Bill Text: NY A02962 | 2019-2020 | General Assembly | Introduced

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Bill Title: Relates to insurance coverage of early intervention services.

Spectrum: Strong Partisan Bill (Democrat 15-1)

Status: (Introduced - Dead) 2020-01-08 - referred to insurance [A02962 Detail]

Download: New_York-2019-A02962-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          2962
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                    January 28, 2019
                                       ___________
        Introduced  by M. of A. PAULIN, COLTON, CAHILL, ABINANTI, JAFFEE, GALEF,
          PRETLOW,  WEPRIN,  ORTIZ,  RIVERA,  GOODELL,  MAGNARELLI,  GUNTHER  --
          Multi-Sponsored  by  -- M. of A. ENGLEBRIGHT, GOTTFRIED, PERRY -- 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  (e)  and  (f)  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    (e) 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 provider shall remove or redact
    19  any  information  contained  in  the  insured's  individualized   family
    20  services  plan that is not required by the insurer for payment purposes.
    21  Payment for a service covered under  the  policy  or  contract  that  is
    22  provided  under  the early intervention program shall be at rates estab-
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00618-01-9
        A. 2962                             2
     1  lished by the commissioner of health for such service pursuant to  regu-
     2  lations.
     3    (f)  No  insurer, including a health maintenance organization issued a
     4  certificate of authority under article forty-four of the  public  health
     5  law  and a corporation organized under article forty-three of this chap-
     6  ter, shall deny payment of an early  intervention  claim  based  on  the
     7  following:
     8    (1) the location where services are provided;
     9    (2)  the  duration  of  the  child's condition and/or that the child's
    10  condition is not amenable to significant improvement  within  a  certain
    11  period of time as specified in the policy; or
    12    (3)  that  the  provider of services is not a network or participating
    13  provider.
    14    § 2. This act shall take effect immediately.