Senate Bill S403

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

                                   403

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 7, 2009
                               ___________

Introduced  by  Sen.  ROBACH -- 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 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 26 to read as follows:
  (26) 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 15 to read as follows:
  (15) 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

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

                                                           LBD03505-01-9

S. 403                              2

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 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 added  by
chapter 504 of the laws of 1995, 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 or  well  child  visits
provided  pursuant  to  paragraph  two of subsection (j) of section four
thousand three hundred three of this  article  for  which  no  copayment
shall  apply.  A copayment of fifteen dollars shall be imposed on equip-
ment, supplies  and  self-management  education  for  the  treatment  of
diabetes.   A COPAYMENT OF FIFTEEN DOLLARS SHALL BE IMPOSED ON EQUIPMENT
AND SUPPLIES USED FOR THE TREATMENT OF OSTOMIES. A fifty  dollar  copay-
ment  shall  be  imposed on emergency services rendered in the emergency
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 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 added  by
chapter 504 of the laws of 1995, is amended to read as follows:

S. 403                              3

  (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 or well child visits provided pursuant
to paragraph two of  subsection  (j)  of  section  four  thousand  three
hundred  three  of  this  article 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 disor-
ders or ailments.  A thirty-five dollar copayment shall  be  imposed  on
emergency  services rendered in the emergency room of a hospital; howev-
er, 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.