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AB1327 Text:

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                         1327

                              2015-2016 Regular Sessions

                                 I N  A S S E M B L Y

                                    January 9, 2015
                                      ___________

       Introduced by M. of A. CAHILL -- read once and referred to the Committee
         on Insurance

       AN ACT to amend the public health law and the insurance law, in relation
         to  requiring  health maintenance organizations to cover court ordered
         health care services

         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:

    1    Section  1.  Section  4406-c  of  the  public health law is amended by
    2  adding a new subdivision 9 to read as follows:
    3    9. A HEALTH CARE PLAN MUST COVER HEALTH CARE  SERVICES  ORDERED  BY  A
    4  COURT  OF COMPETENT JURISDICTION ON THE BASIS OF AN EVALUATION PERFORMED
    5  BY A PHYSICIAN IF:
    6    (A) THE EVALUATION IS PERFORMED BY A PARTICIPATING PROVIDER WHO CERTI-
    7  FIES THAT FURTHER SERVICES ARE NECESSARY;
    8    (B) THE HEALTH CARE SERVICES THAT ARE THE SUBJECT OF  THE  PROSPECTIVE
    9  COURT ORDER ARE A COVERED BENEFIT OF THE HEALTH CARE PLAN; AND
   10    (C)  THE  HEALTH  CARE  SERVICES ARE TO BE PROVIDED BY A PARTICIPATING
   11  HEALTH CARE PROVIDER OF THE HEALTH CARE PLAN.
   12    ANY SUCH HEALTH CARE SERVICE  SHALL  NOT  BE  SUBJECT  TO  A  SEPARATE
   13  MEDICAL NECESSITY DETERMINATION BY THE HEALTH CARE PLAN.
   14    S  2.  Section  3217-b of the insurance law is amended by adding a new
   15  subsection (k) to read as follows:
   16    (K) A HEALTH CARE PLAN MUST COVER HEALTH CARE SERVICES  ORDERED  BY  A
   17  COURT  OF COMPETENT JURISDICTION ON THE BASIS OF AN EVALUATION PERFORMED
   18  BY A PHYSICIAN IF:
   19    (1) THE EVALUATION IS PERFORMED BY A PARTICIPATING PROVIDER WHO CERTI-
   20  FIES THAT FURTHER SERVICES ARE NECESSARY;
   21    (2) THE HEALTH CARE SERVICES THAT ARE THE SUBJECT OF  THE  PROSPECTIVE
   22  COURT ORDER ARE A COVERED BENEFIT OF THE HEALTH CARE PLAN; AND
   23    (3)  THE  HEALTH  CARE  SERVICES ARE TO BE PROVIDED BY A PARTICIPATING
   24  HEALTH CARE PROVIDER OF THE HEALTH  CARE  PLAN.  ANY  SUCH  HEALTH  CARE

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD06406-01-5
       A. 1327                             2

    1  SERVICE  SHALL  NOT  BE SUBJECT TO A SEPARATE MEDICAL NECESSITY DETERMI-
    2  NATION BY THE HEALTH CARE PLAN.
    3    S  3.  Section  4325  of  the insurance law is amended by adding a new
    4  subsection (l) to read as follows:
    5    (L) A HEALTH CARE PLAN MUST COVER HEALTH CARE SERVICES  ORDERED  BY  A
    6  COURT  OF COMPETENT JURISDICTION ON THE BASIS OF AN EVALUATION PERFORMED
    7  BY A PHYSICIAN IF:
    8    (1) THE EVALUATION IS PERFORMED BY A PARTICIPATING PROVIDER WHO CERTI-
    9  FIES THAT FURTHER SERVICES ARE NECESSARY;
   10    (2) THE HEALTH CARE SERVICES THAT ARE THE SUBJECT OF  THE  PROSPECTIVE
   11  COURT ORDER ARE A COVERED BENEFIT OF THE HEALTH CARE PLAN; AND
   12    (3)  THE  HEALTH  CARE  SERVICES ARE TO BE PROVIDED BY A PARTICIPATING
   13  HEALTH CARE PROVIDER OF THE HEALTH  CARE  PLAN.  ANY  SUCH  HEALTH  CARE
   14  SERVICE  SHALL  NOT  BE SUBJECT TO A SEPARATE MEDICAL NECESSITY DETERMI-
   15  NATION BY THE HEALTH CARE PLAN.
   16    S 4. This act shall take effect July 1, 2016.
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