Bill Text: NY A08851 | 2011-2012 | General Assembly | Introduced

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Bill Title: Relates to insurance coverage of early intervention services.

Spectrum: Partisan Bill (Democrat 25-1)

Status: (Introduced - Dead) 2012-01-04 - referred to insurance [A08851 Detail]

Download: New_York-2011-A08851-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         8851
                                 I N  A S S E M B L Y
                                      (PREFILED)
                                    January 4, 2012
                                      ___________
       Introduced  by  M.  of  A. PAULIN, McENENY, BRENNAN, WEISENBERG, COLTON,
         REILLY, CAHILL, ABINANTI, JAFFEE, GALEF, P. RIVERA,  PRETLOW,  WEPRIN,
         ORTIZ,  J. RIVERA,  HOOPER,  GOODELL -- Multi-Sponsored by -- M. of A.
         ENGLEBRIGHT, GOTTFRIED, MILLMAN, ROBERTS,  TITONE  --  read  once  and
         referred to the Committee on Insurance
       AN  ACT  to  amend  the  insurance law, in relation to coverage of early
         intervention services
         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section  1.  Subsection (a) of section 3235-a of the insurance law, as
    2  added by section 3 of part C of chapter  1  of  the  laws  of  2002,  is
    3  amended  and  two  new  subsections  (f)  and  (g)  are added to read as
    4  follows:
    5    (a) No policy of accident and health  insurance,  including  contracts
    6  issued  pursuant  to  article forty-three of this chapter, shall exclude
    7  coverage for otherwise covered services [solely on the  basis  that  the
    8  services  constitute  early  intervention  program  services]  THAT  ARE
    9  PROVIDED under title two-A of article twenty-five of the  public  health
   10  law.
   11    (F)  WHERE  A  SERVICE  PROVIDED  TO AN INSURED UNDER THE EARLY INTER-
   12  VENTION PROGRAM IS A COVERED  SERVICE  UNDER  THE  INSURER'S  POLICY  OR
   13  CONTRACT, THE INDIVIDUALIZED FAMILY SERVICES PLAN, UPON CERTIFICATION BY
   14  THE  EARLY  INTERVENTION  OFFICIAL,  AS  DEFINED  IN SECTION TWENTY-FIVE
   15  HUNDRED FORTY-ONE OF THE PUBLIC HEALTH LAW, OR SUCH OFFICIAL'S DESIGNEE,
   16  SHALL BE DEEMED TO  MEET  ANY  PRECERTIFICATION,  PREAUTHORIZATION,  AND
   17  MEDICAL  NECESSITY  REQUIREMENTS IMPOSED ON BENEFITS UNDER THE POLICY OR
   18  CONTRACT; PROVIDED, HOWEVER, THAT THE EARLY INTERVENTION OFFICIAL  SHALL
   19  REMOVE  OR REDACT ANY INFORMATION CONTAINED IN THE INSURED'S INDIVIDUAL-
   20  IZED FAMILY SERVICES PLAN THAT  IS  NOT  REQUIRED  BY  THE  INSURER  FOR
   21  PAYMENT  PURPOSES.  PAYMENT  FOR  A  SERVICE COVERED UNDER THE POLICY OR
   22  CONTRACT THAT IS PROVIDED UNDER THE EARLY INTERVENTION PROGRAM SHALL  BE
   23  AT  RATES  ESTABLISHED  BY  THE  COMMISSIONER OF HEALTH FOR SUCH SERVICE
   24  PURSUANT TO REGULATIONS.
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD13676-02-2
       A. 8851                             2
    1    (G) NO INSURER, INCLUDING A HEALTH MAINTENANCE ORGANIZATION  ISSUED  A
    2  CERTIFICATE  OF  AUTHORITY UNDER ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
    3  LAW AND A CORPORATION ORGANIZED UNDER ARTICLE FORTY-THREE OF THIS  CHAP-
    4  TER,  SHALL  DENY  PAYMENT  OF  AN EARLY INTERVENTION CLAIM BASED ON THE
    5  FOLLOWING:
    6    (1) THE LOCATION WHERE SERVICES ARE PROVIDED;
    7    (2)  THE  DURATION  OF  THE  CHILD'S CONDITION AND/OR THAT THE CHILD'S
    8  CONDITION IS NOT AMENABLE TO SIGNIFICANT IMPROVEMENT  WITHIN  A  CERTAIN
    9  PERIOD OF TIME AS SPECIFIED IN THE POLICY; OR
   10    (3)  THAT  THE  PROVIDER OF SERVICES IS NOT A NETWORK OR PARTICIPATING
   11  PROVIDER.
   12    S 2. This act shall take effect immediately.