Bill Text: NY S01315 | 2023-2024 | General Assembly | Introduced
Bill Title: Requires mandatory health insurance coverage for prosthetic devices; requires coverage where the model is determined to be medically necessary for rehabilitative and habilitative purposes.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced) 2024-01-03 - REFERRED TO INSURANCE [S01315 Detail]
Download: New_York-2023-S01315-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 1315 2023-2024 Regular Sessions IN SENATE January 11, 2023 ___________ 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 39 to read as follows: 3 (39) 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. LBD05098-01-3S. 1315 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 22 to read as follows: 5 (22) 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 (uu) to read as follows: 32 (uu) 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. 1315 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.
