senate Bill S5937

Amended

Authorizes insurance coverage for equipment and supplies used for the treatment of ostomies

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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

  • 18 / Sep / 2013
    • REFERRED TO RULES
  • 08 / Jan / 2014
    • REFERRED TO INSURANCE
  • 06 / Jun / 2014
    • AMEND AND RECOMMIT TO INSURANCE
  • 06 / Jun / 2014
    • PRINT NUMBER 5937A
  • 18 / Jun / 2014
    • COMMITTEE DISCHARGED AND COMMITTED TO RULES
  • 18 / Jun / 2014
    • ORDERED TO THIRD READING CAL.1558
  • 18 / Jun / 2014
    • SUBSTITUTED BY A8137A

Summary

Authorizes insurance coverage for equipment and supplies used for the treatment of ostomies.

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Bill Details

Versions:
S5937
S5937A
Legislative Cycle:
2013-2014
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221, 4303, 4321 & 4322, Ins L

Sponsor Memo

BILL NUMBER:S5937

TITLE OF BILL: An act to amend the insurance law, in relation to
authorizing insurance coverage for equipment and supplies used for the
treatment of ostomies

PURPOSE:

This bill would require every policy which provides medical, major
medical, or similar comprehensive-type coverage to include equipment
and supplies necessary for the treatment of ostomies.

SUMMARY OF PROVISIONS:

Section 1: Adds a new paragraph (30) to subsection (i) of § 3216 of
the Insurance Law.

Section 2: Adds new paragraph (19) to subsection (k) § 3221 of the
Insurance Law.

Section 3: Adds new subdivision (u-1) to § 4303 of the Insurance Law.

Section 4: Amends subsection (c) of § 4321 of the Insurance Law.

Section 5: Adds new paragraph (28) to subsection (b) of § 4322 of the
Insurance Law.

Section 6: Amends subsection (c) of § 4322 of the Insurance Law.

Section 7: Establishes the Effective Date.

JUSTIFICATION:

Ostomies are a lifelong health condition and require equipment and
supplies that can become costly. The current law allows for the full
coverage of equipment and supplies used to treat other chronic
conditions, such as diabetes. This legislation seeks to require health
insurers and health maintenance organizations to include full coverage
of equipment and supplies used to treat ostomies, in order to ease
some of the burden associated with this condition

LEGISLATIVE HISTORY:

1999-00: A.6663;
2001-02: A.5638;
2003-04: A.3859;
2005-06: A.2824;
2007-8: S.2975;
2009-10; S.403

FISCAL IMPLICATIONS:

None to the State.

EFFECTIVE DATE:


This act shall take effect on the first of January next succeeding the
date on which it shall have become a law.

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

                                  5937

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                           September 18, 2013
                               ___________

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

AN ACT to amend the insurance law, in relation to authorizing  insurance
  coverage for equipment and supplies used for the treatment of ostomies

  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 COVERAGE THAT INCLUDES COVER-
AGE  FOR  PHYSICIAN  SERVICES  IN  A PHYSICIAN'S OFFICE AND EVERY POLICY
WHICH PROVIDES MAJOR  MEDICAL  OR  SIMILAR  COMPREHENSIVE-TYPE  COVERAGE
SHALL INCLUDE COVERAGE FOR THE FOLLOWING EQUIPMENT AND SUPPLIES USED FOR
THE  TREATMENT  OF OSTOMIES, IF RECOMMENDED OR PRESCRIBED BY A PHYSICIAN
OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED  TO  PRESCRIBE
UNDER  TITLE  EIGHT  OF  THE  EDUCATION  LAW:  FLANGES, COLLECTION BAGS,
CLAMPS, IRRIGATION DEVICES, SANITIZING PRODUCTS, OSTOMY RINGS AND OSTOMY
BELTS. IN ADDITION, THE COMMISSIONER OF THE DEPARTMENT OF  HEALTH  SHALL
PROVIDE  AND  PERIODICALLY  UPDATE BY RULE OR REGULATION A LIST OF ADDI-
TIONAL OSTOMY EQUIPMENT AND  RELATED  SUPPLIES  SUCH  AS  ARE  MEDICALLY
NECESSARY  FOR  THE  TREATMENT OF OSTOMIES FOR WHICH THERE SHALL ALSO BE
COVERAGE.
  S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 19 to read as follows:
  (19) EVERY GROUP OR  BLANKET  ACCIDENT  AND  HEALTH  INSURANCE  POLICY
ISSUED  OR  ISSUED  FOR  DELIVERY  IN  THIS STATE WHICH PROVIDES MEDICAL
COVERAGE THAT INCLUDES COVERAGE FOR PHYSICIAN SERVICES IN A  PHYSICIAN'S
OFFICE  AND EVERY POLICY WHICH PROVIDES MAJOR MEDICAL OR SIMILAR COMPRE-
HENSIVE-TYPE COVERAGE SHALL INCLUDE COVERAGE FOR THE FOLLOWING EQUIPMENT
AND SUPPLIES USED FOR THE  TREATMENT  OF  OSTOMIES,  IF  RECOMMENDED  OR
PRESCRIBED BY A PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY
AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW: FLANGES,

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11677-01-3

S. 5937                             2

COLLECTION BAGS, CLAMPS, IRRIGATION DEVICES, SANITIZING PRODUCTS, OSTOMY
RINGS  AND OSTOMY BELTS. IN ADDITION, THE COMMISSIONER OF THE DEPARTMENT
OF HEALTH SHALL PROVIDE AND PERIODICALLY UPDATE BY RULE OR REGULATION  A
LIST  OF  ADDITIONAL  OSTOMY  EQUIPMENT AND RELATED SUPPLIES SUCH AS ARE
MEDICALLY NECESSARY FOR THE TREATMENT OF OSTOMIES FOR WHICH THERE  SHALL
ALSO BE COVERAGE.
  S  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (u-1) to read as follows:
  (U-1)(1) A MEDICAL EXPENSE INDEMNITY CORPORATION OR A  HEALTH  SERVICE
CORPORATION  WHICH  PROVIDES MEDICAL COVERAGE THAT INCLUDES COVERAGE FOR
PHYSICIAN SERVICES IN  A  PHYSICIAN'S  OFFICE  AND  EVERY  POLICY  WHICH
PROVIDES  MAJOR  MEDICAL  OR  SIMILAR  COMPREHENSIVE-TYPE COVERAGE SHALL
INCLUDE COVERAGE FOR THE FOLLOWING EQUIPMENT AND SUPPLIES USED  FOR  THE
TREATMENT  OF  OSTOMIES,  IF RECOMMENDED OR PRESCRIBED BY A PHYSICIAN OR
OTHER LICENSED HEALTH CARE  PROVIDER  LEGALLY  AUTHORIZED  TO  PRESCRIBE
UNDER  TITLE  EIGHT  OF  THE  EDUCATION  LAW:  FLANGES, COLLECTION BAGS,
CLAMPS, IRRIGATION DEVICES, SANITIZING PRODUCTS, OSTOMY RINGS AND OSTOMY
BELTS. IN ADDITION, THE COMMISSIONER OF THE DEPARTMENT OF  HEALTH  SHALL
PROVIDE  AND  PERIODICALLY  UPDATE BY RULE OR REGULATION A LIST OF ADDI-
TIONAL OSTOMY EQUIPMENT AND  RELATED  SUPPLIES  SUCH  AS  ARE  MEDICALLY
NECESSARY  FOR  THE  TREATMENT OF OSTOMIES FOR WHICH THERE SHALL ALSO BE
COVERAGE.
  (2) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE
AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT
WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
  (3) THIS SUBSECTION SHALL NOT APPLY TO A POLICY WHICH  COVERS  PERSONS
EMPLOYED  IN  MORE  THAN ONE STATE OR THE BENEFIT STRUCTURE OF WHICH WAS
THE SUBJECT OF COLLECTIVE BARGAINING AFFECTING PERSONS EMPLOYED IN  MORE
THAN ONE STATE.
  S  4.  Subsection (c) of section 4321 of the insurance law, as amended
by chapter 219 of the laws of 2011, is amended to read as follows:
  (c) The health maintenance organization shall impose a fifteen  dollar
copayment on all visits to a physician or other provider with the excep-
tion  of  visits  for  pre-natal  and post-natal care, well child visits
provided pursuant to paragraph two of subsection  (j)  of  section  four
thousand three hundred three of this article, preventive health services
provided  pursuant  to  subparagraph (F) of paragraph four of subsection
(b) of section four thousand three hundred twenty-two of  this  article,
or  items  or  services  for  bone  mineral density provided pursuant to
subparagraph (D) of paragraph twenty-six of subsection  (b)  of  section
four  thousand  three  hundred  twenty-two  of this article for which no
copayment shall apply. A copayment of fifteen dollars shall  be  imposed
on  equipment,  supplies and self-management education for the treatment
of diabetes. A COPAYMENT OF FIFTEEN DOLLARS SHALL BE IMPOSED  ON  EQUIP-
MENT  AND  SUPPLIES  USED  FOR THE TREATMENT OF OSTOMIES. A fifty dollar
copayment shall be imposed on emergency services rendered in  the  emer-
gency  room  of  a  hospital;  however, this copayment must be waived if
hospital admission results. Surgical services  shall  be  subject  to  a
copayment  of  the lesser of twenty percent of the cost of such services
or two hundred dollars per occurrence. A five hundred  dollar  copayment
shall  be imposed on inpatient hospital services per continuous hospital
confinement. Ambulatory surgical services shall be subject to a facility
copayment charge of seventy-five dollars.  Coinsurance  of  ten  percent
shall apply to visits for the diagnosis and treatment of mental, nervous
or emotional disorders or ailments.

S. 5937                             3

  S 5. Subsection (b) of section 4322 of the insurance law is amended by
adding a new paragraph 28 to read as follows:
  (28) EQUIPMENT AND SUPPLIES USED FOR THE TREATMENT OF OSTOMIES.
  S  6.  Subsection (c) of section 4322 of the insurance law, as amended
by chapter 219 of the laws of 2011, is amended to read as follows:
  (c) The in-plan benefit system shall impose a ten dollar copayment  on
all visits to a physician or other provider with the exception of visits
for  pre-natal  and post-natal care, well child visits provided pursuant
to paragraph two of  subsection  (j)  of  section  four  thousand  three
hundred  three  of  this  article,  preventive  health services provided
pursuant to subparagraph (F) of paragraph four of subsection (b) of this
section or items or services for bone mineral density provided  pursuant
to  subparagraph  (D)  of paragraph twenty-six of subsection (b) of this
section for which no copayment shall apply. A copayment of  ten  dollars
shall  be  imposed  on equipment, supplies and self-management education
for the treatment of diabetes. A  COPAYMENT  OF  TEN  DOLLARS  SHALL  BE
IMPOSED  ON  EQUIPMENT  AND SUPPLIES USED FOR THE TREATMENT OF OSTOMIES.
Coinsurance of ten percent shall apply to visits for the  diagnosis  and
treatment of mental, nervous or emotional disorders or ailments. A thir-
ty-five dollar copayment shall be imposed on emergency services rendered
in  the  emergency  room  of a hospital; however, this copayment must be
waived if hospital admission results.
  S 7. This act shall take effect on the first of January next  succeed-
ing  the date on which it shall have become a law and shall apply to all
policies and contracts issued, renewed, modified, altered or amended  on
or after such effective date.

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