Senate Bill S7423

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

                                  7423

                            I N  S E N A T E

                              May 14, 2012
                               ___________

Introduced  by  Sen.  PARKER -- 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 providing coverage for
  biologically-based mental illness under the Healthy New York program

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Paragraphs 14 and 15 of subsection (d) of section 4326 of
the insurance law, paragraph 14 as amended and paragraph 15 as added  by
chapter  219  of the laws of 2011, are amended and a new paragraph 16 is
added to read as follows:
  (14) prescription drugs obtained at a participating pharmacy. In addi-
tion to providing coverage at a participating pharmacy,  health  mainte-
nance  organizations may utilize a mail order prescription drug program.
Health maintenance organizations may provide prescription drugs pursuant
to a drug formulary;  however,  health  maintenance  organizations  must
implement   an   appeals  process  so  that  the  use  of  non-formulary
prescription drugs may be requested by a physician; [and]
  (15) for a contract that is  not  a  grandfathered  health  plan,  the
following additional preventive health services:
  (A)  evidence-based  items or services that have in effect a rating of
'A' or 'B' in the current recommendations of the United  States  preven-
tive services task force;
  (B)  immunizations that have in effect a recommendation from the advi-
sory committee on immunization practices  of  the  centers  for  disease
control and prevention with respect to the individual involved;
  (C)  with  respect  to  children,  including  infants and adolescents,
evidence-informed preventive care and screenings  provided  for  in  the
comprehensive  guidelines supported by the health resources and services
administration; and
  (D) with respect to women, such additional preventive care and screen-
ings not described in subparagraph (A) of this paragraph as provided for
in comprehensive  guidelines  supported  by  the  health  resources  and
services administration.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11682-02-2
              

S. 7423                             2

  (E)  For purposes of this paragraph, "grandfathered health plan" means
coverage provided by a corporation in which an individual  was  enrolled
on  March  twenty-third,  two  thousand  ten for as long as the coverage
maintains grandfathered status in accordance with section 1251(e) of the
Affordable Care Act, 42 U.S.C. S 18011(e)[.]; AND
  (16)  PSYCHIATRIC  OR PSYCHOLOGICAL SERVICES OR DIAGNOSIS OR TREATMENT
OF MENTAL, NERVOUS OR EMOTIONAL DISORDERS OR AILMENTS AND  BIOLOGICALLY-
BASED MENTAL ILLNESS.
  S 2. This act shall take effect immediately.