S T A T E O F N E W Y O R K
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5937
2013-2014 Regular Sessions
I N S E N A T E
September 18, 2013
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Introduced by Sen. VALESKY -- read twice and ordered printed, and when
printed to be committed to the Committee on Rules
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 30 to read as follows:
(30) 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 19 to read as follows:
(19) 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
AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW: FLANGES,
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11677-01-3
S. 5937 2
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 amended
by chapter 219 of the laws of 2011, 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, well child visits
provided pursuant to paragraph two of subsection (j) of section four
thousand three hundred three of this article, preventive health services
provided pursuant to subparagraph (F) of paragraph four of subsection
(b) of section four thousand three hundred twenty-two of this article,
or items or services for bone mineral density provided pursuant to
subparagraph (D) of paragraph twenty-six of subsection (b) of section
four thousand three hundred twenty-two of this article for which no
copayment shall apply. A copayment of fifteen dollars shall be imposed
on equipment, supplies and self-management education for the treatment
of diabetes. A COPAYMENT OF FIFTEEN DOLLARS SHALL BE IMPOSED ON EQUIP-
MENT AND SUPPLIES USED FOR THE TREATMENT OF OSTOMIES. A fifty dollar
copayment shall be imposed on emergency services rendered in the emer-
gency 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. 5937 3
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 amended
by chapter 219 of the laws of 2011, is amended to read as follows:
(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, well child visits provided pursuant
to paragraph two of subsection (j) of section four thousand three
hundred three of this article, preventive health services provided
pursuant to subparagraph (F) of paragraph four of subsection (b) of this
section or items or services for bone mineral density provided pursuant
to subparagraph (D) of paragraph twenty-six of subsection (b) of this
section 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 disorders or ailments. A thir-
ty-five dollar copayment shall be imposed on emergency services rendered
in the emergency room of a hospital; however, 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.
