S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1065
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 7, 2021
                                ___________
 
 Introduced by M. of A. PAULIN, COLTON, CAHILL, ABINANTI, GALEF, PRETLOW,
   WEPRIN,  J. RIVERA, GOODELL, MAGNARELLI, GUNTHER -- Multi-Sponsored by
   -- M. of A. ENGLEBRIGHT, GOTTFRIED, PERRY -- read once and referred to
   the Committee on Insurance
 
 AN ACT to amend the insurance law, in  relation  to  coverage  of  early
   intervention services

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (a) of section 3235-a of the insurance  law,  as
 added  by  section  3  of  part  C  of chapter 1 of the laws of 2002, is
 amended and two new subsections  (e)  and  (f)  are  added  to  read  as
 follows:
   (a)  No  policy  of accident and health insurance, including contracts
 issued pursuant to article forty-three of this  chapter,  shall  exclude
 coverage  for  otherwise  covered services [solely on the basis that the
 services  constitute  early  intervention  program  services]  THAT  ARE
 PROVIDED  under  title two-A of article twenty-five of the public health
 law.
   (E) WHERE A SERVICE PROVIDED TO AN  INSURED  UNDER  THE  EARLY  INTER-
 VENTION  PROGRAM  IS  A  COVERED  SERVICE  UNDER THE INSURER'S POLICY OR
 CONTRACT, THE INDIVIDUALIZED FAMILY SERVICES PLAN, UPON CERTIFICATION BY
 THE EARLY INTERVENTION  OFFICIAL,  AS  DEFINED  IN  SECTION  TWENTY-FIVE
 HUNDRED FORTY-ONE OF THE PUBLIC HEALTH LAW, OR SUCH OFFICIAL'S DESIGNEE,
 SHALL  BE  DEEMED  TO  MEET  ANY PRECERTIFICATION, PREAUTHORIZATION, AND
 MEDICAL NECESSITY REQUIREMENTS IMPOSED ON BENEFITS UNDER THE  POLICY  OR
 CONTRACT;  PROVIDED,  HOWEVER,  THAT THE PROVIDER SHALL REMOVE OR REDACT
 ANY  INFORMATION  CONTAINED  IN  THE  INSURED'S  INDIVIDUALIZED   FAMILY
 SERVICES  PLAN THAT IS NOT REQUIRED BY THE INSURER FOR PAYMENT PURPOSES.
 PAYMENT FOR A SERVICE COVERED UNDER  THE  POLICY  OR  CONTRACT  THAT  IS
 PROVIDED  UNDER  THE EARLY INTERVENTION PROGRAM SHALL BE AT RATES ESTAB-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01967-01-1
              

 A. 1065                             2
 
 LISHED BY THE COMMISSIONER OF HEALTH FOR SUCH SERVICE PURSUANT TO  REGU-
 LATIONS.
   (F)  NO  INSURER, INCLUDING A HEALTH MAINTENANCE ORGANIZATION ISSUED A
 CERTIFICATE OF AUTHORITY UNDER ARTICLE FORTY-FOUR OF THE  PUBLIC  HEALTH
 LAW  AND A CORPORATION ORGANIZED UNDER ARTICLE FORTY-THREE OF THIS CHAP-
 TER, SHALL DENY PAYMENT OF AN EARLY  INTERVENTION  CLAIM  BASED  ON  THE
 FOLLOWING:
   (1) THE LOCATION WHERE SERVICES ARE PROVIDED;
   (2)  THE  DURATION  OF  THE  CHILD'S CONDITION AND/OR THAT THE CHILD'S
 CONDITION IS NOT AMENABLE TO SIGNIFICANT IMPROVEMENT  WITHIN  A  CERTAIN
 PERIOD OF TIME AS SPECIFIED IN THE POLICY; OR
   (3)  THAT  THE  PROVIDER OF SERVICES IS NOT A NETWORK OR PARTICIPATING
 PROVIDER.
   § 2. This act shall take effect immediately.