S T A T E O F N E W Y O R K
________________________________________________________________________
7256
I N S E N A T E
January 5, 2018
___________
Introduced by Sen. LITTLE -- 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 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.
§ 3. Section 4303 of the insurance law is amended by adding a new
subsection (oo) to read as follows:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13658-02-7
S. 7256 2
(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.