Senate Bill S5175

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

                                  5175

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                               May 3, 2011
                               ___________

Introduced  by Sen. GALLIVAN -- 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  ensuring  insurance
  coverage for children in need of early intervention services

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

  Section 1. Section 3235-a of the insurance law, as added by section  3
of  part  C  of  chapter  1  of  the laws of 2002, is amended to read as
follows:
  S 3235-a. Payment for early intervention services. (a)  No  policy  of
accident  and  health  insurance, including contracts issued pursuant to
article forty-three of this chapter, shall exclude coverage  for  other-
wise  covered  services solely on the basis that the services constitute
early intervention program services under title two-A of  article  twen-
ty-five of the public health law.
  (b)  Where  a  policy  of  accident  and health insurance, including a
contract  issued  pursuant  to  article  forty-three  of  this  chapter,
provides  coverage  for  [an]  A  SERVICE THAT IS PROVIDED TO AN INSURED
UNDER THE early intervention program service, such coverage shall not be
applied against any maximum annual or lifetime monetary limits set forth
in such policy or contract. Visit limitations and other terms and condi-
tions of the policy will continue to apply to COVERED SERVICES  PROVIDED
UNDER  THE  early  intervention [services] PROGRAM.  However, any visits
used for early intervention program services shall not reduce the number
of visits otherwise available under the  policy  or  contract  for  such
services.  WHERE A SERVICE PROVIDED TO AN INSURED UNDER THE EARLY INTER-
VENTION  PROGRAM  IS  A  COVERED  SERVICE  UNDER THE INSURER'S POLICY OR
CONTRACT, THE INDIVIDUALIZED FAMILY SERVICES PLAN AS DEFINED IN  SECTION
TWENTY-FIVE  HUNDRED FORTY-ONE OF THE PUBLIC HEALTH LAW AND CERTIFIED BY
THE EARLY INTERVENTION OFFICIAL OR SUCH OFFICIAL'S  DESIGNEE,  SHALL  BE
DEEMED TO MEET ANY PRECERTIFICATION, PREAUTHORIZATION AND MEDICAL NECES-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11317-01-1
              

S. 5175                             2

SITY  REQUIREMENTS  IMPOSED  ON  BENEFITS  UNDER THE POLICY OR CONTRACT,
PROVIDED, HOWEVER, THAT THE EARLY INTERVENTION OFFICIAL SHALL REMOVE  OR
REDACT  ANY INFORMATION CONTAINED ON THE INSURED'S INDIVIDUALIZED FAMILY
SERVICE  PLAN  THAT IS NOT REQUIRED BY THE INSURER FOR PAYMENT PURPOSES.
PAYMENT FOR A SERVICE COVERED UNDER  THE  POLICY  OR  CONTRACT  THAT  IS
PROVIDED  UNDER  THE EARLY INTERVENTION PROGRAM SHALL BE AT RATES ESTAB-
LISHED BY THE COMMISSIONER OF HEALTH FOR SUCH SERVICE PURSUANT TO  REGU-
LATIONS.
  (c)  NO  INSURER, INCLUDING A HEALTH MAINTENANCE ORGANIZATION ISSUED A
CERTIFICATE OF AUTHORITY UNDER ARTICLE FORTY-FOUR OF THE  PUBLIC  HEALTH
LAW  AND A CORPORATION ORGANIZED UNDER ARTICLE FORTY-THREE OF THIS CHAP-
TER SHALL DENY PAYMENT OF A CLAIM SUBMITTED FOR A SERVICE COVERED  UNDER
THE  INSURER'S  POLICY  OR  CONTRACT AND PROVIDED UNDER THE EARLY INTER-
VENTION PROGRAM BASED UPON THE FOLLOWING:
  (I) THE LOCATION WHERE SERVICES ARE PROVIDED;
  (II) THE DURATION OF THE INSURED'S CONDITION  OR  THAT  THE  INSURED'S
CONDITION  IS  NOT  AMENABLE TO SIGNIFICANT IMPROVEMENT WITHIN A CERTAIN
PERIOD OF TIME AS SPECIFIED IN THE POLICY OR CONTRACT;
  (III) THAT THE PROVIDER OF SERVICES IS NOT A PARTICIPATING PROVIDER IN
THE INSURER'S NETWORK; OR
  (IV) THE ABSENCE OF A PRIMARY CARE REFERRAL.
  (D) Any right of subrogation to benefits which a municipality is enti-
tled in accordance with paragraph (d) of subdivision  three  of  section
twenty-five  hundred  fifty-nine of the public health law shall be valid
and enforceable to the extent benefits are available under any  accident
and health insurance policy. The right of subrogation does not attach to
insurance benefits paid or provided under any accident and health insur-
ance  policy  prior to receipt by the insurer of written notice from the
municipality. UPON THE INSURER'S RECEIPT  OF  WRITTEN  NOTICE  FROM  THE
MUNICIPALITY THE INSURER SHALL PROVIDE THE MUNICIPALITY WITH INFORMATION
ON THE EXTENT OF BENEFITS AVAILABLE TO AN INSURED UNDER THE POLICY.
  [(d)]  (E)  No  insurer,  including  a health maintenance organization
issued a certificate of authority under article forty-four of the public
health law and a corporation organized under article forty-three of this
chapter, shall refuse to issue an accident and health  insurance  policy
or  contract  or refuse to renew an accident and health insurance policy
or contract  solely  because  the  applicant  or  insured  is  receiving
services under the early intervention program.
  S  2.  This  act  shall take effect immediately and shall apply to any
contracts entered into, altered, modified, extended  or  removed  on  or
after such effective date.