STATE OF NEW YORK
________________________________________________________________________
8851
IN ASSEMBLY(Prefiled)
January 4, 2012
___________
Introduced by M. of A. PAULIN, McENENY, BRENNAN, WEISENBERG, COLTON,
REILLY, CAHILL, ABINANTI, JAFFEE, GALEF, P. RIVERA, PRETLOW, WEPRIN,
ORTIZ, J. RIVERA, HOOPER, GOODELL -- Multi-Sponsored by -- M. of A.
ENGLEBRIGHT, GOTTFRIED, MILLMAN, ROBERTS, TITONE -- read once and
referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to coverage of early
intervention services
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subsection (a) of section 3235-a of the insurance law, as
2 added by section 3 of part C of chapter 1 of the laws of 2002, is
3 amended and two new subsections (f) and (g) are added to read as
4 follows:
5 (a) No policy of accident and health insurance, including contracts
6 issued pursuant to article forty-three of this chapter, shall exclude
7 coverage for otherwise covered services [solely on the basis that the
8 services constitute early intervention program services] that are
9 provided under title two-A of article twenty-five of the public health
10 law.
11 (f) Where a service provided to an insured under the early inter-
12 vention program is a covered service under the insurer's policy or
13 contract, the individualized family services plan, upon certification by
14 the early intervention official, as defined in section twenty-five
15 hundred forty-one of the public health law, or such official's designee,
16 shall be deemed to meet any precertification, preauthorization, and
17 medical necessity requirements imposed on benefits under the policy or
18 contract; provided, however, that the early intervention official shall
19 remove or redact any information contained in the insured's individual-
20 ized family services plan that is not required by the insurer for
21 payment purposes. Payment for a service covered under the policy or
22 contract that is provided under the early intervention program shall be
23 at rates established by the commissioner of health for such service
24 pursuant to regulations.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13676-02-2
A. 8851 2
1 (g) No insurer, including a health maintenance organization issued a
2 certificate of authority under article forty-four of the public health
3 law and a corporation organized under article forty-three of this chap-
4 ter, shall deny payment of an early intervention claim based on the
5 following:
6 (1) the location where services are provided;
7 (2) the duration of the child's condition and/or that the child's
8 condition is not amenable to significant improvement within a certain
9 period of time as specified in the policy; or
10 (3) that the provider of services is not a network or participating
11 provider.
12 § 2. This act shall take effect immediately.
