senate Bill S5390C

2013-2014 Legislative Session

Requires mandatory health insurance coverage for prosthetic devices

download bill text pdf

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Archive: Last Bill Status - In Senate Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

view actions (8)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jun 11, 2014 print number 5390c
amend and recommit to insurance
Jun 09, 2014 print number 5390b
amend and recommit to insurance
Jan 29, 2014 print number 5390a
amend and recommit to insurance
Jan 08, 2014 referred to insurance
May 16, 2013 referred to insurance

S5390 - Details

See Assembly Version of this Bill:
A6820C
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L

S5390 - Summary

Requires mandatory health insurance coverage for certain individuals with prosthetic limbs; requires coverage where the model is determined to adequately meet the medical needs of the policy holder.

S5390 - Sponsor Memo

S5390 - Bill Text download pdf

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

                                  5390

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              May 16, 2013
                               ___________

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  mandatory  health
  insurance coverage for prosthetic devices

  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, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE  EQUAL  TO  OR  ABOVE
MEDICARE'S  STANDARD OF COVERAGE FOR PROSTHETIC DEVICES FOR POLICY HOLD-
ERS. THIS SHALL INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF  A  PROS-
THETIC  DEVICE  REQUIRED  TO BE WORN OR USED BY A POLICY HOLDER BUT ALSO
THE REPAIR OR REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE WORN  OR
USED BY A POLICY HOLDER. COVERAGE SHALL INCLUDE EXPENSES FOR ASSESSMENT,
EVALUATION,  TREATMENT,  MANAGEMENT,  AND FOLLOW-UP CARE. COVERAGE SHALL
NOT BE DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC
DEVICE IS THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS  THE  MEDICAL
NEEDS  OF  THE  POLICY  HOLDER  TO PERFORM ACTIVITIES OF DAILY LIVING OR
ESSENTIAL JOB-RELATED ACTIVITIES.  THE TERM "PROSTHETIC DEVICE" AS  USED
IN  THIS  PARAGRAPH  INCLUDES  AN  ARTIFICIAL LIMB BUT SHALL NOT INCLUDE
SHOES OR ANY OTHER  ARTICLE  CONSIDERED  AS  ORDINARY  WEARING  APPAREL,
WHETHER  OR NOT SPECIALLY CONSTRUCTED.  THE TERM "POLICY HOLDER" AS USED
IN THIS PARAGRAPH SHALL MEAN A VETERAN OF THE ARMED FORCES  WHO  RESIDES
IN THE STATE OF NEW YORK.
  S 2. Subsection (l) of section 3221 of the insurance law is amended by
adding a new paragraph 19 to read as follows:
  (19)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE  EQUAL  TO  OR  ABOVE
MEDICARE'S  STANDARD OF COVERAGE FOR PROSTHETIC DEVICES FOR POLICY HOLD-
ERS. THIS SHALL INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF  A  PROS-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10223-02-3

S5390A - Details

See Assembly Version of this Bill:
A6820C
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L

S5390A - Summary

Requires mandatory health insurance coverage for certain individuals with prosthetic limbs; requires coverage where the model is determined to adequately meet the medical needs of the policy holder.

S5390A - Sponsor Memo

S5390A - Bill Text download pdf

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

                                 5390--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              May 16, 2013
                               ___________

Introduced  by  Sen.  PARKER -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance  --  recommitted
  to the Committee on Insurance in accordance with Senate Rule 6, sec. 8
  --  committee  discharged,  bill amended, ordered reprinted as amended
  and recommitted to said committee

AN ACT to amend the insurance  law,  in  relation  to  mandatory  health
  insurance coverage for prosthetic devices

  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, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE  EQUAL  TO  OR  ABOVE
MEDICARE'S  STANDARD OF COVERAGE FOR PROSTHETIC DEVICES FOR POLICY HOLD-
ERS. THIS SHALL INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF  A  PROS-
THETIC  DEVICE  REQUIRED  TO BE WORN OR USED BY A POLICY HOLDER BUT ALSO
THE REPAIR OR REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE WORN  OR
USED BY A POLICY HOLDER. COVERAGE SHALL INCLUDE EXPENSES FOR ASSESSMENT,
EVALUATION,  TREATMENT,  MANAGEMENT,  AND FOLLOW-UP CARE. COVERAGE SHALL
NOT BE DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC
DEVICE IS THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS  THE  MEDICAL
NEEDS  OF  THE  POLICY  HOLDER  TO PERFORM ACTIVITIES OF DAILY LIVING OR
ESSENTIAL JOB-RELATED ACTIVITIES.  THE TERM "PROSTHETIC DEVICE" AS  USED
IN  THIS  PARAGRAPH  INCLUDES  AN  ARTIFICIAL LIMB BUT SHALL NOT INCLUDE
SHOES OR ANY OTHER  ARTICLE  CONSIDERED  AS  ORDINARY  WEARING  APPAREL,
WHETHER  OR NOT SPECIALLY CONSTRUCTED.  THE TERM "POLICY HOLDER" AS USED
IN THIS PARAGRAPH SHALL MEAN A VETERAN OF THE ARMED FORCES  WHO  RESIDES
IN THE STATE OF NEW YORK.
  S 2. Subsection (l) of section 3221 of the insurance law is amended by
adding a new paragraph 19 to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10223-03-4

S5390B - Details

See Assembly Version of this Bill:
A6820C
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L

S5390B - Summary

Requires mandatory health insurance coverage for certain individuals with prosthetic limbs; requires coverage where the model is determined to adequately meet the medical needs of the policy holder.

S5390B - Sponsor Memo

S5390B - Bill Text download pdf

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

                                 5390--B

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              May 16, 2013
                               ___________

Introduced  by  Sen.  PARKER -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance  --  recommitted
  to the Committee on Insurance in accordance with Senate Rule 6, sec. 8
  --  committee  discharged,  bill amended, ordered reprinted as amended
  and recommitted  to  said  committee  --  committee  discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee

AN ACT to amend the insurance  law,  in  relation  to  mandatory  health
  insurance coverage for prosthetic devices

  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, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE TYPE COVERAGE AND PROVIDES COVERAGE  FOR  DURABLE  MEDICAL
EQUIPMENT  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC  DEVICES  THAT  ARE
INTENDED  FOR  MEDICALLY  NECESSARY  REHABILITATIVE   AND   HABILITATIVE
PURPOSES  AS  REQUIRED  BY  42  U.S.C. S 18022 THAT IS EQUIVALENT TO THE
COVERAGE PROVIDED FOR DURABLE MEDICAL EQUIPMENT.    THIS  SHALL  INCLUDE
COVERAGE  NOT  ONLY FOR THE PROVISION OF A PROSTHETIC DEVICE REQUIRED TO
BE WORN OR USED BY A POLICY HOLDER BUT ALSO THE REPAIR OR REPLACEMENT OF
A PROSTHETIC DEVICE REQUIRED TO BE WORN OR  USED  BY  A  POLICY  HOLDER.
COVERAGE  SHALL  INCLUDE EXPENSES FOR ASSESSMENT, EVALUATION, TREATMENT,
MANAGEMENT, AND FOLLOW-UP CARE. COVERAGE SHALL  NOT  BE  DENIED  IF  THE
POLICY  HOLDER'S  PHYSICIAN DETERMINES THE PROSTHETIC DEVICE IS THE MOST
APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL NEEDS OF THE  POLICY
HOLDER.  THE TERM "PROSTHETIC DEVICE" AS USED IN THIS PARAGRAPH INCLUDES
AN ARTIFICIAL LIMB BUT SHALL NOT INCLUDE  SHOES  OR  ANY  OTHER  ARTICLE
CONSIDERED  AS  ORDINARY  WEARING  APPAREL,  WHETHER  OR  NOT  SPECIALLY
CONSTRUCTED.  THE TERM "POLICY HOLDER" AS USED IN THIS  PARAGRAPH  SHALL
MEAN  A VETERAN OF THE ARMED FORCES WHO RESIDES IN THE STATE OF NEW YORK

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10223-07-4

S5390C (ACTIVE) - Details

See Assembly Version of this Bill:
A6820C
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L

S5390C (ACTIVE) - Summary

Requires mandatory health insurance coverage for certain individuals with prosthetic limbs; requires coverage where the model is determined to adequately meet the medical needs of the policy holder.

S5390C (ACTIVE) - Sponsor Memo

S5390C (ACTIVE) - Bill Text download pdf

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

                                 5390--C

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              May 16, 2013
                               ___________

Introduced  by  Sen.  PARKER -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance  --  recommitted
  to the Committee on Insurance in accordance with Senate Rule 6, sec. 8
  --  committee  discharged,  bill amended, ordered reprinted as amended
  and recommitted  to  said  committee  --  committee  discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee --  committee  discharged,  bill  amended,  ordered  reprinted  as
  amended and recommitted to said committee

AN  ACT  to  amend  the  insurance  law, in relation to mandatory health
  insurance coverage for prosthetic devices

  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, MAJOR  MEDICAL,  OR  SIMILAR
COMPREHENSIVE  TYPE  COVERAGE  AND PROVIDES COVERAGE FOR DURABLE MEDICAL
EQUIPMENT  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC  DEVICES  THAT  ARE
INTENDED   FOR   MEDICALLY  NECESSARY  REHABILITATIVE  AND  HABILITATIVE
PURPOSES AS REQUIRED BY 42 U.S.C. S 18022  THAT  IS  EQUIVALENT  TO  THE
COVERAGE  PROVIDED FOR DURABLE MEDICAL EQUIPMENT.  COVERAGE SHALL NOT BE
DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC DEVICE
IS THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL NEEDS OF
THE POLICY HOLDER. THE TERM "PROSTHETIC DEVICE" AS USED  IN  THIS  PARA-
GRAPH  INCLUDES  AN  ARTIFICIAL  LIMB BUT SHALL NOT INCLUDE SHOES OR ANY
OTHER ARTICLE CONSIDERED AS ORDINARY WEARING  APPAREL,  WHETHER  OR  NOT
SPECIALLY  CONSTRUCTED.   THE TERM "POLICY HOLDER" AS USED IN THIS PARA-
GRAPH SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES IN THE  STATE
OF  NEW  YORK AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE RESULTED
FROM AN INJURY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN  THE  ARMED
FORCES.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10223-09-4

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