Bill Text: NY S06045 | 2017-2018 | General Assembly | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relates to coverage for eating disorders; requires comparable coverage for adults and children with eating disorders; defines eating disorder.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2018-04-13 - PRINT NUMBER 6045C [S06045 Detail]

Download: New_York-2017-S06045-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                         6045--B
                               2017-2018 Regular Sessions
                    IN SENATE
                                      May 10, 2017
                                       ___________
        Introduced  by  Sens.  MARCHIONE,  RANZENHOFER -- read twice and ordered
          printed, and when printed to be committed to the Committee  on  Insur-
          ance  --  committee  discharged,  bill  amended,  ordered reprinted as
          amended and recommitted to said  committee  --  committee  discharged,
          bill  amended,  ordered  reprinted  as amended and recommitted to said
          committee
        AN ACT to amend the insurance law, in relation to  coverage  for  eating
          disorders
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Subparagraph (B)  of  paragraph  5  of  subsection  (1)  of
     2  section 3221 of the insurance law, as amended by chapter 502 of the laws
     3  of 2007, is amended to read as follows:
     4    (B)  (i)  Every insurer delivering a group or school blanket policy or
     5  issuing a group or school blanket policy for delivery,  in  this  state,
     6  which  provides  coverage  for  inpatient  hospital care or coverage for
     7  physician services, shall provide comparable  coverage  for  adults  and
     8  children  with  biologically based mental illness or an eating disorder.
     9  Such group policies issued or delivered in this state shall also provide
    10  such comparable coverage for children with  serious  emotional  disturb-
    11  ances.  Such  coverage  shall be provided under the terms and conditions
    12  otherwise applicable under the policy, including network limitations  or
    13  variations,  exclusions,  co-pays,  coinsurance,  deductibles  or  other
    14  specific cost sharing  mechanisms.  Provided  further,  where  a  policy
    15  provides both in-network and out-of-network benefits, the out-of-network
    16  benefits  may  have different coinsurance, co-pays, or deductibles, than
    17  the in-network benefits, regardless of whether  the  policy  is  written
    18  under one license or two licenses.
    19    (ii)  For  purposes  of  this  paragraph, the term "biologically based
    20  mental illness" means a mental, nervous, or emotional condition that  is
    21  caused by a biological disorder of the brain and results in a clinically
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD06526-05-7
        S. 6045--B                          2
     1  significant, psychological syndrome or pattern that substantially limits
     2  the  functioning of the person with the illness. Such biologically based
     3  mental illnesses are defined as schizophrenia/psychotic disorders, major
     4  depression,  bipolar  disorder,  delusional  disorders,  panic disorder,
     5  obsessive compulsive disorders[, bulimia, and  anorexia]  or  an  eating
     6  disorder.
     7    (iii) For purposes of this paragraph, the term "eating disorder" means
     8  pica,  rumination  disorder,  avoidant/restrictive food intake disorder,
     9  anorexia nervosa, bulimia nervosa, binge eating disorder,  other  speci-
    10  fied feeding or eating disorder, and any other eating disorder contained
    11  in  the  most recent version of the Diagnostic and Statistical Manual of
    12  Mental Disorders published by the American Psychiatric Association.
    13    § 2. Paragraph 2 of subsection (g) of section 4303  of  the  insurance
    14  law,  as  amended by chapter 502 of the laws of 2007, is amended to read
    15  as follows:
    16    (2) (A) A hospital service corporation  or  a  health  service  corpo-
    17  ration,  which provides group, group remittance or school blanket cover-
    18  age for inpatient hospital care, shall provide comparable  coverage  for
    19  adults  and children with biologically based mental illness or an eating
    20  disorder. Such hospital service corporation  or  health  service  corpo-
    21  ration  shall  also  provide  such comparable coverage for children with
    22  serious emotional disturbances. Such coverage shall  be  provided  under
    23  the  terms  and  conditions  otherwise  applicable  under  the contract,
    24  including network limitations or variations, exclusions, co-pays,  coin-
    25  surance, deductibles or other specific cost sharing mechanisms. Provided
    26  further,  where  a  contract provides both in-network and out-of-network
    27  benefits, the out-of-network benefits may  have  different  coinsurance,
    28  co-pays,  or  deductibles,  than  the in-network benefits, regardless of
    29  whether the contract is written under one license or two licenses.
    30    (B) For purposes of this  subsection,  the  term  "biologically  based
    31  mental  illness" means a mental, nervous, or emotional condition that is
    32  caused by a biological disorder of the brain and results in a clinically
    33  significant, psychological syndrome or pattern that substantially limits
    34  the functioning of the person with the illness. Such biologically  based
    35  mental illnesses are defined as schizophrenia/psychotic disorders, major
    36  depression,  bipolar  disorder,  delusional  disorders,  panic disorder,
    37  obsessive compulsive disorders[, anorexia, and  bulimia]  or  an  eating
    38  disorder.
    39    (C)  For purposes of this subsection, the term "eating disorder" means
    40  pica, rumination disorder, avoidant/restrictive  food  intake  disorder,
    41  anorexia  nervosa,  bulimia nervosa, binge eating disorder, other speci-
    42  fied feeding or eating disorder, and any other eating disorder contained
    43  in the most recent version of the Diagnostic and Statistical  Manual  of
    44  Mental Disorders published by the American Psychiatric Association.
    45    §  3.  Paragraph  2 of subsection (h) of section 4303 of the insurance
    46  law, as amended by chapter 502 of the laws of 2007, is amended  to  read
    47  as follows:
    48    (2)  (A)  A  medical expense indemnity corporation or a health service
    49  corporation, which provides group, group remittance  or  school  blanket
    50  coverage  for  physician services, shall provide comparable coverage for
    51  adults and children with biologically based mental illness or an  eating
    52  disorder.  Such  medical expense indemnity corporation or health service
    53  corporation shall also provide such  comparable  coverage  for  children
    54  with  serious  emotional  disturbances.  Such coverage shall be provided
    55  under the terms and conditions otherwise applicable under the  contract,
    56  including  network limitations or variations, exclusions, co-pays, coin-
        S. 6045--B                          3
     1  surance, deductibles or other specific cost sharing mechanisms. Provided
     2  further, where a contract provides both  in-network  and  out-of-network
     3  benefits,  the  out-of-network  benefits may have different coinsurance,
     4  co-pays,  or  deductibles,  than  the in-network benefits, regardless of
     5  whether the contract is written under one license or two licenses.
     6    (B) For purposes of this  subsection,  the  term  "biologically  based
     7  mental  illness" means a mental, nervous, or emotional condition that is
     8  caused by a biological disorder of the brain and results in a clinically
     9  significant, psychological syndrome or pattern that substantially limits
    10  the functioning of the person with the illness. Such biologically  based
    11  mental illnesses are defined as schizophrenia/psychotic disorders, major
    12  depression,  bipolar  disorder,  delusional  disorders,  panic disorder,
    13  obsessive compulsive disorder[, anorexia,  and  bulimia]  or  an  eating
    14  disorder.
    15    (C)  For purposes of this subsection, the term "eating disorder" means
    16  pica, rumination disorder, avoidant/restrictive  food  intake  disorder,
    17  anorexia  nervosa,  bulimia nervosa, binge eating disorder, other speci-
    18  fied feeding or eating disorder, and any other eating disorder contained
    19  in the most recent version of the Diagnostic and Statistical  Manual  of
    20  Mental Disorders published by the American Psychiatric Association.
    21    §  4.  This  act shall take effect on the ninetieth day after it shall
    22  have become a law; provided, however, that the provisions  of  this  act
    23  shall apply to policies and contracts issued, renewed, modified, altered
    24  or amended on or after such effective date.