Bill Text: NY S08684 | 2021-2022 | General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Requires coverage for hearing aids for patients who are covered under a policy or contract of insurance if the hearing aids are fitted and dispensed by a licensed audiologist certified by the American Speech-Language-Hearing Association following medical clearance by a physician licensed to practice medicine and an audiological evaluation.

Spectrum: Partisan Bill (Democrat 7-0)

Status: (Introduced - Dead) 2022-05-20 - PRINT NUMBER 8684A [S08684 Detail]

Download: New_York-2021-S08684-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          8684

                    IN SENATE

                                     March 30, 2022
                                       ___________

        Introduced  by  Sen. PERSAUD -- 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 the mandatory coverage
          of hearing aids by insurers and other organizations

          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 36 to read as follows:
     3    (36) (A) As used in this paragraph, "hearing aid" shall mean  a  medi-
     4  cally-prescribed,  non-disposable device that is of a design and circui-
     5  try to optimize audition and listening skills.
     6    (B) This paragraph shall apply to the following entities:
     7    (i) Insurers and nonprofit health service plans, including the  office
     8  of  group benefits, that provide hospital, medical, or surgical benefits
     9  to individuals or groups  on  an  expense-incurred  basis  under  health
    10  insurance  policies  or  contracts  that are issued or delivered in this
    11  state.
    12    (ii) Managed care organizations as defined and licensed by  state  law
    13  that  provide  hospital,  medical or surgical benefits to individuals or
    14  groups under contracts that are issued or delivered in this state.
    15    (C) An entity subject to this paragraph  shall  provide  coverage  for
    16  hearing  aids for patients who are covered under a policy or contract of
    17  insurance if the hearing aids are fitted and  dispensed  by  a  licensed
    18  audiologist  certified  by  the American Speech-Language-Hearing Associ-
    19  ation following medical clearance by a physician  licensed  to  practice
    20  medicine and an audiological evaluation, provided:
    21    (i)  an entity subject to this paragraph may limit the benefit payable
    22  under this paragraph to five thousand dollars per hearing aid  for  each
    23  hearing-impaired ear every twenty-four months.
    24    (ii)  an  insured or enrolled individual may choose a hearing aid that
    25  is priced higher than the benefit payable under this paragraph  and  may
    26  pay  the difference between the price of the hearing aid and the benefit
    27  payable under this paragraph without financial or contractual penalty to
    28  the provider of the hearing aid.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD15037-01-2
        S. 8684                             2

     1    (iii) in the case of a health insurer  or  managed  care  organization
     2  that  administers  benefits  according  to  contracts  with  health care
     3  providers, hearing aids covered pursuant  to  this  paragraph  shall  be
     4  obtained  from  health care providers contracted with the health insurer
     5  or  managed  care  organization.  Such providers shall be subject to the
     6  same contracting and credentialing  requirements  that  apply  to  other
     7  contracted health care providers.
     8    (D)  This  paragraph  does  not  prohibit  an  entity  subject  to the
     9  provisions of this paragraph from providing coverage that is greater  or
    10  more  favorable  to  an insured or enrolled individual than the coverage
    11  required under this paragraph.
    12    (E) The provisions of this paragraph shall apply to  any  new  policy,
    13  contract, program, or plan issued by an entity subject to the provisions
    14  of  this paragraph on or after January first, two thousand twenty-three.
    15  Any such policy, contract, program or plan in effect  prior  to  January
    16  first, two thousand twenty-three shall convert to the provisions of this
    17  paragraph  on  or  before the renewal date thereof but in no event later
    18  than January first, two thousand twenty-three. Any  policy  affected  by
    19  the  provisions  of  this paragraph shall apply to an insured or partic-
    20  ipant under such policy, contract, program, or plan whether or  not  the
    21  hearing impairment is a pre-existing condition of the insured or partic-
    22  ipant.
    23    §  2.  Section  3221  of  the insurance law is amended by adding a new
    24  subsection (u) to read as follows:
    25    (u) (1) As used in this subsection, "hearing aid" shall mean  a  medi-
    26  cally-prescribed,  non-disposable device that is of a design and circui-
    27  try to optimize audition and listening.
    28    (2) This subsection shall apply to the following entities:
    29    (A) Insurers and nonprofit health service plans, including the  office
    30  of  group benefits, that provide hospital, medical, or surgical benefits
    31  to individuals or groups  on  an  expense-incurred  basis  under  health
    32  insurance  policies  or  contracts  that are issued or delivered in this
    33  state.
    34    (B) Managed care organizations as defined and licensed  by  state  law
    35  that  provide  hospital,  medical or surgical benefits to individuals or
    36  groups under contracts that are issued or delivered in this state.
    37    (3) An entity subject to this subsection shall  provide  coverage  for
    38  hearing  aids for patients who are covered under a policy or contract of
    39  insurance if the hearing aids are fitted and  dispensed  by  a  licensed
    40  audiologist  certified  by  the American Speech-Language-Hearing Associ-
    41  ation following medical clearance by a physician  licensed  to  practice
    42  medicine and an audiological evaluation, provided:
    43    (A) An entity subject to this subsection may limit the benefit payable
    44  under  this subsection to five thousand dollars per hearing aid for each
    45  hearing-impaired ear every twenty-four months.
    46    (B) An insured or enrolled individual may choose a hearing aid that is
    47  priced higher than the benefit payable under this subsection and may pay
    48  the difference between the price of the  hearing  aid  and  the  benefit
    49  payable  under  this subsection without financial or contractual penalty
    50  to the provider of the hearing aid.
    51    (C) In the case of a health insurer or managed care organization  that
    52  administers  benefits according to contracts with health care providers,
    53  hearing aids covered pursuant to this subsection shall be obtained  from
    54  health  care  providers  contracted with   the health insurer or managed
    55  care organization. Such providers shall be subject to the same contract-
        S. 8684                             3

     1  ing and credentialing requirements that apply to other contracted health
     2  care providers.
     3    (4)  This  subsection  does  not  prohibit  an  entity  subject to the
     4  provisions of this subsection from providing coverage that is greater or
     5  more favorable to an insured or enrolled individual  than  the  coverage
     6  required under this subsection.
     7    (5)  The  provisions of this subsection shall apply to any new policy,
     8  contract, program, or plan issued by an entity subject to the provisions
     9  of this subsection on or after January first, two thousand twenty-three.
    10  Any such policy, contract, program or plan in effect  prior  to  January
    11  first, two thousand twenty-three shall convert to the provisions of this
    12  subsection  on  or before the renewal date thereof but in no event later
    13  than January first, two thousand twenty-three. Any  policy  affected  by
    14  the  provisions  of this subsection shall apply to an insured or partic-
    15  ipant under such policy, contract, program, or plan whether or  not  the
    16  hearing impairment is a pre-existing condition of the insured or partic-
    17  ipant.
    18    §  3.  Section  4303  of  the insurance law is amended by adding a new
    19  subsection (ss) to read as follows:
    20    (ss)(1) As used in this subsection, "hearing aid" shall mean  a  medi-
    21  cally-prescribed,  non-disposable device that is of a design and circui-
    22  try to optimize audition and listening.
    23    (2) This subsection shall apply to the following entities:
    24    (A) Insurers and nonprofit health service plans, including the  office
    25  of  group benefits, that provide hospital, medical, or surgical benefits
    26  to individuals or groups  on  an  expense-incurred  basis  under  health
    27  insurance  policies  or  contracts  that are issued or delivered in this
    28  state.
    29    (B) Managed care organizations as defined and licensed  by  state  law
    30  that  provide  hospital,  medical or surgical benefits to individuals or
    31  groups under contracts that are issued or delivered in this state.
    32    (3) An entity subject to this subsection shall  provide  coverage  for
    33  hearing  aids for patients who are covered under a policy or contract of
    34  insurance if the hearing aids are fitted and  dispensed  by  a  licensed
    35  audiologist  certified  by  the American Speech-Language-Hearing Associ-
    36  ation following medical clearance by a physician  licensed  to  practice
    37  medicine and an audiological evaluation, provided:
    38    (A) An entity subject to this subsection may limit the benefit payable
    39  under  this subsection to five thousand dollars per hearing aid for each
    40  hearing-impaired ear every twenty-four months.
    41    (B) An insured or enrolled individual may choose a hearing aid that is
    42  priced  higher then the benefit payable under this  subsection  and  may
    43  pay  the difference between the price of the hearing aid and the benefit
    44  payable under this subsection without financial or  contractual  penalty
    45  to the provider of the hearing aid.
    46    (C)  In  the  case  of the health insurer or managed care organization
    47  that administers  benefits  according  to  contracts  with  health  care
    48  providers,  hearing  aids  covered  pursuant to this subsection shall be
    49  obtained from health care providers contracted with the  health  insurer
    50  or  managed  care  organization.  Such providers shall be subject to the
    51  same contracting and credentialing  requirements  that  apply  to  other
    52  contracted health care providers.
    53    (4)  This  subsection  does  not  prohibit  an  entity  subject to the
    54  provisions of this subsection from providing coverage that is greater or
    55  more favorable to an insured or enrolled individual  than  the  coverage
    56  required under this subsection.
        S. 8684                             4

     1    (5)  The  provisions of this subsection shall apply to any new policy,
     2  contract, program, or plan issued by an entity subject to the provisions
     3  of this subsection on or after January first, two thousand twenty-three.
     4  Any such policy, contract, program or plan in effect  prior  to  January
     5  first, two thousand twenty-three shall convert to the provisions of this
     6  subsection  on  or before the renewal date thereof but in no event later
     7  than January first, two thousand twenty-three. Any  policy  affected  by
     8  the  provisions  of this subsection shall apply to an insured or partic-
     9  ipant under such policy, contract, program, or plan whether or  not  the
    10  hearing impairment is a pre-existing condition of the insured or partic-
    11  ipant.
    12    §  4.  This  act shall take effect on the ninetieth day after it shall
    13  have become a law. Effective immediately, the addition, amendment and/or
    14  repeal of any rule or regulation necessary  for  the  implementation  of
    15  this  act  on its effective date are authorized to be made and completed
    16  on or before such date.