S T A T E   O F   N E W   Y O R K
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                                  2401

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            January 15, 2013
                               ___________

Introduced  by  M.  of  A.  PAULIN, BRENNAN, WEISENBERG, COLTON, CAHILL,
  ABINANTI, JAFFEE,  GALEF,  PRETLOW,  WEPRIN,  ORTIZ,  RIVERA,  HOOPER,
  GOODELL, MAGNARELLI, GUNTHER, CASTRO -- Multi-Sponsored by -- M. of A.
  ENGLEBRIGHT, GOTTFRIED, MILLMAN, ROBERTS, SCHIMEL, TITONE -- read once
  and referred to the Committee on Insurance

AN  ACT  to  amend  the  insurance law, in relation to coverage of early
  intervention services

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

  Section  1.  Subsection (a) of 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  and  two  new  subsections  (f)  and  (g)  are added to read as
follows:
  (a) No policy of accident and health  insurance,  including  contracts
issued  pursuant  to  article forty-three of this chapter, shall exclude
coverage for otherwise covered services [solely on the  basis  that  the
services  constitute  early  intervention  program  services]  THAT  ARE
PROVIDED under title two-A of article twenty-five of the  public  health
law.
  (F)  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, UPON CERTIFICATION BY
THE  EARLY  INTERVENTION  OFFICIAL,  AS  DEFINED  IN SECTION TWENTY-FIVE
HUNDRED FORTY-ONE OF THE PUBLIC HEALTH LAW, OR SUCH OFFICIAL'S DESIGNEE,
SHALL BE DEEMED TO  MEET  ANY  PRECERTIFICATION,  PREAUTHORIZATION,  AND
MEDICAL  NECESSITY  REQUIREMENTS IMPOSED ON BENEFITS UNDER THE POLICY OR
CONTRACT; PROVIDED, HOWEVER, THAT THE PROVIDER SHALL  REMOVE  OR  REDACT
ANY   INFORMATION  CONTAINED  IN  THE  INSURED'S  INDIVIDUALIZED  FAMILY
SERVICES 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-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05388-01-3
              

A. 2401                             2

LISHED  BY THE COMMISSIONER OF HEALTH FOR SUCH SERVICE PURSUANT TO REGU-
LATIONS.
  (G)  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 AN EARLY  INTERVENTION  CLAIM  BASED  ON  THE
FOLLOWING:
  (1) THE LOCATION WHERE SERVICES ARE PROVIDED;
  (2)  THE  DURATION  OF  THE  CHILD'S CONDITION AND/OR THAT THE CHILD'S
CONDITION IS NOT AMENABLE TO SIGNIFICANT IMPROVEMENT  WITHIN  A  CERTAIN
PERIOD OF TIME AS SPECIFIED IN THE POLICY; OR
  (3)  THAT  THE  PROVIDER OF SERVICES IS NOT A NETWORK OR PARTICIPATING
PROVIDER.
  S 2. This act shall take effect immediately.