Bill Text: NY S00704 | 2017-2018 | General Assembly | Amended
Bill Title: Requires mandatory health insurance coverage for prosthetic devices; requires coverage where the model is determined to be medically necessary for rehabilitative and habilitative purposes.
Spectrum: Slight Partisan Bill (Democrat 2-1)
Status: (Engrossed - Dead) 2018-01-19 - PRINT NUMBER 704A [S00704 Detail]
Download: New_York-2017-S00704-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 704--A 2017-2018 Regular Sessions IN SENATE January 4, 2017 ___________ Introduced by Sens. ORTT, CARLUCCI, HAMILTON -- read twice and ordered printed, and when printed to be committed to the Committee on Insur- ance -- recommitted to the Committee on Insurance in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to mandatory health insurance coverage for providing 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 34 to read as follows: 3 (34) Every policy which provides medical, major medical, or similar 4 comprehensive type coverage to a policyholder shall provide coverage for 5 prosthetic devices that are intended for medially necessary rehabilita- 6 tive and habilitative purposes as required by 42 U.S.C. § 18022. Cover- 7 age shall include the cost of repair or replacement of prosthetic 8 devices due to normal wear and tear, if a prosthetic device has been 9 outgrown or no longer fits properly, or where a change in the medical 10 condition makes replacement necessary. Coverage shall not include the 11 costs of repair or replacement of a prosthetic device that is covered 12 under the warranty of the manufacture or when the repair or replacement 13 is necessary due to misuse or negligence. The term "prosthetic device" 14 as used in this paragraph includes an artificial limb, but shall not 15 include shoes or any other article considered as ordinary wearing 16 apparel, whether or not specifically constructed. The term "policyhold- 17 er" as used in this paragraph shall mean a veteran of the armed forces 18 who resides in the state of New York and whose medical need for such 19 prosthetic device resulted from an injury suffered while in active duty 20 serving in the armed forces. Such coverage shall be subject to annual 21 deductibles and coinsurance as deemed appropriate by the superintendent. 22 The coverage required by this paragraph shall be identical to, and shall EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD04583-02-8S. 704--A 2 1 not enhance or increase the essential health benefit coverage chosen by 2 the state pursuant to 45 CFR 156.100. Nothing in this paragraph shall be 3 construed to prevent the medical management or utilization review of 4 benefits for medically necessary rehabilitative and habilitative 5 purposes. 6 § 2. Subsection (l) of section 3221 of the insurance law is amended by 7 adding a new paragraph 20 to read as follows: 8 (20) Every policy which provides medical, major medical, or similar 9 comprehensive type coverage to a policyholder shall provide coverage for 10 prosthetic devices that are intended for medically necessary rehabilita- 11 tive and habilitative purposes as required by 42 U.S.C. § 18022. Cover- 12 age shall include the cost of repair or replacement of prosthetic 13 devices due to normal wear and tear, if a prosthetic device has been 14 outgrown or no longer fits properly, or where a change in the medical 15 condition makes replacement necessary. Coverage shall not include the 16 costs of repair or replacement of a prosthetic device that is covered 17 under the warranty of the manufacturer or when the repair or replacement 18 is necessary due to misuse or negligence. The term "prosthetic device" 19 as used in this paragraph includes an artificial limb, but shall not 20 include shoes or any other article considered as ordinary wearing 21 apparel, whether or not specifically constructed. The term "policyhold- 22 er" as used in this paragraph shall mean a veteran of the armed forces 23 who resides in the state of New York and whose medical need for such 24 prosthetic device resulted from an injury suffered while on active duty 25 serving in the armed forces. Such coverage shall be subject to annual 26 deductibles and coinsurance as deeded appropriate by the superintendent. 27 The coverage required by this paragraph shall be identical to, and shall 28 not enhance or increase the essential health benefit coverage chosen by 29 the state pursuant to 45 CFR 156.100. Nothing in this paragraph shall be 30 construed to prevent the medical management or utilization review of 31 benefits for medically necessary rehabilitative and habilitative 32 purposes. 33 § 3. Section 4303 of the insurance law is amended by adding a new 34 subsection (rr) to read as follows: 35 (rr) Every policy which provides medical, major medical, or similar 36 comprehensive type coverage to a policyholder shall provide coverage for 37 prosthetic devices that are intended for medically necessary rehabilita- 38 tive and habilitative purposes as required by 42 U.S.C. § 18022. Cover- 39 age shall include the cost of repair or replacement of prosthetic 40 devices due to normal wear and tear, if a prosthetic device has been 41 outgrown or no longer fits properly, or where a change in the medical 42 condition makes replacement necessary. Coverage shall not include the 43 costs of repair or replacement of a prosthetic device that is covered 44 under the warranty of the manufacturer or when the repair or replacement 45 is necessary due to misuse or negligence. The term "prosthetic device" 46 as used in this subsection includes an artificial limb, but shall not 47 include shoes or any other article considered as ordinary wearing 48 apparel, whether or not specifically constructed. The term "policyhold- 49 er" as used in this subsection shall mean a veteran of the armed forces 50 who resides in the state of New York and whose medical need for such 51 prosthetic device resulted from an injury suffered while on active duty 52 serving in the armed forces. Such coverage shall be subject to annual 53 deductibles and coinsurance as deemed appropriate by the superintendent. 54 The coverage required by this subsection shall be identical to, and 55 shall not enhance or increase the essential health benefit coverage 56 chosen by the state pursuant to 45 CFR 156.100. Nothing in thisS. 704--A 3 1 subsection shall be construed to prevent the medical management or 2 utilization review of benefits for medically necessary rehabilitation 3 and habilitation purpose. 4 § 4. This act shall take effect on the one hundred eightieth day after 5 it shall have become a law and shall apply to policies and contracts 6 issued, renewed, modified, altered or amended on or after such effective 7 date.
