NY State Senate Bill 2009-S6996

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Mar 04, 2010	referred to insurance

2009-S6996 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2011-2012: S139
2013-2014: S1049

2009-S6996 (ACTIVE) - Summary

Requires insurance coverage under health insurance plans for diagnosis and treatment of craniofacial disorder; provides a referral from a health care provider under contract with the policy may be required.

2009-S6996 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S6996

 TITLE OF BILL :
An act to amend the insurance law, in relation to health insurance
coverage for craniofacial disorders


 PURPOSE :
To require health insurance policies providing coverage for physician
services, major medical or similar comprehensive-type coverage to
cover the diagnosis and treatment of temporomandibular joint disorder.

 SUMMARY OF PROVISIONS :
Amends the insurance law by adding a new paragraph 25(A) to section
3216(i), a new paragraph 15 (A) to section 3221(k) and a new
subsection (ff) to section 4303 to require every individual, group and
managed care health policy and plan which provides medical coverage
that includes physician services in a physician's office, or major
medical, or similar comprehensive-type coverage to provide coverage
for the diagnosis and treatment of temporomandibular joint disorder.
Such coverage shall include orthodontic and dental treatment necessary
to treat and repair all damage traceable to such temporomandibular
joint disorder. The coverage may be subject to annual deductibles and
coinsurance as deemed appropriate.

 JUSTIFICATION :

A temporomandibular joint disorder, or TMJ, is a collection of medical
and dental conditions related to the complex jaw joint
(temporomandibular joint). It can be precipitated by trauma,
arthritis, tumors or by long-term stress that causes clenching of the
jaw or grinding of the teeth. Whatever the precipitating factor, the
bones of the joint and the muscles that open, close and chew become
out of sync and result in pain, discomfort, limited range of movement,
collapse of bite, wearing of the teeth, headache and speech impediment
as well as many other common problems that every other malfunctioning
joint in the body is capable of creating.

While TMJ is ultimately a disorder affecting the TM joint, it is
treated by a variety of therapies ranging from massage, physical
therapy, craniosacral therapy, acupuncture, orthodontic appliances to
surgery.  The disorder also may be the direct cause of damage to the
teeth, which may be repaired or replaced by dental or orthodontic work
in prosthesis.  Unfortunately, many sufferers find that TMJ diagnosis
and treatment falls into a gray area between medical and dental
insurance coverage.  This legislation would resolve this impasse in
favor of regarding TMJ as a disorder of the joint, categorizing it as
medical in nature and covered by medical insurance.

 LEGISLATIVE HISTORY :
S.4558A/A.9596 of 2003/04; Referred to Senate Insurance Committee
S.113-A/A.1175 of 2005/06; Amended and Recommended to Senate Insurance
Committee
S.502 of 2007 Referred to Senate Insurance Committee
S.502 of 2008 Referred to Senate Insurance Committee

 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 law.

2009-S6996 (ACTIVE) - Bill Text download pdf

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

                                  6996

                            I N  S E N A T E

                              March 4, 2010
                               ___________

Introduced  by  Sen. MAZIARZ -- 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  health  insurance
  coverage for craniofacial disorders

  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 27 to read as follows:
  (27)(A)  EVERY  POLICY  DELIVERED 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 COMPREHENSIVE-TYPE COVERAGE  SHALL  PROVIDE  COVERAGE
FOR  DIAGNOSIS AND MEDICALLY NECESSARY TREATMENT, INCLUDING SURGICAL AND
NONSURGICAL PROCEDURES, FOR A MUSCULOSKELETAL DISORDER THAT AFFECTS  ANY
BONE  OR  JOINT IN THE FACE, NECK OR HEAD AND IS THE RESULT OF ACCIDENT,
TRAUMA, CONGENITAL DEFECT, DEVELOPMENTAL DEFECT, OR  PATHOLOGY.  SUBJECT
TO  SUBPARAGRAPH  (B) OF THIS PARAGRAPH, THIS COVERAGE SHALL BE THE SAME
AS THAT PROVIDED UNDER THE HEALTH INSURANCE PLAN FOR  ANY  OTHER  MUSCU-
LOSKELETAL  DISORDER  IN THE BODY AND MAY BE PROVIDED WHEN PRESCRIBED OR
ADMINISTERED BY A PHYSICIAN OR A DENTIST. THIS PARAGRAPH  SHALL  NOT  BE
CONSTRUED  TO  REQUIRE COVERAGE FOR DENTAL SERVICES FOR THE DIAGNOSIS OR
TREATMENT OF DENTAL DISORDERS OR DENTAL  PATHOLOGY  PRIMARILY  AFFECTING
THE GUMS, TEETH, OR ALVEOLAR RIDGE.
  (B)  A  REFERRAL  FROM  A HEALTH CARE PROVIDER UNDER CONTRACT WITH THE
POLICY MAY BE REQUIRED.
  S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 16 to read as follows:
  (16)(A) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY
IN THIS STATE WHICH PROVIDES MEDICAL COVERAGE THAT INCLUDES COVERAGE FOR
PHYSICIAN SERVICES IN A PHYSICIAN'S OFFICE OR MAJOR MEDICAL  OR  SIMILAR
COMPREHENSIVE-TYPE  COVERAGE  SHALL  PROVIDE  COVERAGE FOR DIAGNOSIS AND
MEDICALLY NECESSARY TREATMENT, INCLUDING SURGICAL AND NONSURGICAL PROCE-
DURES, FOR A MUSCULOSKELETAL DISORDER THAT AFFECTS ANY BONE OR JOINT  IN
THE FACE, NECK OR HEAD AND IS THE RESULT OF ACCIDENT, TRAUMA, CONGENITAL

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

                                                           LBD02193-02-0

S. 6996                             2

DEFECT,  DEVELOPMENTAL DEFECT, OR PATHOLOGY. SUBJECT TO SUBPARAGRAPH (B)
OF THIS PARAGRAPH, THIS COVERAGE SHALL BE  THE  SAME  AS  THAT  PROVIDED
UNDER  THE  HEALTH INSURANCE PLAN FOR ANY OTHER MUSCULOSKELETAL DISORDER
IN  THE  BODY  AND  MAY BE PROVIDED WHEN PRESCRIBED OR ADMINISTERED BY A
PHYSICIAN OR A DENTIST. THIS PARAGRAPH SHALL NOT BE CONSTRUED TO REQUIRE
COVERAGE FOR DENTAL SERVICES FOR THE DIAGNOSIS OR  TREATMENT  OF  DENTAL
DISORDERS  OR  DENTAL  PATHOLOGY PRIMARILY AFFECTING THE GUMS, TEETH, OR
ALVEOLAR RIDGE.
  (B) A REFERRAL FROM A HEALTH CARE PROVIDER  UNDER  CONTRACT  WITH  THE
POLICY MAY BE REQUIRED.
  S  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (gg) to read as follows:
  (GG)(1) A HOSPITAL  SERVICE  CORPORATION,  MEDICAL  EXPENSE  INDEMNITY
CORPORATION  OR HEALTH SERVICE CORPORATION WHICH PROVIDES MEDICAL COVER-
AGE THAT INCLUDES COVERAGE  FOR  PHYSICIAN  SERVICES  IN  A  PHYSICIAN'S
OFFICE  OR  MAJOR  MEDICAL  OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL
PROVIDE  COVERAGE  FOR  DIAGNOSIS  AND  MEDICALLY  NECESSARY  TREATMENT,
INCLUDING  SURGICAL  AND  NONSURGICAL  PROCEDURES, FOR A MUSCULOSKELETAL
DISORDER THAT AFFECTS ANY BONE OR JOINT IN THE FACE, NECK OR HEAD AND IS
THE RESULT OF ACCIDENT, TRAUMA, CONGENITAL DEFECT, DEVELOPMENTAL DEFECT,
OR PATHOLOGY. SUBJECT TO PARAGRAPH TWO OF THIS SUBSECTION, THIS COVERAGE
SHALL BE THE SAME AS THAT PROVIDED UNDER THE HEALTH INSURANCE  PLAN  FOR
ANY  OTHER MUSCULOSKELETAL DISORDER IN THE BODY AND MAY BE PROVIDED WHEN
PRESCRIBED OR ADMINISTERED BY A PHYSICIAN OR A DENTIST. THIS  SUBSECTION
SHALL  NOT  BE CONSTRUED TO REQUIRE COVERAGE FOR DENTAL SERVICES FOR THE
DIAGNOSIS OR TREATMENT OF DENTAL DISORDERS OR DENTAL PATHOLOGY PRIMARILY
AFFECTING THE GUMS, TEETH, OR ALVEOLAR RIDGE.
  (2) A REFERRAL FROM A HEALTH CARE PROVIDER  UNDER  CONTRACT  WITH  THE
POLICY MAY BE REQUIRED.
  S  4. 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 issued, renewed, altered or modified on or after such date.

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Senate Bill S6996

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

2009-S6996 (ACTIVE) - Details

2009-S6996 (ACTIVE) - Summary

2009-S6996 (ACTIVE) - Sponsor Memo

2009-S6996 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S6996

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Sponsored By

George D. Maziarz

Archive: Last Bill Status - In Senate Committee Insurance Committee

2009-S6996 (ACTIVE) - Details

2009-S6996 (ACTIVE) - Summary

2009-S6996 (ACTIVE) - Sponsor Memo

2009-S6996 (ACTIVE) - Bill Text download pdf

Comments