S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  1178

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                             January 8, 2015
                               ___________

Introduced by M. of A. GUNTHER, ORTIZ, ROSENTHAL, WRIGHT, JAFFEE, PERRY,
  CLARK,  HOOPER, DINOWITZ, ZEBROWSKI, TITONE, RIVERA, ABINANTI, COLTON,
  DenDEKKER, McKEVITT, DUPREY, RAIA -- Multi-Sponsored by --  M.  of  A.
  ABBATE,  BENEDETTO,  COOK,  CROUCH,  CUSICK, GALEF, GIGLIO, GOTTFRIED,
  MAGNARELLI, McDONOUGH, PAULIN, SCARBOROUGH, SCHIMEL, SKARTADOS, THIELE
  -- read once and referred 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:

  Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
amended by adding a new paragraph 32 to read as follows:
  (32)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE  EQUAL  TO  OR  ABOVE
MEDICARE'S  STANDARD  OF  COVERAGE  FOR PROSTHETIC DEVICES.   THIS SHALL
INCLUDE COVERAGE NOT ONLY FOR  THE  PROVISION  OF  A  PROSTHETIC  DEVICE
REQUIRED  TO  BE  WORN OR USED BY A POLICY HOLDER BUT ALSO THE REPAIR OR
REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE  WORN  OR  USED  BY  A
POLICY  HOLDER.  COVERAGE  SHALL INCLUDE EXPENSES FOR ASSESSMENT, EVALU-
ATION, TREATMENT, MANAGEMENT, AND FOLLOW-UP CARE. COVERAGE SHALL NOT  BE
DENIED  ON  THE  GROUND THAT IT IS FOR COSMETIC PURPOSES OR IS NOT FOR A
FUNCTIONAL DEFECT OR IMPAIRMENT. THE TERM "PROSTHETIC DEVICE" AS USED IN
THIS SECTION INCLUDES AN ARTIFICIAL LIMB OR ARTIFICIAL EYE BUT SHALL NOT
INCLUDE SHOES OR  ANY  OTHER  ARTICLE  CONSIDERED  AS  ORDINARY  WEARING
APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED.
  S 2. Subsection (l) of section 3221 of the insurance law is amended by
adding a new paragraph 19 to read as follows:
  (19)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE  EQUAL  TO  OR  ABOVE
MEDICARE'S  STANDARD  OF  COVERAGE  FOR PROSTHETIC DEVICES.   THIS SHALL
INCLUDE COVERAGE NOT ONLY FOR  THE  PROVISION  OF  A  PROSTHETIC  DEVICE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00990-02-5
              

A. 1178                             2

REQUIRED  TO  BE  WORN OR USED BY A POLICY HOLDER BUT ALSO THE REPAIR OR
REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE  WORN  OR  USED  BY  A
POLICY  HOLDER.  COVERAGE  SHALL INCLUDE EXPENSES FOR ASSESSMENT, EVALU-
ATION,  TREATMENT, MANAGEMENT, AND FOLLOW-UP CARE. COVERAGE SHALL NOT BE
DENIED ON THE GROUND THAT IT IS FOR COSMETIC PURPOSES OR IS  NOT  FOR  A
FUNCTIONAL DEFECT OR IMPAIRMENT. THE TERM "PROSTHETIC DEVICE" AS USED IN
THIS SECTION INCLUDES AN ARTIFICIAL LIMB OR ARTIFICIAL EYE BUT SHALL NOT
INCLUDE  SHOES  OR  ANY  OTHER  ARTICLE  CONSIDERED  AS ORDINARY WEARING
APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED.
  S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (pp) to read as follows:
  (PP)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE  EQUAL  TO  OR  ABOVE
MEDICARE'S  STANDARD  OF  COVERAGE  FOR PROSTHETIC DEVICES.   THIS SHALL
INCLUDE COVERAGE NOT ONLY FOR  THE  PROVISION  OF  A  PROSTHETIC  DEVICE
REQUIRED  TO  BE  WORN OR USED BY A POLICY HOLDER BUT ALSO THE REPAIR OR
REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE  WORN  OR  USED  BY  A
POLICY  HOLDER.  COVERAGE  SHALL INCLUDE EXPENSES FOR ASSESSMENT, EVALU-
ATION, TREATMENT, MANAGEMENT, AND FOLLOW-UP CARE. COVERAGE SHALL NOT  BE
DENIED  ON  THE  GROUND THAT IT IS FOR COSMETIC PURPOSES OR IS NOT FOR A
FUNCTIONAL DEFECT OR IMPAIRMENT. THE TERM "PROSTHETIC DEVICE" AS USED IN
THIS SECTION INCLUDES AN ARTIFICIAL LIMB OR ARTIFICIAL EYE BUT SHALL NOT
INCLUDE SHOES OR  ANY  OTHER  ARTICLE  CONSIDERED  AS  ORDINARY  WEARING
APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED.
  S  4.  This  act shall take effect on the ninetieth day after it shall
have become a law and shall apply  to  policies  and  contracts  issued,
renewed, modified, altered or amended on or after such effective date.

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 1178--A

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                             January 8, 2015
                               ___________

Introduced by M. of A. GUNTHER, ORTIZ, ROSENTHAL, WRIGHT, JAFFEE, PERRY,
  CLARK,  HOOPER, DINOWITZ, ZEBROWSKI, TITONE, RIVERA, ABINANTI, COLTON,
  DenDEKKER, McKEVITT, DUPREY, RAIA, LAVINE -- Multi-Sponsored by --  M.
  of  A.  ABBATE,  BENEDETTO, COOK, CROUCH, CUSICK, GALEF, GIGLIO, GOTT-
  FRIED, MAGNARELLI, McDONOUGH, MONTESANO, PAULIN,  SCHIMEL,  SKARTADOS,
  THIELE  --  read  once  and  referred to the Committee on Insurance --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted to said committee

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:

  Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
amended by adding a new paragraph 32 to read as follows:
  (32) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR  MEDICAL,  OR  SIMILAR
COMPREHENSIVE  TYPE  COVERAGE  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC
DEVICES THAT ARE INTENDED FOR  MEDICALLY  NECESSARY  REHABILITATIVE  AND
HABILITATIVE  PURPOSES  AS REQUIRED BY 42 U.S.C. S 18022. COVERAGE SHALL
NOT BE DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC
DEVICE ADEQUATELY MEETS THE  MEDICAL  NEEDS  OF  THE  POLICY  HOLDER  IN
COMPLIANCE  WITH  THE  AGE,  DISABILITY  AND  EXPECTED  LENGTH  OF  LIFE
ANTI-DISCRIMINATION REQUIREMENTS OF 42 U.S.C. S 18022(B)(4)(B)  AND  THE
REQUIREMENT TO CONSIDER THE HEALTH CARE NEEDS OF DIVERSE SEGMENTS OF THE
POPULATION, INCLUDING PERSONS WITH DISABILITIES, PURSUANT TO 42 U.S.C. S
18022(B)(4)(C).  THE  TERM "PROSTHETIC DEVICE" AS USED IN THIS PARAGRAPH
INCLUDES AN ARTIFICIAL LIMB BUT SHALL NOT INCLUDE  SHOES  OR  ANY  OTHER
ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL, WHETHER OR NOT SPECIALLY
CONSTRUCTED.  SUCH  COVERAGE  SHALL BE SUBJECT TO ANNUAL DEDUCTIBLES AND
COINSURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.   THE  COVERAGE
REQUIRED  BY THIS PARAGRAPH SHALL BE IDENTICAL TO, AND SHALL NOT ENHANCE
OR INCREASE THE COVERAGE REQUIRED AS PART OF ESSENTIAL  HEALTH  BENEFITS

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00990-03-5
              

A. 1178--A                          2

AS  REQUIRED  PURSUANT TO SECTION 2707 (A) OF THE PUBLIC HEALTH SERVICES
ACT 42 U.S.C. 300 GG-6(A).
  S 2. Subsection (l) of section 3221 of the insurance law is amended by
adding a new paragraph 19 to read as follows:
  (19)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE  TYPE  COVERAGE  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC
DEVICES  THAT  ARE  INTENDED  FOR MEDICALLY NECESSARY REHABILITATIVE AND
HABILITATIVE PURPOSES AS REQUIRED BY 42 U.S.C. S 18022.  COVERAGE  SHALL
NOT BE DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC
DEVICE  ADEQUATELY  MEETS  THE  MEDICAL  NEEDS  OF  THE POLICY HOLDER IN
COMPLIANCE  WITH  THE  AGE,  DISABILITY  AND  EXPECTED  LENGTH  OF  LIFE
ANTI-DISCRIMINATION  REQUIREMENTS  OF 42 U.S.C. S 18022(B)(4)(B) AND THE
REQUIREMENT TO CONSIDER THE HEALTH CARE NEEDS OF DIVERSE SEGMENTS OF THE
POPULATION, INCLUDING PERSONS WITH DISABILITIES, PURSUANT TO 42 U.S.C. S
18022(B)(4)(C). THE TERM "PROSTHETIC DEVICE" AS USED IN  THIS  PARAGRAPH
INCLUDES  AN  ARTIFICIAL  LIMB  BUT SHALL NOT INCLUDE SHOES OR ANY OTHER
ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL, WHETHER OR NOT SPECIALLY
CONSTRUCTED. SUCH COVERAGE SHALL BE SUBJECT TO  ANNUAL  DEDUCTIBLES  AND
COINSURANCE  AS  DEEMED APPROPRIATE BY THE SUPERINTENDENT.  THE COVERAGE
REQUIRED BY THIS PARAGRAPH SHALL BE IDENTICAL TO, AND SHALL NOT  ENHANCE
OR  INCREASE  THE COVERAGE REQUIRED AS PART OF ESSENTIAL HEALTH BENEFITS
AS REQUIRED PURSUANT TO SECTION 2707 (A) OF THE PUBLIC  HEALTH  SERVICES
ACT 42 U.S.C. 300 GG-6(A).
  S  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (pp) to read as follows:
  (PP) EVERY CONTRACT WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR  SIMILAR
COMPREHENSIVE  TYPE  COVERAGE  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC
DEVICES THAT ARE INTENDED FOR  MEDICALLY  NECESSARY  REHABILITATIVE  AND
HABILITATIVE  PURPOSES  AS REQUIRED BY 42 U.S.C. S 18022. COVERAGE SHALL
NOT BE DENIED IF THE CONTRACT HOLDER'S PHYSICIAN  DETERMINES  THE  PROS-
THETIC  DEVICE ADEQUATELY MEETS THE MEDICAL NEEDS OF THE CONTRACT HOLDER
IN COMPLIANCE WITH THE AGE,  DISABILITY  AND  EXPECTED  LENGTH  OF  LIFE
ANTI-DISCRIMINATION  REQUIREMENTS  OF 42 U.S.C. S 18022(B)(4)(B) AND THE
REQUIREMENT TO CONSIDER THE HEALTH CARE NEEDS OF DIVERSE SEGMENTS OF THE
POPULATION, INCLUDING PERSONS WITH DISABILITIES, PURSUANT TO 42 U.S.C. S
18022(B)(4)(C). THE TERM "PROSTHETIC DEVICE" AS USED IN THIS  SUBSECTION
INCLUDES  AN  ARTIFICIAL  LIMB  BUT SHALL NOT INCLUDE SHOES OR ANY OTHER
ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL, WHETHER OR NOT SPECIALLY
CONSTRUCTED. SUCH COVERAGE SHALL BE SUBJECT TO  ANNUAL  DEDUCTIBLES  AND
COINSURANCE  AS  DEEMED APPROPRIATE BY THE SUPERINTENDENT.  THE COVERAGE
REQUIRED BY THIS SUBSECTION SHALL BE IDENTICAL TO, AND SHALL NOT ENHANCE
OR INCREASE THE COVERAGE REQUIRED AS PART OF ESSENTIAL  HEALTH  BENEFITS
AS  REQUIRED  PURSUANT  TO SECTION 2707(A) OF THE PUBLIC HEALTH SERVICES
ACT 42 U.S.C. 300 GG-6(A).
  S 4. This act shall take effect on the ninetieth day  after  it  shall
have  become  a  law  and  shall apply to policies and contracts issued,
renewed, modified, altered or amended on or after such effective date.

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 1178--B

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                             January 8, 2015
                               ___________

Introduced by M. of A. GUNTHER, ORTIZ, ROSENTHAL, WRIGHT, JAFFEE, PERRY,
  CLARK,  HOOPER, DINOWITZ, ZEBROWSKI, TITONE, RIVERA, ABINANTI, COLTON,
  DenDEKKER, McKEVITT, DUPREY, RAIA, LAVINE, SALADINO, LALOR  --  Multi-
  Sponsored  by  --  M.  of  A. ABBATE, BENEDETTO, COOK, CROUCH, CUSICK,
  GALEF, GIGLIO, GOTTFRIED, MAGNARELLI,  McDONOUGH,  MONTESANO,  PAULIN,
  SCHIMEL,  SKARTADOS, THIELE -- read once and referred to the Committee
  on Insurance -- committee discharged, bill amended, ordered  reprinted
  as  amended and recommitted to said committee -- reported and referred
  to the Committee on Ways and Means -- reported  and  referred  to  the
  Committee  on  Rules  --  Rules  Committee  discharged,  bill amended,
  ordered reprinted as amended and recommitted to the Committee on Rules

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:

  Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
amended by adding a new paragraph 32 to read as follows:
  (32)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE  TYPE  COVERAGE  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC
DEVICES,  INCLUDING  REPAIRS  AND  REPLACEMENTS,  THAT  ARE INTENDED FOR
MEDICALLY NECESSARY REHABILITATIVE AND HABILITATIVE PURPOSES AS REQUIRED
BY 42 U.S.C. S18022.  AS  SUCH,  PROSTHETIC  DEVICE  COVERAGE  SHALL  BE
SUBJECT  TO  ANNUAL DEDUCTIBLES AND COINSURANCE AS DEEMED APPROPRIATE BY
THE SUPERINTENDENT IN AMOUNTS NO GREATER  THAN  OTHER  ESSENTIAL  HEALTH
BENEFITS  COVERED BY THE POLICY. THE TERM "PROSTHETIC DEVICE" AS USED IN
THIS PARAGRAPH INCLUDES AN ARTIFICIAL LIMB AND ALL OF THE COMPONENTS AND
RELATED SERVICES THAT COMPRISE PROSTHETIC CARE  BUT  SHALL  NOT  INCLUDE
SHOES  OR  ANY  OTHER  ARTICLE  CONSIDERED  AS ORDINARY WEARING APPAREL,
WHETHER OR NOT SPECIALLY CONSTRUCTED.
  S 2. Subsection (l) of section 3221 of the insurance law is amended by
adding a new paragraph 19 to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00990-05-5
              

A. 1178--B                          2

  (19) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR  MEDICAL,  OR  SIMILAR
COMPREHENSIVE  TYPE  COVERAGE  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC
DEVICES, INCLUDING REPAIRS  AND  REPLACEMENTS,  THAT  ARE  INTENDED  FOR
MEDICALLY NECESSARY REHABILITATIVE AND HABILITATIVE PURPOSES AS REQUIRED
BY  42  U.S.C.  S18022.  AS  SUCH,  PROSTHETIC  DEVICE COVERAGE SHALL BE
SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS DEEMED  APPROPRIATE  BY
THE  SUPERINTENDENT  IN  AMOUNTS  NO GREATER THAN OTHER ESSENTIAL HEALTH
BENEFITS COVERED BY THE POLICY. THE TERM "PROSTHETIC DEVICE" AS USED  IN
THIS PARAGRAPH INCLUDES AN ARTIFICIAL LIMB AND ALL OF THE COMPONENTS AND
RELATED  SERVICES  THAT  COMPRISE  PROSTHETIC CARE BUT SHALL NOT INCLUDE
SHOES OR ANY OTHER  ARTICLE  CONSIDERED  AS  ORDINARY  WEARING  APPAREL,
WHETHER OR NOT SPECIALLY CONSTRUCTED.
  S  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (pp) to read as follows:
  (PP) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR  MEDICAL,  OR  SIMILAR
COMPREHENSIVE  TYPE  COVERAGE  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC
DEVICES, INCLUDING REPAIRS  AND  REPLACEMENTS,  THAT  ARE  INTENDED  FOR
MEDICALLY NECESSARY REHABILITATIVE AND HABILITATIVE PURPOSES AS REQUIRED
BY  42  U.S.C.  S18022.  AS  SUCH,  PROSTHETIC  DEVICE COVERAGE SHALL BE
SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS DEEMED  APPROPRIATE  BY
THE  SUPERINTENDENT  IN  AMOUNTS  NO GREATER THAN OTHER ESSENTIAL HEALTH
BENEFITS COVERED BY THE POLICY. THE TERM "PROSTHETIC DEVICE" AS USED  IN
THIS  SUBSECTION  INCLUDES  AN ARTIFICIAL LIMB AND ALL OF THE COMPONENTS
AND RELATED SERVICES THAT COMPRISE PROSTHETIC CARE BUT SHALL NOT INCLUDE
SHOES OR ANY OTHER  ARTICLE  CONSIDERED  AS  ORDINARY  WEARING  APPAREL,
WHETHER OR NOT SPECIALLY CONSTRUCTED.
  S  4.  This  act shall take effect on the ninetieth day after it shall
have become a law and shall apply  to  policies  and  contracts  issued,
renewed, modified, altered or amended on or after such effective date.