Assembly Bill A10100

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

                                  10100

                          I N  A S S E M B L Y

                              June 13, 2014
                               ___________

Introduced  by  COMMITTEE ON RULES -- (at request of M. of A. Cahill) --
  read once and referred to the Committee on Insurance

AN ACT to amend the public health law and the insurance law, in relation
  to requiring health maintenance organizations to cover  court  ordered
  health care services

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

  Section 1. Section 4406-c of the  public  health  law  is  amended  by
adding a new subdivision 9 to read as follows:
  9.  A  HEALTH  CARE  PLAN MUST COVER HEALTH CARE SERVICES ORDERED BY A
COURT OF COMPETENT JURISDICTION ON THE BASIS OF AN EVALUATION  PERFORMED
BY A PHYSICIAN IF:
  (A) THE EVALUATION IS PERFORMED BY A PARTICIPATING PROVIDER WHO CERTI-
FIES THAT FURTHER SERVICES ARE NECESSARY;
  (B)  THE  HEALTH CARE SERVICES THAT ARE THE SUBJECT OF THE PROSPECTIVE
COURT ORDER ARE A COVERED BENEFIT OF THE HEALTH CARE PLAN; AND
  (C) THE HEALTH CARE SERVICES ARE TO BE  PROVIDED  BY  A  PARTICIPATING
HEALTH CARE PROVIDER OF THE HEALTH CARE PLAN.
  ANY  SUCH  HEALTH  CARE  SERVICE  SHALL  NOT  BE SUBJECT TO A SEPARATE
MEDICAL NECESSITY DETERMINATION BY THE HEALTH CARE PLAN.
  S 2. Section 3217-b of the insurance law is amended by  adding  a  new
subsection (k) to read as follows:
  (K)  A  HEALTH  CARE PLAN MUST COVER HEALTH CARE SERVICES ORDERED BY A
COURT OF COMPETENT JURISDICTION ON THE BASIS OF AN EVALUATION  PERFORMED
BY A PHYSICIAN IF:
  (1) THE EVALUATION IS PERFORMED BY A PARTICIPATING PROVIDER WHO CERTI-
FIES THAT FURTHER SERVICES ARE NECESSARY;
  (2)  THE  HEALTH CARE SERVICES THAT ARE THE SUBJECT OF THE PROSPECTIVE
COURT ORDER ARE A COVERED BENEFIT OF THE HEALTH CARE PLAN; AND
  (3) THE HEALTH CARE SERVICES ARE TO BE  PROVIDED  BY  A  PARTICIPATING
HEALTH  CARE  PROVIDER  OF  THE  HEALTH  CARE PLAN. ANY SUCH HEALTH CARE
SERVICE SHALL NOT BE SUBJECT TO A SEPARATE  MEDICAL  NECESSITY  DETERMI-
NATION BY THE HEALTH CARE PLAN.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD15121-03-4
              

A. 10100                            2

  S  3.  Section  4325  of  the insurance law is amended by adding a new
subsection (l) to read as follows:
  (L)  A  HEALTH  CARE PLAN MUST COVER HEALTH CARE SERVICES ORDERED BY A
COURT OF COMPETENT JURISDICTION ON THE BASIS OF AN EVALUATION  PERFORMED
BY A PHYSICIAN IF:
  (1) THE EVALUATION IS PERFORMED BY A PARTICIPATING PROVIDER WHO CERTI-
FIES THAT FURTHER SERVICES ARE NECESSARY;
  (2)  THE  HEALTH CARE SERVICES THAT ARE THE SUBJECT OF THE PROSPECTIVE
COURT ORDER ARE A COVERED BENEFIT OF THE HEALTH CARE PLAN; AND
  (3) THE HEALTH CARE SERVICES ARE TO BE  PROVIDED  BY  A  PARTICIPATING
HEALTH  CARE  PROVIDER  OF  THE  HEALTH  CARE PLAN. ANY SUCH HEALTH CARE
SERVICE SHALL NOT BE SUBJECT TO A SEPARATE  MEDICAL  NECESSITY  DETERMI-
NATION BY THE HEALTH CARE PLAN.
  S 4. This act shall take effect July 1, 2015.