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

                                  7489

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                             April 13, 2009
                               ___________

Introduced by M. of A. CARROZZA -- read once and referred to the Commit-
  tee on Insurance

AN  ACT  to  amend  the  insurance  law, in relation to the provision of
  preventive and primary care services

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1. Clauses (ii) and (iii) of subparagraph (B) of paragraph 17
of subsection (i) of section 3216 of the  insurance  law,  as  added  by
chapter  728  of  the laws of 1993, are amended and a new clause (iv) is
added to read as follows:
  (ii) at each visit, services in accordance with the  prevailing  clin-
ical  standards  of  such  designated  association,  including a medical
history, a  complete  physical  examination,  developmental  assessment,
anticipatory  guidance,  appropriate  immunizations and laboratory tests
which tests are ordered at the time of the visit and  performed  in  the
practitioner's  office, as authorized by law, or in a clinical laborato-
ry; [and]
  (iii) necessary immunizations as determined by the  superintendent  in
consultation  with  the  commissioner  of  health consisting of at least
adequate dosages of  vaccine  against  diphtheria,  pertussis,  tetanus,
polio,  measles, rubella, mumps, haemophilus influenzae type b and hepa-
titis b which meet the standards approved by the  United  States  public
health service for such biological products[.]; AND
  (IV) IMMUNIZATIONS DETERMINED BY THE DEPENDENT CHILD'S PHYSICIAN TO BE
MEDICALLY  APPROPRIATE  CONSISTING OF AT LEAST ADEQUATE DOSES OF VACCINE
AGAINST HUMAN PAPILLOMA VIRUS WHICH MEETS THE STANDARD APPROVED  BY  THE
UNITED STATES PUBLIC HEALTH SERVICE FOR SUCH BIOLOGICAL PRODUCTS.
  S  2.  Clauses  (ii)  and  (iii) of subparagraph (B) of paragraph 8 of
subsection (l) of section 3221 of the insurance law, as amended by chap-
ter 728 of the laws of 1993, are amended and a new clause (iv) is  added
to read as follows:
  (ii)  at  each visit, services in accordance with the prevailing clin-
ical standards of  such  designated  association,  including  a  medical
history,  a  complete  physical  examination,  developmental assessment,

              

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06538-01-9

A. 7489                             2

anticipatory guidance, appropriate immunizations  and  laboratory  tests
which  tests  are  ordered at the time of the visit and performed in the
practitioner's office, as authorized by law, or in a clinical  laborato-
ry; [and]
  (iii)  necessary  immunizations as determined by the superintendent in
consultation with the commissioner of  health  consisting  of  at  least
adequate  dosages  of  vaccine  against  diphtheria, pertussis, tetanus,
polio, measles, rubella, mumps, haemophilus influenzae type b and  hepa-
titis  b  which  meet the standards approved by the United States public
health service for such biological products[.]; AND
  (IV) IMMUNIZATIONS DETERMINED BY THE DEPENDENT CHILD'S PHYSICIAN TO BE
MEDICALLY APPROPRIATE CONSISTING OF AT LEAST ADEQUATE DOSES  OF  VACCINE
AGAINST  HUMAN  PAPILLOMA VIRUS WHICH MEETS THE STANDARD APPROVED BY THE
UNITED STATES PUBLIC HEALTH SERVICE FOR SUCH BIOLOGICAL PRODUCTS.
  S 3. Paragraph 2 of subsection (j) of section 4303  of  the  insurance
law,  as  amended by chapter 728 of the laws of 1993, is amended to read
as follows:
  (2) For purposes of  this  subsection,  preventive  and  primary  care
services shall mean the following services rendered to a dependent child
of  a  subscriber from the date of birth through the attainment of nine-
teen years of age: (i)  an  initial  hospital  check-up  and  well-child
visits scheduled in accordance with the prevailing clinical standards of
a national association of pediatric physicians designated by the commis-
sioner of health (except for any standard that would limit the specialty
or  forum  of  licensure of the practitioner providing the service other
than the limits under state law). Coverage for  such  services  rendered
shall  be provided only to the extent that such services are provided by
or under the supervision of a physician, or other professional  licensed
under  article  one hundred thirty-nine of the education law whose scope
of practice pursuant to such law includes the authority to  provide  the
specified  services.  Coverage  shall  be  provided  for  such  services
rendered in a hospital, as defined in section twenty-eight  hundred  one
of  the  public  health  law,  or  in  an office of a physician or other
professional licensed under  article  one  hundred  thirty-nine  of  the
education  law whose scope of practice pursuant to such law includes the
authority to  provide  the  specified  services,  (ii)  at  each  visit,
services  in  accordance  with the prevailing clinical standards of such
designated association, including a medical history, a complete physical
examination, developmental assessment, anticipatory guidance,  appropri-
ate  immunizations  and  laboratory tests which tests are ordered at the
time of the visit and performed in the practitioner's office, as author-
ized by law, or in a clinical laboratory, [and] (iii) necessary  immuni-
zations  as  determined  by  the superintendent in consultation with the
commissioner of health  consisting  of  at  least  adequate  dosages  of
vaccine against diphtheria, pertussis, tetanus, polio, measles, rubella,
mumps,  haemophilus  influenzae  type  b  and hepatitis b which meet the
standards approved by the United States public health service  for  such
biological  products, AND (IV) IMMUNIZATIONS DETERMINED BY THE DEPENDENT
CHILD'S PHYSICIAN TO BE MEDICALLY APPROPRIATE  CONSISTING  OF  AT  LEAST
ADEQUATE  DOSES OF VACCINE AGAINST HUMAN PAPILLOMA VIRUS WHICH MEETS THE
STANDARD APPROVED BY THE UNITED STATES PUBLIC HEALTH  SERVICE  FOR  SUCH
BIOLOGICAL  PRODUCTS.    Such  coverage  shall  not be subject to annual
deductibles and/or coinsurance. Such  coverage  shall  not  restrict  or
eliminate existing coverage provided by the contract.
  S 4. This act shall take effect immediately.