S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2897
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 28, 2019
                                ___________
 
 Introduced  by  M.  of  A.  JONES, D'URSO, GALEF, SIMON, LUPARDO, ENGLE-
   BRIGHT, MAGNARELLI, ARROYO, RICHARDSON,  MONTESANO,  COLTON,  PALUMBO,
   M. L. MILLER,  BLANKENBUSH  -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance law,  in  relation  to  requiring  certain
   health  insurance  policies  to  cover costs for pediatric acute-onset
   neuropsychiatric syndrome
 
   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 35 to read as follows:
   (35)(A) EVERY HEALTH PLAN, AND HEALTH INSURANCE ISSUER OFFERING HEALTH
 INSURANCE COVERAGE IN CONNECTION WITH A GROUP HEALTH PLAN, SHALL PROVIDE
 COVERAGE FOR A PARTICIPANT OR BENEFICIARY WHO HAS PEDIATRIC  ACUTE-ONSET
 NEUROPSYCHIATRIC  SYNDROME IF THE ATTENDING PHYSICIAN OF THE PARTICIPANT
 OR BENEFICIARY CERTIFIES  IN  WRITING  THE  MEDICAL  NECESSITY  OF  THAT
 PROPOSED COURSE OF REHABILITATIVE TREATMENT.
   (B) AS USED IN THIS PARAGRAPH, THE TERM "PEDIATRIC ACUTE-ONSET NEUROP-
 SYCHIATRIC SYNDROME" SHALL HAVE THE SAME MEANING AS SUCH TERM IS USED IN
 PARAGRAPH  (N)  OF  SUBDIVISION  ONE OF SECTION TWO HUNDRED SEVEN OF THE
 PUBLIC HEALTH LAW.
   § 2. Subsection (k) of section 3221 of the insurance law is amended by
 adding a new paragraph 22 to read as follows:
   (22) (A) EVERY HEALTH  PLAN,  AND  HEALTH  INSURANCE  ISSUER  OFFERING
 HEALTH  INSURANCE COVERAGE IN CONNECTION WITH A GROUP HEALTH PLAN, SHALL
 PROVIDE COVERAGE FOR A PARTICIPANT  OR  BENEFICIARY  WHO  HAS  PEDIATRIC
 ACUTE-ONSET  NEUROPSYCHIATRIC SYNDROME IF THE ATTENDING PHYSICIAN OF THE
 PARTICIPANT OR BENEFICIARY CERTIFIES IN WRITING THE MEDICAL NECESSITY OF
 THAT PROPOSED COURSE OF REHABILITATIVE TREATMENT.
   (B) AS USED IN THIS PARAGRAPH, THE TERM "PEDIATRIC ACUTE-ONSET NEUROP-
 SYCHIATRIC SYNDROME" SHALL HAVE THE SAME MEANING AS SUCH TERM IS USED IN
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD02904-01-9

 A. 2897                             2
 
 PARAGRAPH (N) OF SUBDIVISION ONE OF SECTION TWO  HUNDRED  SEVEN  OF  THE
 PUBLIC HEALTH LAW.
   §  3.  Section  4303  of  the insurance law is amended by adding a new
 subsection (ss) to read as follows:
   (SS)(1) EVERY HEALTH PLAN, AND HEALTH INSURANCE ISSUER OFFERING HEALTH
 INSURANCE COVERAGE IN CONNECTION WITH A GROUP HEALTH PLAN, SHALL PROVIDE
 COVERAGE FOR A PARTICIPANT OR BENEFICIARY WHO HAS PEDIATRIC  ACUTE-ONSET
 NEUROPSYCHIATRIC  SYNDROME IF THE ATTENDING PHYSICIAN OF THE PARTICIPANT
 OR BENEFICIARY CERTIFIES  IN  WRITING  THE  MEDICAL  NECESSITY  OF  THAT
 PROPOSED COURSE OF REHABILITATIVE TREATMENT.
   (2) AS USED IN THIS PARAGRAPH, THE TERM "PEDIATRIC ACUTE-ONSET NEUROP-
 SYCHIATRIC SYNDROME" SHALL HAVE THE SAME MEANING AS SUCH TERM IS USED IN
 PARAGRAPH  (N)  OF  SUBDIVISION  ONE OF SECTION TWO HUNDRED SEVEN OF THE
 PUBLIC HEALTH LAW.
   § 4. This act shall take effect on the first of January next  succeed-
 ing the date on which it shall have become a law and shall apply accord-
 ing  to  its  terms  to all policies, contracts and certificates issued,
 renewed, modified, altered or amended on or after such effective date.