Bill Text: NY S05175 | 2011-2012 | General Assembly | Introduced
Bill Title: Relates to insurance coverage for children in need of early intervention services.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2012-01-04 - REFERRED TO INSURANCE [S05175 Detail]
Download: New_York-2011-S05175-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
5175
2011-2012 Regular Sessions
I N S E N A T E
May 3, 2011
___________
Introduced by Sen. GALLIVAN -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to ensuring insurance
coverage for children in need 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. Section 3235-a of the insurance law, as added by section 3
2 of part C of chapter 1 of the laws of 2002, is amended to read as
3 follows:
4 S 3235-a. Payment for early intervention services. (a) No policy of
5 accident and health insurance, including contracts issued pursuant to
6 article forty-three of this chapter, shall exclude coverage for other-
7 wise covered services solely on the basis that the services constitute
8 early intervention program services under title two-A of article twen-
9 ty-five of the public health law.
10 (b) Where a policy of accident and health insurance, including a
11 contract issued pursuant to article forty-three of this chapter,
12 provides coverage for [an] A SERVICE THAT IS PROVIDED TO AN INSURED
13 UNDER THE early intervention program service, such coverage shall not be
14 applied against any maximum annual or lifetime monetary limits set forth
15 in such policy or contract. Visit limitations and other terms and condi-
16 tions of the policy will continue to apply to COVERED SERVICES PROVIDED
17 UNDER THE early intervention [services] PROGRAM. However, any visits
18 used for early intervention program services shall not reduce the number
19 of visits otherwise available under the policy or contract for such
20 services. WHERE A SERVICE PROVIDED TO AN INSURED UNDER THE EARLY INTER-
21 VENTION PROGRAM IS A COVERED SERVICE UNDER THE INSURER'S POLICY OR
22 CONTRACT, THE INDIVIDUALIZED FAMILY SERVICES PLAN AS DEFINED IN SECTION
23 TWENTY-FIVE HUNDRED FORTY-ONE OF THE PUBLIC HEALTH LAW AND CERTIFIED BY
24 THE EARLY INTERVENTION OFFICIAL OR SUCH OFFICIAL'S DESIGNEE, SHALL BE
25 DEEMED TO MEET ANY PRECERTIFICATION, PREAUTHORIZATION AND MEDICAL NECES-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11317-01-1
S. 5175 2
1 SITY REQUIREMENTS IMPOSED ON BENEFITS UNDER THE POLICY OR CONTRACT,
2 PROVIDED, HOWEVER, THAT THE EARLY INTERVENTION OFFICIAL SHALL REMOVE OR
3 REDACT ANY INFORMATION CONTAINED ON THE INSURED'S INDIVIDUALIZED FAMILY
4 SERVICE PLAN THAT IS NOT REQUIRED BY THE INSURER FOR PAYMENT PURPOSES.
5 PAYMENT FOR A SERVICE COVERED UNDER THE POLICY OR CONTRACT THAT IS
6 PROVIDED UNDER THE EARLY INTERVENTION PROGRAM SHALL BE AT RATES ESTAB-
7 LISHED BY THE COMMISSIONER OF HEALTH FOR SUCH SERVICE PURSUANT TO REGU-
8 LATIONS.
9 (c) NO INSURER, INCLUDING A HEALTH MAINTENANCE ORGANIZATION ISSUED A
10 CERTIFICATE OF AUTHORITY UNDER ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
11 LAW AND A CORPORATION ORGANIZED UNDER ARTICLE FORTY-THREE OF THIS CHAP-
12 TER SHALL DENY PAYMENT OF A CLAIM SUBMITTED FOR A SERVICE COVERED UNDER
13 THE INSURER'S POLICY OR CONTRACT AND PROVIDED UNDER THE EARLY INTER-
14 VENTION PROGRAM BASED UPON THE FOLLOWING:
15 (I) THE LOCATION WHERE SERVICES ARE PROVIDED;
16 (II) THE DURATION OF THE INSURED'S CONDITION OR THAT THE INSURED'S
17 CONDITION IS NOT AMENABLE TO SIGNIFICANT IMPROVEMENT WITHIN A CERTAIN
18 PERIOD OF TIME AS SPECIFIED IN THE POLICY OR CONTRACT;
19 (III) THAT THE PROVIDER OF SERVICES IS NOT A PARTICIPATING PROVIDER IN
20 THE INSURER'S NETWORK; OR
21 (IV) THE ABSENCE OF A PRIMARY CARE REFERRAL.
22 (D) Any right of subrogation to benefits which a municipality is enti-
23 tled in accordance with paragraph (d) of subdivision three of section
24 twenty-five hundred fifty-nine of the public health law shall be valid
25 and enforceable to the extent benefits are available under any accident
26 and health insurance policy. The right of subrogation does not attach to
27 insurance benefits paid or provided under any accident and health insur-
28 ance policy prior to receipt by the insurer of written notice from the
29 municipality. UPON THE INSURER'S RECEIPT OF WRITTEN NOTICE FROM THE
30 MUNICIPALITY THE INSURER SHALL PROVIDE THE MUNICIPALITY WITH INFORMATION
31 ON THE EXTENT OF BENEFITS AVAILABLE TO AN INSURED UNDER THE POLICY.
32 [(d)] (E) No insurer, including a health maintenance organization
33 issued a certificate of authority under article forty-four of the public
34 health law and a corporation organized under article forty-three of this
35 chapter, shall refuse to issue an accident and health insurance policy
36 or contract or refuse to renew an accident and health insurance policy
37 or contract solely because the applicant or insured is receiving
38 services under the early intervention program.
39 S 2. This act shall take effect immediately and shall apply to any
40 contracts entered into, altered, modified, extended or removed on or
41 after such effective date.
