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

                                  7549

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                              May 18, 2015
                               ___________

Introduced by M. of A. CRESPO -- read once and referred to the Committee
  on Insurance

AN  ACT  to  amend  the  insurance  law, in relation to mandatory health
  insurance coverage for 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
AS REQUIRED PURSUANT TO SECTION 2707(A) OF THE  PUBLIC  HEALTH  SERVICES
ACT  42  U.S.C. S 300 GG-6(A).  THE TERM "POLICY HOLDER" AS USED IN THIS
PARAGRAPH SHALL MEAN A VETERAN OF THE ARMED FORCES WHO  RESIDES  IN  THE
STATE  OF  NEW  YORK  AND  WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE
RESULTED FROM AN INJURY SUFFERED IN THE LINE OF DUTY  WHILE  SERVING  IN
THE ARMED FORCES.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11218-01-5
              

A. 7549                             2

  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. S 300 GG-6(A).  THE TERM "POLICY HOLDER" AS USED  IN  THIS
PARAGRAPH  SHALL  MEAN  A VETERAN OF THE ARMED FORCES WHO RESIDES IN THE
STATE OF NEW YORK AND WHOSE MEDICAL  NEED  FOR  SUCH  PROSTHETIC  DEVICE
RESULTED  FROM  AN  INJURY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN
THE ARMED FORCES.
  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  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
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 DEDUCT-
IBLES 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. S 300 GG-6(A).  THE TERM "POLICY HOLDER" AS USED
IN THIS SUBSECTION SHALL MEAN A VETERAN OF THE ARMED FORCES WHO  RESIDES
IN  THE  STATE  OF  NEW  YORK AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC
DEVICE RESULTED FROM AN INJURY SUFFERED IN THE LINE OF DUTY WHILE  SERV-
ING IN THE ARMED FORCES.
  S  4.  This  act  shall take effect May 1, 2016 and shall apply to all
policies and contracts issued, renewed, altered, or amended on or  after
such effective date.