NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A8628A
SPONSOR: Solages TITLE OF BILL: An act to amend the insurance law, in relation to the
mandatory coverage of hearing aids by insurers and other organizations
PURPOSE OR GENERAL IDEA OF BILL:
To require all managed care organizations that provide hospital,
medical, or surgical benefits to individuals or groups under contracts
that are issued in this state to provide coverage for hearing aids.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1. Subdivision (i) of section 3216 of the insurance law is
amended by adding a new paragraph 34 to read as follows:
(A) As used in this paragraph, "hearing aid" shall mean a non-disposable
device that is of a design and circuitry to optimize audition and
listening skills in the environment commonly experienced by children.
(B) This paragraph shall apply to the following entities: (i) Insurers
and nonprofit health service plans, including the office of group bene-
fits, that provide hospital, medical, or surgical benefits to individ-
uals or groups on an expense-incurred basis under health insurance poli-
cies or contracts that are issued or delivered in this state.
(ii) Managed care organizations as defined and licensed by state law
that provide hospital, medical or surgical benefits to individuals or
groups under contracts that are issued or delivered in this state.
(C) An entity subject to this paragraph shall provide coverage for hear-
ing 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 Associ-
ation following medical clearance by a physician licensed to practice
medicine and a audiological evaluation medically appropriate to the age
of the child, provided;
(i)an entity subject to this paragraph may limit the benefit payable
under this paragraph to three thousand dollars per hearing aid for each
hearing-impaired ear twenty-four months
(ii) an insured or enrolled individual may choose a hearing aid that is
priced higher than the benefit payable under this paragraph and may pay
the difference between the price of the hearing aid and the benefit
payable under this paragraph without financial or contractual penalty to
the provider of the hearing aid.
(iii) in the case of a health insurer or managed care organization that
administers benefits according to contracts with health care providers,
hearing aids covered pursuant to this paragraph shall be obtained from
health care providers contracted with the health insurer or managed care
organization. Such providers shall be subject to the same contracting
and credentialing requirements that apply to other contracted health
care providers.
(D) This paragraph does not prohibit an entity subject to the provisions
of this paragraph from providing coverage that is greater or more favor-
able to an insured or enrolled individual than the coverage required
under this paragraph.
JUSTIFICATION:
This legislation seeks to offer insurance coverage for hearing aids by
all insurers, non-profit health plans, and ;managed care organizations
to provide funding for the purchase of hearing aids and hearing aid
related services for all patients regardless of their age.
PRIOR, LEGISLATIVE HISTORY:
New Bill
FISCAL IMPLICATIONS:
To be determined
EFFECTIVE DATE:
This act shall take effect after the ninetieth day after it shall have
become law.
STATE OF NEW YORK
________________________________________________________________________
8628--A
2017-2018 Regular Sessions
IN ASSEMBLY
September 1, 2017
___________
Introduced by M. of A. SOLAGES -- read once and referred to the Commit-
tee on Insurance -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee
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 34 to read as follows:
3 (34) (A) As used in this paragraph, "hearing aid" shall mean a non-
4 disposable device that is of a design and circuitry to optimize audition
5 and listening skills in the environment commonly experienced by chil-
6 dren.
7 (B) This paragraph shall apply to the following entities:
8 (i) Insurers and nonprofit health service plans, including the office
9 of group benefits, that provide hospital, medical, or surgical benefits
10 to individuals or groups on an expense-incurred basis under health
11 insurance policies or contracts that are issued or delivered in this
12 state.
13 (ii) Managed care organizations as defined and licensed by state law
14 that provide hospital, medical or surgical benefits to individuals or
15 groups under contracts that are issued or delivered in this state.
16 (C) An entity subject to this paragraph shall provide coverage for
17 hearing aids for patients who are covered under a policy or contract of
18 insurance if the hearing aids are fitted and dispensed by a licensed
19 audiologist certified by the American Speech-Language-Hearing Associ-
20 ation following medical clearance by a physician licensed to practice
21 medicine and an audiological evaluation medically appropriate to the age
22 of the child, provided:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13317-02-7
A. 8628--A 2
1 (i) an entity subject to this paragraph may limit the benefit payable
2 under this paragraph to three thousand dollars per hearing aid for each
3 hearing-impaired ear every twenty-four months.
4 (ii) an insured or enrolled individual may choose a hearing aid that
5 is priced higher than the benefit payable under this paragraph and may
6 pay the difference between the price of the hearing aid and the benefit
7 payable under this paragraph without financial or contractual penalty to
8 the provider of the hearing aid.
9 (iii) in the case of a health insurer or managed care organization
10 that administers benefits according to contracts with health care
11 providers, hearing aids covered pursuant to this paragraph shall be
12 obtained from health care providers contracted with the health insurer
13 or managed care organization. Such providers shall be subject to the
14 same contracting and credentialing requirements that apply to other
15 contracted health care providers.
16 (D) This paragraph does not prohibit an entity subject to the
17 provisions of this paragraph from providing coverage that is greater or
18 more favorable to an insured or enrolled individual than the coverage
19 required under this paragraph.
20 (E) The provisions of this paragraph shall apply to any new policy,
21 contract, program, or plan issued by an entity subject to the provisions
22 of this paragraph on or after January first, two thousand nineteen. Any
23 such policy, contract, program or plan in effect prior to January first,
24 two thousand nineteen shall convert to the provisions of this paragraph
25 on or before the renewal date thereof but in no event later than January
26 first, two thousand nineteen. Any policy affected by the provisions of
27 this paragraph shall apply to an insured or participant under such poli-
28 cy, contract, program, or plan whether or not the hearing impairment is
29 a pre-existing condition of the insured or participant.
30 § 2. Section 3221 of the insurance law is amended by adding a new
31 subsection (t) to read as follows:
32 (t) (1) As used in this subsection, "hearing aid" shall mean a non-
33 disposable device that is of a design and circuitry to optimize audition
34 and listening skills in the environment commonly experienced by chil-
35 dren.
36 (2) This subsection shall apply to the following entities:
37 (A) Insurers and nonprofit health service plans, including the office
38 of group benefits, that provide hospital, medical, or surgical benefits
39 to individuals or groups on an expense-incurred basis under health
40 insurance policies or contracts that are issued or delivered in this
41 state.
42 (B) Managed care organizations as defined and licensed by state law
43 that provide hospital, medical or surgical benefits to individuals or
44 groups under contracts that are issued or delivered in this state.
45 (3) An entity subject to this subsection shall provide coverage for
46 hearing aids for patients who are covered under a policy or contract of
47 insurance if the hearing aids are fitted and dispensed by a licensed
48 audiologist certified by the American Speech-Language-Hearing Associ-
49 ation following medical clearance by a physician licensed to practice
50 medicine and an audiological evaluation medically appropriate to the age
51 of the child, provided:
52 (A) An entity subject to this subsection may limit the benefit payable
53 under this subsection to three thousand dollars per hearing aid for each
54 hearing-impaired ear every twenty-four months.
55 (B) An insured or enrolled individual may choose a hearing aid that is
56 priced higher than the benefit payable under this subsection and may pay
A. 8628--A 3
1 the difference between the price of the hearing aid and the benefit
2 payably under this subsection without financial or contractual penalty
3 to the provider of the hearing aid.
4 (C) In the case of a health insurer or managed care organization that
5 administers benefits according to contracts with health care providers,
6 hearing aids covered pursuant to this subsection shall be obtained from
7 health care providers contracted with the health insurer or managed
8 care organization. Such providers shall be subject to the same contract-
9 ing and credentialing requirements that apply to other contracted health
10 care providers.
11 (4) This subsection does not prohibit an entity subject to the
12 provisions of this subsection from providing coverage that is greater or
13 more favorable to an insured or enrolled individual than the coverage
14 required under this subsection.
15 (5) The provisions of this subsection shall apply to any new policy,
16 contract, program, or plan issued by an entity subject to the provisions
17 of this subsection on or after January first, two thousand nineteen. Any
18 such policy, contract, program or plan in effect prior to January first,
19 two thousand nineteen shall convert to the provisions of this subsection
20 on or before the renewal date thereof but in no event later than January
21 first, two thousand nineteen. Any policy affected by the provisions of
22 this subsection shall apply to an insured or participant under such
23 policy, contract, program, or plan whether or not the hearing impairment
24 is a pre-existing condition of the insured or participant.
25 § 3. Section 4303 of the insurance law is amended by adding a new
26 subsection (rr) to read as follows:
27 (rr)(1) As used in this subsection, "hearing aid" shall mean a non-
28 disposable device that is of a design and circuitry to optimize audition
29 and listening skills in the environment commonly experienced by chil-
30 dren.
31 (2) This subsection shall apply to the following entities:
32 (A) Insurers and nonprofit health service plans, including the office
33 of group benefits, that provide hospital, medical, or surgical benefits
34 to individuals or groups on an expense-incurred basis under health
35 insurance policies or contracts that are issued or delivered in this
36 state.
37 (B) Managed care organizations as defined and licensed by state law
38 that provide hospital, medical or surgical benefits to individuals or
39 groups under contracts that are issued or delivered in this state.
40 (3) An entity subject to this subsection shall provide coverage for
41 hearing aids for patients who are covered under a policy or contract of
42 insurance if the hearing aids are fitted and dispensed by a licensed
43 audiologist certified by the American Speech-Language-Hearing Associ-
44 ation following medical clearance by a physician licensed to practice
45 medicine and an audiological evaluation medically appropriate to the age
46 of the child, provided:
47 (A) An entity subject to this subsection may limit the benefit payable
48 under this subsection to three thousand dollars per hearing aid for each
49 hearing-impaired ear every twenty-four months.
50 (B) An insured or enrolled individual may choose a hearing aid that is
51 priced higher then the benefit payable under his subsection and may pay
52 the difference between the price of the hearing aid and the benefit
53 payable under this subsection without financial or contractual penalty
54 to the provider of the hearing aid.
55 (C) In the case of the health insurer or managed care organization
56 that administers benefits according to contracts with health care
A. 8628--A 4
1 providers, hearing aids covered pursuant to this subsection shall be
2 obtained from health care providers contracted with the health insurer
3 or managed care organization. Such providers shall be subject to the
4 same contracting and credentialing requirements that apply to other
5 contracted health care providers.
6 (4) This subsection does not prohibit an entity subject to the
7 provisions of this subsection from providing coverage that is greater or
8 more favorable to an insured or enrolled individual than the coverage
9 required under this subsection.
10 (5) The provisions of this subsection shall apply to any new policy,
11 contract, program, or plan issued by an entity subject to the provisions
12 of this subsection on or after January first, two thousand nineteen. Any
13 such policy, contract, program or plan in effect prior to January first,
14 two thousand nineteen shall convert to the provisions of this subsection
15 on or before the renewal date thereof but in no event later than January
16 first, two thousand nineteen. Any policy affected by the provisions of
17 this subsection shall apply to an insured or participant under such
18 policy, contract, program, or plan whether or not the hearing impairment
19 is a pre-existing condition of the insured or participant.
20 § 4. This act shall take effect on the ninetieth day after it shall
21 have become a law.
