Assembly Bill A9539

2023-2024 Legislative Session

Requires insurers to provide insurance coverage for rare diseases, life-threatening conditions or diseases, degenerative and disabling conditions, or diagnoses involving medically fragile children

download bill text pdf

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Current Bill Status - On Floor Calendar


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2023-A9539 (ACTIVE) - Details

See Senate Version of this Bill:
S8957
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L; add §4406-j, Pub Health L

2023-A9539 (ACTIVE) - Summary

Requires insurers to provide insurance coverage for treatment of rare diseases, life-threatening conditions or diseases, degenerative and disabling conditions, or diagnoses involving medically fragile children, by a provider of the patient's choice.

2023-A9539 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9539
 
                           I N  A S S E M B L Y
 
                              March 20, 2024
                                ___________
 
 Introduced  by  M.  of  A.  EICHENSTEIN -- read once and referred to the
   Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to providing insurance coverage for  rare  diseases,  life-threatening
   conditions  or  diseases,  degenerative  and  disabling conditions, or
   diagnoses involving medically fragile children

   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 POLICY WHICH PROVIDES HOSPITAL,  SURGICAL,  MEDICAL  OR
 MAJOR  MEDICAL  COVERAGE  SHALL PROVIDE COVERAGE FOR MEDICALLY NECESSARY
 SERVICES FROM A CHOSEN PROVIDER FOR A CONFIRMED DIAGNOSIS THAT IS DEEMED
 TO BE A RARE DISEASE, LIFE-THREATENING CONDITION OR  DISEASE,  DEGENERA-
 TIVE  AND  DISABLING  CONDITION,  OR INVOLVES A MEDICALLY FRAGILE CHILD,
 WITH NO RESTRICTION TO A PLAN NETWORK, IF THE FOLLOWING  CONDITIONS  ARE
 MET:
   (I) (A) THE COSTS OF THE CHOSEN PROVIDER ARE EQUAL TO OR LESS THAN THE
 AVERAGE  COST  THAT  WOULD  HAVE  OTHERWISE BEEN PAID TO A LOCAL NETWORK
 PROVIDER WHO POSSESSES A SIMILAR SUBSPECIALTY AS SUCH  CHOSEN  PROVIDER;
 AND
   (B)  THE  PATIENT'S  TREATING  SPECIALIST  OR  PRIMARY  CARE  PROVIDER
 PROVIDES A WRITTEN STATEMENT TO RECOMMEND THE CHOSEN  PROVIDER  FOR  THE
 PARTICULAR DISEASE.
   (II)  THE  CHOSEN  PROVIDER  OR  THE  PATIENT'S PRIMARY CARE PHYSICIAN
 PROVIDES ADVANCE NOTICE TO  SUCH  PATIENT'S  NETWORK  PLAN  PRIOR  TO  A
 PLANNED PROCEDURE COVERED PURSUANT TO THIS PARAGRAPH.
   (III)  THE  CHOSEN PROVIDER IS ACCREDITED OR DESIGNATED BY THE DEPART-
 MENT OF HEALTH, THE FEDERAL GOVERNMENT, OR A VOLUNTARY  NATIONAL  HEALTH
 ORGANIZATION  AS  HAVING  SPECIAL  EXPERTISE  IN TREATING, OR HAS DEMON-
 STRATED A CLINICAL FOCUS IN THE AREA OF,  THE  CONFIRMED  DIAGNOSIS  FOR
 WHICH  COVERAGE IS SOUGHT PURSUANT TO THIS PARAGRAPH.  PROVIDED HOWEVER,
 THAT NOTHING IN THIS PARAGRAPH SHALL REQUIRE SUCH CHOSEN PROVIDER TO  BE
 PARTICIPATING  IN  THE  PATIENT'S  NETWORK  OR LOCATED WITHIN THE STATE;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

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