S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2823
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 27, 2023
                                ___________
 
 Introduced by M. of A. JONES, SIMON, LUPARDO, MAGNARELLI, COLTON, BLANK-
   ENBUSH -- 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 39 to read as follows:
   (39)(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 23 to read as follows:
   (23)  (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.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07308-01-3
              

 A. 2823                             2
 
   § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (uu) to read as follows:
   (UU)(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  SUBSECTION,  THE  TERM  "PEDIATRIC  ACUTE-ONSET
 NEUROPSYCHIATRIC  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.