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A06820 Summary:

A06820 Actions:

A06820 Floor Votes:

A06820 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         6820--C
 
                               2013-2014 Regular Sessions
 
                   IN ASSEMBLY
 
                                     April 19, 2013
                                       ___________
 
        Introduced  by  M.  of  A.  CRESPO,  MILLER,  GUNTHER,  SCHIMEL, MOSLEY,
          BARRETT, COLTON, COOK, MAGNARELLI, TITONE, DiPIETRO, FINCH, MONTESANO,
          GRAF, DUPREY, RIVERA, HOOPER, CAHILL, ROBINSON, JAFFEE, OTIS, SCARBOR-
          OUGH, SALADINO, CERETTO, RA, LALOR, BENEDETTO,  JOHNS  --  Multi-Spon-
          sored by -- M. of A.  ARROYO, BRENNAN, GIGLIO, HIKIND, JACOBS, KEARNS,

          MARKEY,  McLAUGHLIN,  PALMESANO, PEOPLES-STOKES, PERRY, STEC, SWEENEY,
          THIELE, WEISENBERG -- read once  and  referred  to  the  Committee  on
          Insurance  --  recommitted to the Committee on Insurance in accordance
          with Assembly Rule 3, sec. 2 -- committee  discharged,  bill  amended,
          ordered  reprinted  as  amended  and  recommitted to said committee --
          again reported from said committee with amendments, ordered  reprinted
          as  amended and recommitted to said committee -- reported and referred
          to the Committee on Ways  and  Means  --  committee  discharged,  bill
          amended,  ordered reprinted as amended and recommitted to said commit-
          tee
 
        AN ACT to amend the insurance  law,  in  relation  to  mandatory  health
          insurance coverage for prosthetic devices
 
          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 30 to read as follows:
     3    (30)  Every  policy  which provides medical, major medical, or similar
     4  comprehensive type coverage and provides coverage  for  durable  medical
     5  equipment  shall  provide  coverage  for  prosthetic  devices  that  are
     6  intended  for  medically  necessary  rehabilitative   and   habilitative
     7  purposes  as  required  by  42  U.S.C. § 18022 that is equivalent to the
     8  coverage provided for durable medical equipment.  Coverage shall not  be
     9  denied if the policy holder's physician determines the prosthetic device
    10  is the most appropriate model that adequately meets the medical needs of

    11  the  policy  holder.  The term "prosthetic device" as used in this para-
    12  graph includes an artificial limb but shall not  include  shoes  or  any
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10223-08-4
        A. 6820--C                          2
 
     1  other  article  considered  as  ordinary wearing apparel, whether or not
     2  specially constructed.  The term "policy holder" as used in  this  para-
     3  graph  shall mean a veteran of the armed forces who resides in the state
     4  of  New  York and whose medical need for such prosthetic device resulted

     5  from an injury suffered in the line of duty while serving in  the  armed
     6  forces.
     7    § 2. Subsection (l) of section 3221 of the insurance law is amended by
     8  adding a new paragraph 19 to read as follows:
     9    (19)  Every  policy  which provides medical, major medical, or similar
    10  comprehensive type coverage and provides coverage  for  durable  medical
    11  equipment  shall  provide  coverage  for  prosthetic  devices  that  are
    12  intended  for  medically  necessary  rehabilitative   and   habilitative
    13  purposes  as  required  by  42  U.S.C. § 18022 that is equivalent to the
    14  coverage provided for durable medical equipment.  Coverage shall not  be
    15  denied if the policy holder's physician determines the prosthetic device

    16  is the most appropriate model that adequately meets the medical needs of
    17  the  policy  holder.  The term "prosthetic device" as used in this para-
    18  graph includes an artificial limb but shall not  include  shoes  or  any
    19  other  article  considered  as  ordinary wearing apparel, whether or not
    20  specially constructed. The term "policy holder" as used  in  this  para-
    21  graph  shall mean a veteran of the armed forces who resides in the state
    22  of New York and whose medical need for such prosthetic  device  resulted
    23  from  an  injury suffered in the line of duty while serving in the armed
    24  forces.
    25    § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
    26  subsection (oo) to read as follows:

    27    (oo)  Every  policy  which provides medical, major medical, or similar
    28  comprehensive type coverage and provides coverage  for  durable  medical
    29  equipment  shall  provide  coverage  for  prosthetic  devices  that  are
    30  intended  for  medically  necessary  rehabilitative   and   habilitative
    31  purposes  as  required  by  42  U.S.C. § 18022 that is equivalent to the
    32  coverage provided for durable medical equipment.  Coverage shall not  be
    33  denied if the policy holder's physician determines the prosthetic device
    34  is the most appropriate model that adequately meets the medical needs of
    35  the  policy  holder.    The  term  "prosthetic  device"  as used in this
    36  subsection includes an artificial limb but shall not  include  shoes  or

    37  any other article considered as ordinary wearing apparel, whether or not
    38  specially  constructed.    The  term  "policy  holder"  as  used in this
    39  subsection shall mean a veteran of the armed forces who resides  in  the
    40  state  of  New  York  and  whose medical need for such prosthetic device
    41  resulted from an injury suffered in the line of duty  while  serving  in
    42  the armed forces.
    43    §  4.  This  act  shall take effect May 1, 2015 and shall apply to all
    44  policies and contracts issued, renewed, altered, or amended on or  after
    45  such effective date.