senate Bill S1611

Requires medical care insurance policies to include coverage for the care of Alzheimer's and related disease patients upon request

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 10 / Jan / 2011
    • REFERRED TO INSURANCE
  • 04 / Jan / 2012
    • REFERRED TO INSURANCE

Summary

Provides for the coverage of Alzheimer's and related disease patients under group and individual health insurance contracts and non-profit medical or health service corporations; certain terms defined.

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Bill Details

Versions:
S1611
Legislative Cycle:
2011-2012
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221, 4301 & 4303, Ins L
Versions Introduced in 2009-2010 Legislative Cycle:
S4229

Sponsor Memo

BILL NUMBER:S1611

TITLE OF BILL:
An act
to amend the insurance law, in relation to coverage for the care of
Alzheimer's and related disease
patients

PURPOSE OF THE BILL:
To require all health insurance providers of New York State to make
available, when requested by a contract holder, coverage for a
designated group of non-health related services provided to
Alzheimer's or related diseases. These services are custodial in
nature, and include crisis intervention, adult day care, home care,
and respite care.

SUMMARY OF SPECIFIC PROVISIONS:
This bill adds insurance coverage for non-health related services
required by Alzheimer's and related disease victims. Under current
Insurance Law there is no provision for that group of services.

Subsection (i) of §3216 of the Insurance Law is amended by adding a
new paragraph eleven. Subsection (1) of §3221 of such law is amended
by adding a new paragraph eighteen.

JUSTIFICATION:
Alzheimer's disease is a progressively degenerative neurological
disorder with no known cause or cure. The course of this disease as
well as other dementias usually extends over a number of years,
necessitating the use of many non-health related services, such as
adult day care, home care, and respite care. Because this type of
care is considered custodial, victims of Alzheimer's and related
dementias do not have access to the traditional funding mechanisms
for health care.

Medicare and Medicaid are currently the major sources of financing for
both institutional and community based care. Because Medicare does
not cover services needed for long-term chronic care, and Medicaid
requires that an individual be financially destitute in order to be
eligible for coverage, Alzheimer's victims are denied reimbursement
for their much needed care. The private/commercial insurers of New
York State currently require that care be of a rehabilitative nature
further eliminating access to reimbursement for this group of
patients. It is time for New York State to require insurers to
provide this coverage.

LEGISLATIVE HISTORY:
2009-10: S.4229

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
To be determined.

EFFECTIVE DATE:
One hundred twenty days after it shall have become a law, with
provisions.


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

                                  1611

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                            January 10, 2011
                               ___________

Introduced  by  Sen.  SAVINO -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance law, in relation to coverage for the  care
  of Alzheimer's and related disease patients

  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 28 to read as follows:
  (28)  (A) EVERY POLICY WHICH PROVIDES FOR SURGICAL OR MEDICAL COVERAGE
OR IN-PATIENT HOSPITAL CARE AS  WELL  AS  NON-HEALTH  RELATED  SERVICES,
SHALL  MAKE  AVAILABLE,  WHEN REQUESTED BY THE CONTRACT HOLDER, COVERAGE
FOR OUT-PATIENT TREATMENT OF ALZHEIMER'S OR RELATED DISEASES.
  (B) FOR THE PURPOSES OF THIS PARAGRAPH, THE FOLLOWING TERMS SHALL HAVE
THE FOLLOWING MEANINGS:
  (I) "NON-HEALTH RELATED SERVICES"  MEANS  THOSE  OUT-PATIENT  SERVICES
WHICH  MEET  THE CARE AND BEHAVIORAL NEEDS OF THE PATIENT, INCLUDING BUT
NOT LIMITED TO CRISIS  INTERVENTION,  ADULT  DAY  CARE,  HOME  CARE  AND
RESPITE CARE.
  (II)  "CARE  AND BEHAVIORAL NEEDS OF THE PATIENT" MEANS THE MANIFESTA-
TION OF SYMPTOMS WHICH MAY INCLUDE BUT NOT LIMITED TO MEMORY LOSS, APHA-
SIA (COMMUNICATION DISORDER), BECOMING LOST  OR  DISORIENTED,  CONFUSION
AND AGITATION WITH THE POTENTIAL FOR COMBATIVENESS AND INCONTINENCE.
  (III)  "ALZHEIMER'S  OR RELATED DISEASES" MEANS ANY OF THOSE IRREVERS-
IBLE BRAIN DISORDERS WHICH RESULT IN  THE  SYMPTOMS  DESCRIBED  IN  THIS
PARAGRAPH  BUT  NOT  LIMITED  TO MULTI-INFARCT DEMENTIAS AND PARKINSON'S
DISEASE.
  S 2. Subsection (l) of section 3221 of the insurance law is amended by
adding a new paragraph 18 to read as follows:
  (18) (A) EVERY INSURER DELIVERING A GROUP POLICY OR  ISSUING  A  GROUP
POLICY  FOR  DELIVERY IN THIS STATE WHICH PROVIDES HOSPITAL, SURGICAL OR
MEDICAL COVERAGE SHALL, IF REQUESTED BY THE POLICYHOLDER INCLUDE  COVER-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05670-01-1

S. 1611                             2

AGE  FOR THE TREATMENT AND DIAGNOSIS OF ALZHEIMER'S OR RELATED DISEASES.
SUCH COVERAGE FOR THE DIAGNOSIS AND TREATMENT  SHALL  INCLUDE  HOSPITAL,
SURGICAL  OR  MEDICAL  CARE TO THE SAME EXTENT THAT COVERAGE IS PROVIDED
FOR ILLNESS OR DISEASE UNDER THE POLICY.
  (B) COVERAGE SHALL ALSO INCLUDE NON-HEALTH RELATED SERVICES AS WELL AS
BUT  NOT  LIMITED TO NURSING HOME CARE, LICENSED REGISTERED PROFESSIONAL
NURSE, PSYCHIATRISTS OR  PSYCHOLOGISTS  LICENSED  TO  PRACTICE  IN  THIS
STATE,  HOME  HEALTH  SERVICES  AND ANY OTHER MEDICAL AND REHABILITATIVE
TREATMENT.
  (C) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE
AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT.    SUCH  DEDUCTIBLES
AND  COINSURANCE  MAY BE CONSISTENT WITH THOSE IMPOSED ON OTHER BENEFITS
WITHIN A GIVEN POLICY.
  (D) FOR THE PURPOSES OF THIS PARAGRAPH, THE FOLLOWING TERMS SHALL HAVE
THE FOLLOWING MEANINGS:
  (I) "NON-HEALTH RELATED SERVICES"  MEANS  THOSE  OUT-PATIENT  SERVICES
WHICH  MEET  THE CARE AND BEHAVIORAL NEEDS OF THE PATIENT, INCLUDING BUT
NOT LIMITED TO CRISIS  INTERVENTION,  ADULT  DAY  CARE,  HOME  CARE  AND
RESPITE CARE.
  (II)  "CARE  AND BEHAVIORAL NEEDS OF THE PATIENT" MEANS THE MANIFESTA-
TION OF SYMPTOMS WHICH MAY INCLUDE BUT NOT LIMITED TO MEMORY LOSS, APHA-
SIA (COMMUNICATION DISORDER), BECOMING LOST  OR  DISORIENTED,  CONFUSION
AND AGITATION WITH THE POTENTIAL FOR COMBATIVENESS AND INCONTINENCE.
  (III)  "ALZHEIMER'S  OR RELATED DISEASES" MEANS ANY OF THOSE IRREVERS-
IBLE BRAIN DISORDERS WHICH RESULT IN  THE  SYMPTOMS  DESCRIBED  IN  THIS
PARAGRAPH  BUT  NOT  LIMITED  TO MULTI-INFARCT DEMENTIAS AND PARKINSON'S
DISEASE.
  S 3. Paragraph 1 of subsection (d) of section 4301  of  the  insurance
law is amended to read as follows:
  (1) (A) Hospital service shall consist of in-patient hospital care and
out-patient  hospital care when such hospital care is provided through a
hospital which is maintained by the state or any of its political subdi-
visions, or maintained by a corporation organized for hospital  purposes
under the laws of this state, or such other hospitals as shall be desig-
nated  by  the state department of health, and hospitals of other states
subject to the  supervision  of  such  other  state,  convalescent  care
provided  by  any  convalescent institution, or nursing care provided by
any nursing home.
  (B) OUT-PATIENT HOSPITAL CARE SHALL INCLUDE, TO THE SAME EXTENT AS  IS
PROVIDED  FOR  ILLNESS  OR  DISEASE  UNDER THE POLICY, THE TREATMENT AND
DIAGNOSIS OF ALZHEIMER'S OR  RELATED  DISEASES  AND  NON-HEALTH  RELATED
SERVICES.
  (C)  FOR THE PURPOSES OF THIS PARAGRAPH THE FOLLOWING TERMS SHALL HAVE
THE FOLLOWING MEANINGS:
  (I) "NON-HEALTH RELATED SERVICES"  MEANS  THOSE  OUT-PATIENT  SERVICES
WHICH  MEET  THE CARE AND BEHAVIORAL NEEDS OF THE PATIENT, INCLUDING BUT
NOT LIMITED TO CRISIS  INTERVENTION,  ADULT  DAY  CARE,  HOME  CARE  AND
RESPITE CARE.
  (II)  "CARE  AND BEHAVIORAL NEEDS OF THE PATIENT" MEANS THE MANIFESTA-
TION OF SYMPTOMS WHICH MAY INCLUDE BUT NOT LIMITED TO MEMORY LOSS, APHA-
SIA (COMMUNICATION DISORDER), BECOMING LOST  OR  DISORIENTED,  CONFUSION
AND AGITATION WITH THE POTENTIAL FOR COMBATIVENESS AND INCONTINENCE.
  (III)  "ALZHEIMER'S  OR RELATED DISEASES" MEANS ANY OF THOSE IRREVERS-
IBLE BRAIN DISORDERS WHICH RESULT IN  THE  SYMPTOMS  DESCRIBED  IN  THIS
PARAGRAPH  BUT  NOT  LIMITED  TO MULTI-INFARCT DEMENTIAS AND PARKINSON'S
DISEASE.

S. 1611                             3

  S 4. Paragraph 2 of subsection (e) and paragraph 2 of  subsection  (f)
of  section  4303 of the insurance law, paragraph 2 of subsection (e) as
amended by chapter 593 of the laws of  2000,  are  amended  to  read  as
follows:
  (2)  For  the  purpose of this subsection, ambulatory care in hospital
out-patient facilities shall mean [services]: (A) SERVICES for  diagnos-
tic x-rays, laboratory and pathological examinations, physical and occu-
pational  therapy  and  radiation  therapy, and services and medications
used for nonexperimental cancer chemotherapy and cancer hormone therapy,
provided that such services and  medications  are  (i)  related  to  and
necessary  for  the  treatment  or diagnosis of the patient's illness or
injury, (ii) ordered by a physician and (iii) in the  case  of  physical
therapy,  services  are  to  be  furnished  in  connection with the same
illness for which the patient had been  hospitalized  or  in  connection
with  surgical  care, but in no event need benefits for physical therapy
be provided which commences more than six months after discharge from  a
hospital  or  the  date surgical care was rendered, and in no event need
benefits for physical therapy be provided after three hundred sixty-five
days from the date of discharge from a hospital  or  the  date  surgical
care  was  rendered. Such coverage shall be made available at the incep-
tion of all new contracts and, with respect to all other  contracts,  at
any anniversary date subject to evidence of insurability.
  (B)  TREATMENT  AND  DIAGNOSIS  OF ALZHEIMER'S OR RELATED DISEASES AND
NON-HEALTH RELATED SERVICES.
  (C) FOR THE PURPOSES OF THIS PARAGRAPH, THE FOLLOWING TERMS SHALL HAVE
THE FOLLOWING MEANINGS:
  (I) "NON-HEALTH RELATED SERVICES"  MEANS  THOSE  OUT-PATIENT  SERVICES
WHICH  MEET  THE CARE AND BEHAVIORAL NEEDS OF THE PATIENT, INCLUDING BUT
NOT LIMITED TO CRISIS  INTERVENTION,  ADULT  DAY  CARE,  HOME  CARE  AND
RESPITE CARE.
  (II)  "CARE  AND BEHAVIORAL NEEDS OF THE PATIENT" MEANS THE MANIFESTA-
TION OF SYMPTOMS WHICH MAY INCLUDE BUT NOT LIMITED TO MEMORY LOSS, APHA-
SIA (COMMUNICATION DISORDER), BECOMING LOST  OR  DISORIENTED,  CONFUSION
AND AGITATION WITH THE POTENTIAL FOR COMBATIVENESS AND INCONTINENCE.
  (III)  "ALZHEIMER'S  OR RELATED DISEASES" MEANS ANY OF THOSE IRREVERS-
IBLE BRAIN DISORDERS WHICH RESULT IN  THE  SYMPTOMS  DESCRIBED  IN  THIS
PARAGRAPH  BUT  NOT  LIMITED  TO MULTI-INFARCT DEMENTIAS AND PARKINSON'S
DISEASE.
  (2)  For the purpose of this subsection,  ambulatory  care  in  physi-
cians'  offices  shall  mean  [services]:  (A)  SERVICES  for diagnostic
x-rays, radiation therapy, laboratory and pathological examinations, and
services and medications used for  nonexperimental  cancer  chemotherapy
and  cancer hormone therapy, provided that such services and medications
are (i) related to and necessary for the treatment or diagnosis  of  the
patient's  illness  or  injury,  and  (ii) ordered by a physician.  Such
coverage shall be made available at the inception of all  new  contracts
and, with respect to all other contracts at any anniversary date subject
to evidence of insurability.
  (B)  TREATMENT  AND  DIAGNOSIS  OF ALZHEIMER'S OR RELATED DISEASES AND
NON-HEALTH RELATED SERVICES.
  (C) FOR THE PURPOSES OF THIS PARAGRAPH THE FOLLOWING TERMS SHALL  HAVE
THE FOLLOWING MEANINGS:
  (I)  "NON-HEALTH  RELATED  SERVICES"  MEANS THOSE OUT-PATIENT SERVICES
WHICH MEET THE CARE AND BEHAVIORAL NEEDS OF THE PATIENT,  INCLUDING  BUT
NOT  LIMITED  TO  CRISIS  INTERVENTION,  ADULT  DAY  CARE, HOME CARE AND
RESPITE CARE.

S. 1611                             4

  (II) "CARE AND BEHAVIORAL NEEDS OF THE PATIENT" MEANS  THE  MANIFESTA-
TION OF SYMPTOMS WHICH MAY INCLUDE BUT NOT LIMITED TO MEMORY LOSS, APHA-
SIA  (COMMUNICATION  DISORDER),  BECOMING LOST OR DISORIENTED, CONFUSION
AND AGITATION WITH THE POTENTIAL FOR COMBATIVENESS AND INCONTINENCE.
  (III)  "ALZHEIMER'S  OR RELATED DISEASES" MEANS ANY OF THOSE IRREVERS-
IBLE BRAIN DISORDERS WHICH RESULT IN  THE  SYMPTOMS  DESCRIBED  IN  THIS
PARAGRAPH  BUT  NOT  LIMITED  TO MULTI-INFARCT DEMENTIAS AND PARKINSON'S
DISEASE.
  S 5. This act shall take effect on the one hundred twentieth day after
it shall have become a law, provided however, that effective  immediate-
ly,  the  addition,  amendment and/or repeal of any rules or regulations
necessary for the implementation of the provisions of this  act  on  its
effective  date  are authorized and directed to be made and completed on
or before such effective date  and  shall  apply  to  all  policies  and
contracts issued, renewed, modified, altered or amended on or after such
effective date.

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