Bill Text: NY A05420 | 2015-2016 | General Assembly | Introduced

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Bill Title: Relates to insurance reimbursement for early intervention services for infants and toddlers with disabilities; provides that insurers and health plans shall not deny claims for such services due to lack of prior approval or out-of- network providers where such services are furnished pursuant to an early intervention individual family service plan.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2016-01-06 - referred to insurance [A05420 Detail]

Download: New_York-2015-A05420-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         5420
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                   February 23, 2015
                                      ___________
       Introduced  by  M.  of  A.  O'DONNELL  --  read once and referred to the
         Committee on Insurance
       AN ACT to amend the public health law and the insurance law, in relation
         to insurance reimbursement for early intervention services for infants
         and toddlers with disabilities
         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section  1.  Subdivision 3 of section 2559 of the public health law is
    2  amended by adding a new paragraph (e) to read as follows:
    3    (E) AN INSURER OR HEALTH PLAN ADMINISTRATOR  SHALL  ACCEPT  THE  EARLY
    4  INTERVENTION  INDIVIDUAL FAMILY SERVICE PLAN AS DOCUMENTATION OF PRE-AU-
    5  THORIZATION AND PRIOR APPROVAL FOR SUCH SERVICES TO AN  ELIGIBLE  CHILD.
    6  ALL  SUCH  SERVICES  SHALL BE CONSIDERED "COVERED SERVICES". A QUALIFIED
    7  PROVIDER OF EARLY INTERVENTION SERVICES, AS  DEFINED  IN  THIS  ARTICLE,
    8  SHALL  NOT  BE  CONSIDERED  AN  OUT-OF-NETWORK  PROVIDER FOR PURPOSES OF
    9  COVERAGE UNDER AN INSURANCE POLICY OR HEALTH INSURANCE PLAN.
   10    S 2. Section 3235-a of the insurance law is amended by  adding  a  new
   11  subsection (e) to read as follows:
   12    (E)  NO  INSURER, INCLUDING A HEALTH MAINTENANCE ORGANIZATION ISSUED A
   13  CERTIFICATE OF AUTHORITY UNDER ARTICLE FORTY-FOUR OF THE  PUBLIC  HEALTH
   14  LAW  AND A CORPORATION ORGANIZED UNDER ARTICLE FORTY-THREE OF THIS CHAP-
   15  TER, SHALL REFUSE TO ACCEPT THE  EARLY  INTERVENTION  INDIVIDUAL  FAMILY
   16  SERVICE  PLAN  AS  DOCUMENTATION OF PRE-AUTHORIZATION AND PRIOR APPROVAL
   17  FOR SUCH SERVICES TO AN ELIGIBLE  CHILD.  ALL  SUCH  SERVICES  SHALL  BE
   18  CONSIDERED  "COVERED  SERVICES".  A  QUALIFIED  PROVIDER OF EARLY INTER-
   19  VENTION SERVICES, AS DEFINED IN THIS ARTICLE, SHALL NOT BE CONSIDERED AN
   20  OUT-OF-NETWORK PROVIDER FOR PURPOSES  OF  COVERAGE  UNDER  AN  INSURANCE
   21  POLICY OR HEALTH INSURANCE PLAN.
   22    S 3. This act shall take effect immediately.
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD07582-01-5