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.