S05174 Summary:

BILL NOS05174
 
SAME ASNo Same As
 
SPONSORORTT
 
COSPNSR
 
MLTSPNSR
 
Amd §§3216, 3221 & 4303, Ins L
 
Requires mandatory health insurance coverage for prosthetic devices; requires coverage where the model is determined to be medically necessary for rehabilitative and habilitative purposes.
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S05174 Actions:

BILL NOS05174
 
04/12/2019REFERRED TO INSURANCE
01/08/2020REFERRED TO INSURANCE
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S05174 Committee Votes:

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S05174 Floor Votes:

There are no votes for this bill in this legislative session.
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S05174 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          5174
 
                               2019-2020 Regular Sessions
 
                    IN SENATE
 
                                     April 12, 2019
                                       ___________
 
        Introduced  by  Sen.  ORTT  --  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  mandatory  health
          insurance coverage for providing 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 35 to read as follows:
     3    (35)  Every  policy  which provides medical, major medical, or similar
     4  comprehensive type coverage to a policyholder shall provide coverage for
     5  prosthetic devices that are intended for medically necessary rehabilita-
     6  tive and habilitative purposes as required by 42 U.S.C. § 18022.  Cover-
     7  age  shall  include  the  cost  of  repair  or replacement of prosthetic
     8  devices due to normal wear and tear, if a  prosthetic  device  has  been
     9  outgrown  or  no  longer fits properly, or where a change in the medical
    10  condition makes replacement necessary. Coverage shall  not  include  the
    11  costs  of  repair  or replacement of a prosthetic device that is covered
    12  under the warranty of the manufacture or when the repair or  replacement
    13  is  necessary  due to misuse or negligence. The term "prosthetic device"
    14  as used in this paragraph includes an artificial  limb,  but  shall  not
    15  include  shoes  or  any  other  article  considered  as ordinary wearing
    16  apparel, whether or not specifically constructed. The term  "policyhold-
    17  er"  as  used in this paragraph shall mean a veteran of the armed forces
    18  who resides in the state of New York and whose  medical  need  for  such
    19  prosthetic  device resulted from an injury suffered while on active duty
    20  serving in the armed forces. Such coverage shall be  subject  to  annual
    21  deductibles and coinsurance as deemed appropriate by the superintendent.
    22  The coverage required by this paragraph shall be identical to, and shall
    23  not  enhance or increase the essential health benefit coverage chosen by
    24  the state pursuant to 45 CFR 156.100. Nothing in this paragraph shall be
    25  construed to prevent the medical management  or  utilization  review  of
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02354-01-9

        S. 5174                             2
 
     1  benefits   for   medically  necessary  rehabilitative  and  habilitative
     2  purposes.
     3    § 2. Subsection (l) of section 3221 of the insurance law is amended by
     4  adding a new paragraph 21 to read as follows:
     5    (21)  Every  policy  which provides medical, major medical, or similar
     6  comprehensive type coverage to a policyholder shall provide coverage for
     7  prosthetic devices that are intended for medically necessary rehabilita-
     8  tive and habilitative purposes as required by 42 U.S.C. § 18022.  Cover-
     9  age  shall  include  the  cost  of  repair  or replacement of prosthetic
    10  devices due to normal wear and tear, if a  prosthetic  device  has  been
    11  outgrown  or  no  longer fits properly, or where a change in the medical
    12  condition makes replacement necessary. Coverage shall  not  include  the
    13  costs  of  repair  or replacement of a prosthetic device that is covered
    14  under the warranty of the manufacturer or when the repair or replacement
    15  is necessary due to misuse or negligence. The term  "prosthetic  device"
    16  as  used  in  this  paragraph includes an artificial limb, but shall not
    17  include shoes or  any  other  article  considered  as  ordinary  wearing
    18  apparel,  whether or not specifically constructed. The term "policyhold-
    19  er" as used in this paragraph shall mean a veteran of the  armed  forces
    20  who  resides  in  the  state of New York and whose medical need for such
    21  prosthetic device resulted from an injury suffered while on active  duty
    22  serving  in  the armed forces.  Such coverage shall be subject to annual
    23  deductibles and coinsurance as deemed appropriate by the superintendent.
    24  The coverage required by this paragraph shall be identical to, and shall
    25  not enhance or increase the essential health benefit coverage chosen  by
    26  the state pursuant to 45 CFR 156.100. Nothing in this paragraph shall be
    27  construed  to  prevent  the  medical management or utilization review of
    28  benefits  for  medically  necessary  rehabilitative   and   habilitative
    29  purposes.
    30    §  3.  Section  4303  of  the insurance law is amended by adding a new
    31  subsection (ss) to read as follows:
    32    (ss) Every policy which provides medical, major  medical,  or  similar
    33  comprehensive type coverage to a policyholder shall provide coverage for
    34  prosthetic devices that are intended for medically necessary rehabilita-
    35  tive  and habilitative purposes as required by 42 U.S.C. § 18022. Cover-
    36  age shall include the  cost  of  repair  or  replacement  of  prosthetic
    37  devices  due  to  normal  wear and tear, if a prosthetic device has been
    38  outgrown or no longer fits properly, or where a change  in  the  medical
    39  condition  makes  replacement  necessary. Coverage shall not include the
    40  costs of repair or replacement of a prosthetic device  that  is  covered
    41  under the warranty of the manufacturer or when the repair or replacement
    42  is  necessary  due to misuse or negligence. The term "prosthetic device"
    43  as used in this subsection includes an artificial limb,  but  shall  not
    44  include  shoes  or  any  other  article  considered  as ordinary wearing
    45  apparel, whether or not specifically constructed. The term  "policyhold-
    46  er"  as used in this subsection shall mean a veteran of the armed forces
    47  who resides in the state of New York and whose  medical  need  for  such
    48  prosthetic  device resulted from an injury suffered while on active duty
    49  serving in the armed forces. Such coverage shall be  subject  to  annual
    50  deductibles and coinsurance as deemed appropriate by the superintendent.
    51  The  coverage  required  by  this  subsection shall be identical to, and
    52  shall not enhance or increase  the  essential  health  benefit  coverage
    53  chosen  by  the  state  pursuant  to  45  CFR  156.100.  Nothing in this
    54  subsection shall be construed  to  prevent  the  medical  management  or
    55  utilization  review  of  benefits for medically necessary rehabilitative
    56  and habilitative purposes.

        S. 5174                             3
 
     1    § 4. This act shall take effect on the one hundred eightieth day after
     2  it shall have become a law and shall apply  to  policies  and  contracts
     3  issued, renewed, modified, altered or amended on or after such effective
     4  date.
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