The New York State Senate

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

                                  8839

                       2017-2018 Regular Sessions

                          I N  A S S E M B L Y

                            December 22, 2017
                               ___________

Introduced  by M. of A. JONES -- read once and referred to the Committee
  on Insurance

AN ACT to amend the insurance law,  in  relation  to  requiring  certain
  health  insurance  policies  to  cover costs for pediatric acute-onset
  neuropsychiatric syndrome

  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 34 to read as follows:
  (34)(A) EVERY HEALTH PLAN, AND HEALTH INSURANCE ISSUER OFFERING HEALTH
INSURANCE COVERAGE IN CONNECTION WITH A GROUP HEALTH PLAN, SHALL PROVIDE
COVERAGE FOR A PARTICIPANT OR BENEFICIARY WHO HAS PEDIATRIC  ACUTE-ONSET
NEUROPSYCHIATRIC  SYNDROME IF THE ATTENDING PHYSICIAN OF THE PARTICIPANT
OR BENEFICIARY CERTIFIES  IN  WRITING  THE  MEDICAL  NECESSITY  OF  THAT
PROPOSED COURSE OF REHABILITATIVE TREATMENT.
  (B) AS USED IN THIS PARAGRAPH, THE TERM "PEDIATRIC ACUTE-ONSET NEUROP-
SYCHIATRIC SYNDROME" SHALL HAVE THE SAME MEANING AS SUCH TERM IS USED IN
PARAGRAPH  (N)  OF  SUBDIVISION  ONE OF SECTION TWO HUNDRED SEVEN OF THE
PUBLIC HEALTH LAW.
  § 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 22 to read as follows:
  (22) (A) EVERY HEALTH  PLAN,  AND  HEALTH  INSURANCE  ISSUER  OFFERING
HEALTH  INSURANCE COVERAGE IN CONNECTION WITH A GROUP HEALTH PLAN, SHALL
PROVIDE COVERAGE FOR A PARTICIPANT  OR  BENEFICIARY  WHO  HAS  PEDIATRIC
ACUTE-ONSET  NEUROPSYCHIATRIC SYNDROME IF THE ATTENDING PHYSICIAN OF THE
PARTICIPANT OR BENEFICIARY CERTIFIES IN WRITING THE MEDICAL NECESSITY OF
THAT PROPOSED COURSE OF REHABILITATIVE TREATMENT.
  (B) AS USED IN THIS PARAGRAPH, THE TERM "PEDIATRIC ACUTE-ONSET NEUROP-
SYCHIATRIC SYNDROME" SHALL HAVE THE SAME MEANING AS SUCH TERM IS USED IN
PARAGRAPH (N) OF SUBDIVISION ONE OF SECTION TWO  HUNDRED  SEVEN  OF  THE
PUBLIC HEALTH LAW.

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

                                                           LBD13658-02-7

A. 8839                             2

  §  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (oo) to read as follows:
  (OO)(1) EVERY HEALTH PLAN, AND HEALTH INSURANCE ISSUER OFFERING HEALTH
INSURANCE COVERAGE IN CONNECTION WITH A GROUP HEALTH PLAN, SHALL PROVIDE
COVERAGE  FOR A PARTICIPANT OR BENEFICIARY WHO HAS PEDIATRIC ACUTE-ONSET
NEUROPSYCHIATRIC SYNDROME IF THE ATTENDING PHYSICIAN OF THE  PARTICIPANT
OR  BENEFICIARY  CERTIFIES  IN  WRITING  THE  MEDICAL  NECESSITY OF THAT
PROPOSED COURSE OF REHABILITATIVE TREATMENT.
  (2) AS USED IN THIS PARAGRAPH, THE TERM "PEDIATRIC ACUTE-ONSET NEUROP-
SYCHIATRIC SYNDROME" SHALL HAVE THE SAME MEANING AS SUCH TERM IS USED IN
PARAGRAPH (N) OF SUBDIVISION ONE OF SECTION TWO  HUNDRED  SEVEN  OF  THE
PUBLIC HEALTH LAW.
  §  4. 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 accord-
ing to its terms to all policies,  contracts  and  certificates  issued,
renewed, modified, altered or amended on or after such effective date.