Provides coverage for biologically-based mental illness, psychiatric or psychological services or diagnosis or treatment of mental, nervous or emotional disorders or ailments under the Healthy New York program.
STATE OF NEW YORK
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2779
2013-2014 Regular Sessions
IN SENATE
January 23, 2013
___________
Introduced by Sen. PARKER -- 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 providing coverage for
biologically-based mental illness under the Healthy New York program
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraphs 14 and 15 of subsection (d) of section 4326 of
2 the insurance law, paragraph 14 as amended and paragraph 15 as added by
3 chapter 219 of the laws of 2011, are amended and a new paragraph 16 is
4 added to read as follows:
5 (14) prescription drugs obtained at a participating pharmacy. In addi-
6 tion to providing coverage at a participating pharmacy, health mainte-
7 nance organizations may utilize a mail order prescription drug program.
8 Health maintenance organizations may provide prescription drugs pursuant
9 to a drug formulary; however, health maintenance organizations must
10 implement an appeals process so that the use of non-formulary
11 prescription drugs may be requested by a physician; [and]
12 (15) for a contract that is not a grandfathered health plan, the
13 following additional preventive health services:
14 (A) evidence-based items or services that have in effect a rating of
15 'A' or 'B' in the current recommendations of the United States preven-
16 tive services task force;
17 (B) immunizations that have in effect a recommendation from the advi-
18 sory committee on immunization practices of the centers for disease
19 control and prevention with respect to the individual involved;
20 (C) with respect to children, including infants and adolescents,
21 evidence-informed preventive care and screenings provided for in the
22 comprehensive guidelines supported by the health resources and services
23 administration; and
24 (D) with respect to women, such additional preventive care and screen-
25 ings not described in subparagraph (A) of this paragraph as provided for
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD07101-01-3
S. 2779 2
1 in comprehensive guidelines supported by the health resources and
2 services administration.
3 (E) For purposes of this paragraph, "grandfathered health plan" means
4 coverage provided by a corporation in which an individual was enrolled
5 on March twenty-third, two thousand ten for as long as the coverage
6 maintains grandfathered status in accordance with section 1251(e) of the
7 Affordable Care Act, 42 U.S.C. § 18011(e)[.]; and
8 (16) psychiatric or psychological services or diagnosis or treatment
9 of mental, nervous or emotional disorders or ailments and biologically-
10 based mental illness.
11 § 2. This act shall take effect immediately.
