senate Bill S5390C

Requires mandatory health insurance coverage for prosthetic devices

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Sponsor

Bill Status


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

  • 16 / May / 2013
    • REFERRED TO INSURANCE
  • 08 / Jan / 2014
    • REFERRED TO INSURANCE
  • 29 / Jan / 2014
    • AMEND AND RECOMMIT TO INSURANCE
  • 29 / Jan / 2014
    • PRINT NUMBER 5390A
  • 09 / Jun / 2014
    • AMEND AND RECOMMIT TO INSURANCE
  • 09 / Jun / 2014
    • PRINT NUMBER 5390B
  • 11 / Jun / 2014
    • AMEND AND RECOMMIT TO INSURANCE
  • 11 / Jun / 2014
    • PRINT NUMBER 5390C

Summary

Requires mandatory health insurance coverage for certain individuals with prosthetic limbs; requires coverage where the model is determined to adequately meet the medical needs of the policy holder.

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Bill Details

See Assembly Version of this Bill:
A6820C
Versions:
S5390
S5390A
S5390B
S5390C
Legislative Cycle:
2013-2014
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3216, 3221 & 4303, Ins L

Sponsor Memo

BILL NUMBER:S5390C

TITLE OF BILL: An act to amend the insurance law, in relation to
mandatory health insurance coverage for prosthetic devices

PURPOSE OR GENERAL IDEA OF THE BILL:

To ensure that coverage for rehabilitative and habilitative services,
including prosthetic devices, are available to military veterans
residing in NYS.

SUMMARY OF SPECIFIC PROVISIONS:

This bill would require that health insurers that provide medical,
major, medical, or similar comprehensive type coverage and cover
durable medical equipment include coverage for prosthetic devices for
veterans of the armed forces who are residents of New York on parity
with the coverage for durable medical, equipment.

JUSTIFICATION:

Two recent wars involving the United States, Iraq and Afghanistan has
left over 600 military men and women as amputees with life-long
injuries. Each year 185,000 amputations occur in the US and there are
nearly 2 million people living with limb loss in the US. Improving
access to quality and updated prosthetic devices will improve the
quality of life of veterans and other amputees, while helping to
reduce other medical costs related to lack of mobility and associated
physical and emotional health.

According to the Veterans Health Administration, approximately 6
percent of wounded service members returning from Iraq are individuals
with amputations. As a society, we owe these veterans the best of our
efforts to help them live improved lives after their sacrifice for our
nation.

PRIOR LEGISLATIVE HISTORY:

New Bill

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENT:

None

EFFECTIVE DATE:

This act shall take effect May 1, 2015.

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

                                 5390--C

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              May 16, 2013
                               ___________

Introduced  by  Sen.  PARKER -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance  --  recommitted
  to the Committee on Insurance in accordance with Senate Rule 6, sec. 8
  --  committee  discharged,  bill amended, ordered reprinted as amended
  and recommitted  to  said  committee  --  committee  discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee --  committee  discharged,  bill  amended,  ordered  reprinted  as
  amended and recommitted to said committee

AN  ACT  to  amend  the  insurance  law, in relation to mandatory health
  insurance coverage for prosthetic devices

  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 30 to read as follows:
  (30) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR  MEDICAL,  OR  SIMILAR
COMPREHENSIVE  TYPE  COVERAGE  AND PROVIDES COVERAGE FOR DURABLE MEDICAL
EQUIPMENT  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC  DEVICES  THAT  ARE
INTENDED   FOR   MEDICALLY  NECESSARY  REHABILITATIVE  AND  HABILITATIVE
PURPOSES AS REQUIRED BY 42 U.S.C. S 18022  THAT  IS  EQUIVALENT  TO  THE
COVERAGE  PROVIDED FOR DURABLE MEDICAL EQUIPMENT.  COVERAGE SHALL NOT BE
DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC DEVICE
IS THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL NEEDS OF
THE POLICY HOLDER. THE TERM "PROSTHETIC DEVICE" AS USED  IN  THIS  PARA-
GRAPH  INCLUDES  AN  ARTIFICIAL  LIMB BUT SHALL NOT INCLUDE SHOES OR ANY
OTHER ARTICLE CONSIDERED AS ORDINARY WEARING  APPAREL,  WHETHER  OR  NOT
SPECIALLY  CONSTRUCTED.   THE TERM "POLICY HOLDER" AS USED IN THIS PARA-
GRAPH SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES IN THE  STATE
OF  NEW  YORK AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE RESULTED
FROM AN INJURY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN  THE  ARMED
FORCES.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10223-09-4

S. 5390--C                          2

  S 2. Subsection (l) of section 3221 of the insurance law is amended by
adding a new paragraph 19 to read as follows:
  (19)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE TYPE COVERAGE AND PROVIDES COVERAGE  FOR  DURABLE  MEDICAL
EQUIPMENT  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC  DEVICES  THAT  ARE
INTENDED  FOR  MEDICALLY  NECESSARY  REHABILITATIVE   AND   HABILITATIVE
PURPOSES  AS  REQUIRED  BY  42  U.S.C. S 18022 THAT IS EQUIVALENT TO THE
COVERAGE PROVIDED FOR DURABLE MEDICAL EQUIPMENT.  COVERAGE SHALL NOT  BE
DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC DEVICE
IS THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL NEEDS OF
THE  POLICY  HOLDER.  THE TERM "PROSTHETIC DEVICE" AS USED IN THIS PARA-
GRAPH INCLUDES AN ARTIFICIAL LIMB BUT SHALL NOT  INCLUDE  SHOES  OR  ANY
OTHER  ARTICLE  CONSIDERED  AS  ORDINARY WEARING APPAREL, WHETHER OR NOT
SPECIALLY CONSTRUCTED. THE TERM "POLICY HOLDER" AS USED  IN  THIS  PARA-
GRAPH  SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES IN THE STATE
OF NEW YORK AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC  DEVICE  RESULTED
FROM  AN  INJURY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN THE ARMED
FORCES.
  S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (oo) to read as follows:
  (OO)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE TYPE COVERAGE AND PROVIDES COVERAGE  FOR  DURABLE  MEDICAL
EQUIPMENT  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC  DEVICES  THAT  ARE
INTENDED  FOR  MEDICALLY  NECESSARY  REHABILITATIVE   AND   HABILITATIVE
PURPOSES  AS  REQUIRED  BY  42  U.S.C. S 18022 THAT IS EQUIVALENT TO THE
COVERAGE PROVIDED FOR DURABLE MEDICAL EQUIPMENT.  COVERAGE SHALL NOT  BE
DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC DEVICE
IS THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL NEEDS OF
THE  POLICY  HOLDER.    THE  TERM  "PROSTHETIC  DEVICE"  AS USED IN THIS
SUBSECTION INCLUDES AN ARTIFICIAL LIMB BUT SHALL NOT  INCLUDE  SHOES  OR
ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL, WHETHER OR NOT
SPECIALLY  CONSTRUCTED.    THE  TERM  "POLICY  HOLDER"  AS  USED IN THIS
SUBSECTION SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES  IN  THE
STATE  OF  NEW  YORK  AND  WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE
RESULTED FROM AN INJURY SUFFERED IN THE LINE OF DUTY  WHILE  SERVING  IN
THE ARMED FORCES.
  S  4.  This  act  shall take effect May 1, 2015 and shall apply to all
policies and contracts issued, renewed, altered, or amended on or  after
such effective date.

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