S T A T E   O F   N E W   Y O R K
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                                  3719

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 28, 2009
                               ___________

Introduced  by M. of A. PAULIN, BRODSKY, CAHILL, GALEF, PRETLOW, JAFFEE,
  LATIMER, PHEFFER -- Multi-Sponsored by -- M. of A.  BOYLAND,  BRENNAN,
  DIAZ,  HOOPER,  JOHN,  KOON,  McENENY, ORTIZ, J. RIVERA, WEISENBERG --
  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. 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 to read as
follows:
  S 3235-a. Payment for early intervention services. (a)  No  policy  of
accident  and  health  insurance, including contracts issued pursuant to
article forty-three of this chapter, shall exclude coverage  for  other-
wise  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.
  (b) Where a policy of  accident  and  health  insurance,  including  a
contract  issued  pursuant  to  article  forty-three  of  this  chapter,
provides coverage for an early intervention program service, such cover-
age shall not be applied against any maximum annual or lifetime monetary
limits set forth in such policy or contract. Visit limitations and other
terms and conditions of the policy  will  continue  to  apply  to  early
intervention  services.  However, any visits used for early intervention
program services shall not reduce the number of visits otherwise  avail-
able under the policy or contract for such services.
  (c) Any right of subrogation to benefits which a municipality is enti-
tled  in  accordance  with paragraph (d) of subdivision three of section
twenty-five hundred fifty-nine of the public health law shall  be  valid
and  enforceable to the extent benefits are available under any accident
and health insurance policy. The right of subrogation does not attach to

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01427-03-9
              

A. 3719                             2

insurance benefits paid or provided under any accident and health insur-
ance policy prior to receipt by the insurer of written notice  from  the
municipality.  UPON  THE  INSURER'S  RECEIPT  OF WRITTEN NOTICE FROM THE
MUNICIPALITY,  THE  INSURER SHALL PROVIDE THE MUNICIPALITY WITH INFORMA-
TION ON THE EXTENT OF BENEFITS AVAILABLE TO AN INSURED UNDER THE POLICY.
  (d) 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.
  (E)  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;
  (3) THE ABSENCE OF A PRIMARY CARE PROVIDER REFERRAL; OR
  (4)  THAT  THE  PROVIDER OF SERVICES IS NOT A NETWORK OR PARTICIPATING
PROVIDER.
   (F) TIME OF LOSS FOR THE PURPOSES OF FILING CLAIMS SHALL BE THE  DATE
OF CONTRACTOR PAYMENT BY THE MUNICIPALITY.
  (G)  THE  INSURER  SHALL  ISSUE  PAYMENT  IN  THE  AMOUNT EQUAL TO THE
APPROVED COSTS FOR EARLY INTERVENTION SERVICES.
  (H) 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  refuse  to issue an accident and health insurance policy or
contract or refuse to renew an accident and health insurance  policy  or
contract  solely  because the applicant or insured is receiving services
under the early intervention program.
  S 2. This act shall take effect immediately.