disorder,  delusional  disorders,  panic  disorder,
    37  obsessive  compulsive  disorders[,  anorexia,  and bulimia] or an eating
    38  disorder.
    39    (C) For purposes of this subsection, the term "eating disorder"  means
    40  pica,  rumination  disorder,  avoidant/restrictive food intake disorder,
    41  anorexia nervosa, bulimia nervosa, binge eating disorder,  other  speci-
    42  fied feeding or eating disorder, and any other eating disorder contained
    43  in  the  most recent version of the Diagnostic and Statistical Manual of
    44  Mental Disorders published by the American Psychiatric Association.
    45    § 3. Paragraph 2 of subsection (h) of section 4303  of  the  insurance
    46  law,  as  amended by chapter 502 of the laws of 2007, is amended to read
    47  as follows:
    48    (2) (A) A medical expense indemnity corporation or  a  health  service
    49  corporation,  which  provides  group, group remittance or school blanket
    50  coverage for physician services, shall provide comparable  coverage  for
    51  adults and children with biologically based mental illness. Such medical
    52  expense  indemnity  corporation or health service corporation shall also
    53  provide such comparable coverage for  children  with  serious  emotional
    54  disturbances. Such coverage shall be provided under the terms and condi-
    55  tions otherwise applicable under the contract, including network limita-
    56  tions  or  variations,  exclusions, co-pays, coinsurance, deductibles or

        A. 1619                             3
     1  other specific  cost  sharing  mechanisms.  Provided  further,  where  a
     2  contract  provides both in-network and out-of-network benefits, the out-
     3  of-network benefits may have different coinsurance, co-pays, or  deduct-
     4  ibles,  than the in-network benefits, regardless of whether the contract
     5  is written under one license or two licenses.
     6    (B) For purposes of this  subsection,  the  term  "biologically  based
     7  mental  illness" means a mental, nervous, or emotional condition that is
     8  caused by a biological disorder of the brain and results in a clinically
     9  significant, psychological syndrome or pattern that substantially limits
    10  the functioning of the person with the illness. Such biologically  based
    11  mental illnesses are defined as schizophrenia/psychotic disorders, major
    12  depression,  bipolar  disorder,  delusional  disorders,  panic disorder,
    13  obsessive compulsive disorder[, anorexia,  and  bulimia]  or  an  eating
    14  disorder.
    15    (C)  For purposes of this subsection, the term "eating disorder" means
    16  pica, rumination disorder, avoidant/restrictive  food  intake  disorder,
    17  anorexia  nervosa,  bulimia nervosa, binge eating disorder, other speci-
    18  fied feeding or eating disorder, and any other eating disorder contained
    19  in the most recent version of the Diagnostic and Statistical  Manual  of
    20  Mental Disorders published by the American Psychiatric Association.
    21    §  4.  This  act shall take effect on the ninetieth day after it shall
    22  have become a law; provided, however, that the provisions  of  this  act
    23  shall apply to policies and contracts issued, renewed, modified, altered
    24  or amended on or after such effective date.
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