NY State Senate Bill 2017-S6045B

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Apr 13, 2018	print number 6045c
Apr 13, 2018	amend and recommit to insurance
Jan 03, 2018	referred to insurance
Jun 05, 2017	print number 6045b
Jun 05, 2017	amend and recommit to insurance
May 15, 2017	print number 6045a
May 15, 2017	amend and recommit to insurance
May 10, 2017	referred to insurance

2017-S6045 - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3221 & 4303, Ins L
Versions Introduced in 2019-2020 Legislative Session:: S3101

2017-S6045 - Summary

Relates to coverage for eating disorders; requires comparable coverage for adults and children with eating disorders; defines eating disorder.

2017-S6045 - Sponsor Memo

                                 BILL NUMBER:  S6045

 TITLE OF BILL :  An act to amend the insurance law, in relation to
coverage for eating disorders

 PURPOSE :

This legislation closes a gap in coverage by requiring insurance
companies to provide full coverage for all the aspects of eating
disorders treatment.

 SUMMARY OF PROVISIONS :

Sections I amends subparagraph (b) of paragraph 5 of subsection (1) of
section 3221 of the insurance law to require insurers in the state to
provide coverage for inpatient hospital care and physician services
for eating disorders. The term "eating disorder" is defined.

Section II amends paragraph 2 of subsection (g) of section 4303 of the
insurance law to require hospital service and health service
corporations to provide coverage for eating disorders. The term
"eating disorder" is defined.

Section III amends paragraph 2 of subsection (h) of section 4303 to
require medical expense indemnity corporations and health service
corporations which provide group, group remittance, or school blanket

coverage for physician services to provide coverage for eating
disorders. The term "eating disorder" is defined.

Section IV sets forth the effective date.

 JUSTIFICATION :

In the United States, 30 million women and men will suffer from a
clinically significant eating disorder at some time in their life,
including anorexia nervosa, bulimia nervosa, binge eating disorder, or
other specified feeding or eating disorder (OSFED). Eating disorders
are real, complex, and devastating conditions that can have serious
consequences for health, productivity, and relationships, and can
impact every organ system in the body. Eating disorders are serious,
potentially life-threatening conditions that affect a person's
emotional and physical health. They are not a fad, phase or lifestyle
choice.

People struggling with an eating disorder need to seek professional
help. Eating Disorders have the highest mortality rate of any mental
illness. For females between fifteen to twenty-four years old who
suffer from anorexia nervosa, the mortality rate associated with the
illness is twelve times higher than the death rate of all other causes
of death. However, with proper medical care, eating disorders are
highly treatable. The earlier a person with an eating disorder
receives treatment, the greater the likelihood of physical and
emotional recovery.

Treatment for an eating disorder can cost up to $30,000 per month.
Despite the severity of these conditions, insurance coverage can be
difficult to obtain, and many families are often forced to choose
between bankruptcy and saving a loved one's life. Despite mental
health parity laws, many insurance companies continue to deny coverage
for an eating disorder, often times because they do not have a solid
understanding of what kind of care a patient requires in order to
reach full recovery. This legislation would close a gap in coverage by
requiring insurance companies to provide full coverage for all the
aspects of eating disorders treatment. The proposed legislation would
help ensure New York residents have access to adequate healthcare

coverage for eating disorders, decreasing the chance of chronic
illness and death.

 LEGISLATIVE HISTORY :

New bill.

 FISCAL IMPACT TO THE STATE :

To be determined.

 EFFECTIVE DATE :
This act shall take effect on the ninetieth day after it shall have
become a law; provided, however, that the provisions of this act shall
apply to policies and contracts issued, renewed, modified, altered, or
amended on or after such effective date.

2017-S6045 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6045
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                               May 10, 2017
                                ___________
 
 Introduced by Sen. MARCHIONE -- 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 coverage for eating
   disorders
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  Subparagraph  (B)  of  paragraph  5  of subsection (1) of
 section 3221 of the insurance law, as amended by chapter 502 of the laws
 of 2007, is amended to read as follows:
   (B) (i) Every insurer delivering a group or school blanket  policy  or
 issuing  a  group  or school blanket policy for delivery, in this state,
 which provides coverage for inpatient  hospital  care  or  coverage  for
 physician  services,  shall  provide  comparable coverage for adults and
 children with biologically based mental illness OR AN  EATING  DISORDER.
 Such group policies issued or delivered in this state shall also provide
 such  comparable  coverage  for children with serious emotional disturb-
 ances. Such coverage shall be provided under the  terms  and  conditions
 otherwise  applicable under the policy, including network limitations or
 variations,  exclusions,  co-pays,  coinsurance,  deductibles  or  other
 specific  cost  sharing  mechanisms.  Provided  further,  where a policy
 provides both in-network and out-of-network benefits, the out-of-network
 benefits may have different coinsurance, co-pays, or  deductibles,  than
 the  in-network  benefits,  regardless  of whether the policy is written
 under one license or two licenses.
   (ii) For purposes of this  paragraph,  the  term  "biologically  based
 mental  illness" means a mental, nervous, or emotional condition that is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the functioning of the person with the illness. Such biologically  based
 mental illnesses are defined as schizophrenia/psychotic disorders, major

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD06526-01-7

 S. 6045                             2
 
 depression, bipolar disorder, delusional disorders, panic disorder[,] OR
 obsessive compulsive disorders[, bulimia, and anorexia].
   (III) FOR PURPOSES OF THIS PARAGRAPH, THE TERM "EATING DISORDER" MEANS
 PICA,  RUMINATION  DISORDER,  AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER,
 ANOREXIA NERVOSA, BULIMIA NERVOSA, BINGE EATING DISORDER,  OTHER  SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN  THE  MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION WHERE
 DIAGNOSED BY A LICENSED PHYSICIAN, PSYCHIATRIST, PSYCHOLOGIST,  CLINICAL
 SOCIAL  WORKER,  LICENSED  MARITAL AND FAMILY THERAPIST, OR PROFESSIONAL
 COUNSELOR DULY LICENSED IN THE STATE  WHERE  HE  OR  SHE  PRACTICES  AND
 ACTING  WITHIN  THEIR APPLICABLE SCOPE OF PRACTICE IN THE STATE WHERE HE
 OR SHE PRACTICES.
   § 2. Paragraph 2 of subsection (g) of section 4303  of  the  insurance
 law,  as  amended by chapter 502 of the laws of 2007, is amended to read
 as follows:
   (2) (A) A hospital service corporation  or  a  health  service  corpo-
 ration,  which provides group, group remittance or school blanket cover-
 age for inpatient hospital care, shall provide comparable  coverage  for
 adults  and children with biologically based mental illness OR AN EATING
 DISORDER. Such hospital service corporation  or  health  service  corpo-
 ration  shall  also  provide  such comparable coverage for children with
 serious emotional disturbances. Such coverage shall  be  provided  under
 the  terms  and  conditions  otherwise  applicable  under  the contract,
 including network limitations or variations, exclusions, co-pays,  coin-
 surance, deductibles or other specific cost sharing mechanisms. Provided
 further,  where  a  contract provides both in-network and out-of-network
 benefits, the out-of-network benefits may  have  different  coinsurance,
 co-pays,  or  deductibles,  than  the in-network benefits, regardless of
 whether the contract is written under one license or two licenses.
   (B) For purposes of this  subsection,  the  term  "biologically  based
 mental  illness" means a mental, nervous, or emotional condition that is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the functioning of the person with the illness. Such biologically  based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression, bipolar disorder, delusional disorders, panic disorder[,] OR
 obsessive compulsive disorders[, anorexia, and bulimia].
   (C)  FOR PURPOSES OF THIS SUBSECTION, THE TERM "EATING DISORDER" MEANS
 PICA, RUMINATION DISORDER, AVOIDANT/RESTRICTIVE  FOOD  INTAKE  DISORDER,
 ANOREXIA  NERVOSA,  BULIMIA NERVOSA, BINGE EATING DISORDER, OTHER SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN THE MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL  MANUAL  OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION WHERE
 DIAGNOSED  BY A LICENSED PHYSICIAN, PSYCHIATRIST, PSYCHOLOGIST, CLINICAL
 SOCIAL WORKER, LICENSED MARITAL AND FAMILY  THERAPIST,  OR  PROFESSIONAL
 COUNSELOR  DULY  LICENSED  IN  THE  STATE  WHERE HE OR SHE PRACTICES AND
 ACTING WITHIN THEIR APPLICABLE SCOPE OF PRACTICE IN THE STATE  WHERE  HE
 OR SHE PRACTICES.
   §  3.  Paragraph  2 of subsection (h) of section 4303 of the insurance
 law, as amended by chapter 502 of the laws of 2007, is amended  to  read
 as follows:
   (2)  (A)  A  medical expense indemnity corporation or a health service
 corporation, which provides group, group remittance  or  school  blanket
 coverage  for  physician services, shall provide comparable coverage for
 adults and children with biologically based mental illness OR AN  EATING

 S. 6045                             3
 
 DISORDER.  Such  medical expense indemnity corporation or health service
 corporation shall also provide such  comparable  coverage  for  children
 with  serious  emotional  disturbances.  Such coverage shall be provided
 under  the terms and conditions otherwise applicable under the contract,
 including network limitations or variations, exclusions, co-pays,  coin-
 surance, deductibles or other specific cost sharing mechanisms. Provided
 further,  where  a  contract provides both in-network and out-of-network
 benefits, the out-of-network benefits may  have  different  coinsurance,
 co-pays,  or  deductibles,  than  the in-network benefits, regardless of
 whether the contract is written under one license or two licenses.
   (B) For purposes of this  subsection,  the  term  "biologically  based
 mental  illness" means a mental, nervous, or emotional condition that is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the functioning of the person with the illness. Such biologically  based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression, bipolar disorder, delusional disorders, panic disorder[,] OR
 obsessive compulsive disorder[, anorexia, and bulimia].
   (C)  FOR PURPOSES OF THIS SUBSECTION, THE TERM "EATING DISORDER" MEANS
 PICA, RUMINATION DISORDER, AVOIDANT/RESTRICTIVE  FOOD  INTAKE  DISORDER,
 ANOREXIA  NERVOSA,  BULIMIA NERVOSA, BINGE EATING DISORDER, OTHER SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN THE MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL  MANUAL  OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION WHERE
 DIAGNOSED  BY A LICENSED PHYSICIAN, PSYCHIATRIST, PSYCHOLOGIST, CLINICAL
 SOCIAL WORKER, LICENSED MARITAL AND FAMILY  THERAPIST,  OR  PROFESSIONAL
 COUNSELOR  DULY  LICENSED  IN  THE  STATE  WHERE HE OR SHE PRACTICES AND
 ACTING WITHIN THEIR APPLICABLE SCOPE OF PRACTICE IN THE STATE  WHERE  HE
 OR SHE PRACTICES.
   §  4.  This  act shall take effect on the ninetieth day after it shall
 have become a law; provided, however, that the provisions  of  this  act
 shall apply to policies and contracts issued, renewed, modified, altered
 or amended on or after such effective date.

co-Sponsors

2017-S6045A - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3221 & 4303, Ins L
Versions Introduced in 2019-2020 Legislative Session:: S3101

2017-S6045A - Summary

Relates to coverage for eating disorders; requires comparable coverage for adults and children with eating disorders; defines eating disorder.

2017-S6045A - Sponsor Memo

                                 BILL NUMBER:  S6045A

 TITLE OF BILL :  An act to amend the insurance law, in relation to
coverage for eating disorders

 PURPOSE :

This legislation closes a gap in coverage by requiring insurance
companies to provide full coverage for all the aspects of eating
disorders treatment.

 SUMMARY OF PROVISIONS :

Sections I amends subparagraph (b) of paragraph 5 of subsection (1) of
section 3221 of the insurance law to require insurers in the state to
provide coverage for inpatient hospital care and physician services
for eating disorders. The term "eating disorder" is defined.

Section II amends paragraph 2 of subsection (g) of section 4303 of the
insurance law to require hospital service and health service
corporations to provide coverage for eating disorders. The term
"eating disorder" is defined.

Section III amends paragraph 2 of subsection (h) of section 4303 to
require medical expense indemnity corporations and health service
corporations which provide group, group remittance, or school blanket

coverage for physician services to provide coverage for eating
disorders. The term "eating disorder" is defined.

Section IV sets forth the effective date.

 JUSTIFICATION :

In the United States, 30 million women and men will suffer from a
clinically significant eating disorder at some time in their life,
including anorexia nervosa, bulimia nervosa, binge eating disorder, or
other specified feeding or eating disorder (OSFED).  Eating disorders
are real, complex, and devastating conditions that can have serious
consequences for health, productivity, and relationships, and can
impact every organ system in the body. Eating disorders are serious,
potentially life-threatening conditions that affect a person's
emotional and physical health. They are not a fad, phase or lifestyle
choice.

People struggling with an eating disorder need to seek professional
help. Eating Disorders have the highest mortality rate of any mental
illness. For females between fifteen to twenty-four years old who
suffer from anorexia nervosa, the mortality rate associated with the
illness is twelve times higher than the death rate of all other causes
of death. However, with proper medical care, eating disorders are
highly treatable. The earlier a person with an eating disorder
receives treatment, the greater the likelihood of physical and
emotional recovery.

Treatment for an eating disorder can cost up to $30,000 per month.
Despite the severity of these conditions, insurance coverage can be
difficult to obtain, and many families are often forced to choose
between bankruptcy and saving a loved one's life. Despite mental
health parity laws, many insurance companies continue to deny coverage
for an eating disorder, often times because they do not have a solid
understanding of what kind of care a patient requires in order to
reach full recovery. This legislation would close a gap in coverage by
requiring insurance companies to provide full coverage for all the
aspects of eating disorders treatment. The proposed legislation would
help ensure New York residents have access to adequate healthcare

coverage for eating disorders, decreasing the chance of chronic
illness and death.

 LEGISLATIVE HISTORY :

This is a new bill in the Senate.

 FISCAL IMPACT TO THE STATE :

To be determined.

 EFFECTIVE DATE :
This act shall take effect on the ninetieth day after it shall have
become a law; provided, however, that the provisions of this act shall
apply to policies and contracts issued, renewed, modified, altered, or
amended on or after such effective date.

2017-S6045A - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6045--A
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                               May 10, 2017
                                ___________
 
 Introduced by Sen. MARCHIONE -- read twice and ordered printed, and when
   printed  to  be  committed  to the Committee on Insurance -- committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee
 
 AN ACT to amend the insurance law, in relation to  coverage  for  eating
   disorders

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (B)  of  paragraph  5  of  subsection  (1)  of
 section 3221 of the insurance law, as amended by chapter 502 of the laws
 of 2007, is amended to read as follows:
   (B)  (i)  Every insurer delivering a group or school blanket policy or
 issuing a group or school blanket policy for delivery,  in  this  state,
 which  provides  coverage  for  inpatient  hospital care or coverage for
 physician services, shall provide comparable  coverage  for  adults  and
 children  with  biologically based mental illness OR AN EATING DISORDER.
 Such group policies issued or delivered in this state shall also provide
 such comparable coverage for children with  serious  emotional  disturb-
 ances.  Such  coverage  shall be provided under the terms and conditions
 otherwise applicable under the policy, including network limitations  or
 variations,  exclusions,  co-pays,  coinsurance,  deductibles  or  other
 specific cost sharing  mechanisms.  Provided  further,  where  a  policy
 provides both in-network and out-of-network benefits, the out-of-network
 benefits  may  have different coinsurance, co-pays, or deductibles, than
 the in-network benefits, regardless of whether  the  policy  is  written
 under one license or two licenses.
   (ii)  For  purposes  of  this  paragraph, the term "biologically based
 mental illness" means a mental, nervous, or emotional condition that  is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the  functioning of the person with the illness. Such biologically based
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD06526-03-7

 S. 6045--A                          2
 
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression, bipolar disorder, delusional disorders, panic disorder[,] OR
 obsessive compulsive disorders[, bulimia, and anorexia].
   (III) FOR PURPOSES OF THIS PARAGRAPH, THE TERM "EATING DISORDER" MEANS
 PICA,  RUMINATION  DISORDER,  AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER,
 ANOREXIA NERVOSA, BULIMIA NERVOSA, BINGE EATING DISORDER,  OTHER  SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN  THE  MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION.
   § 2. Paragraph 2 of subsection (g) of section 4303  of  the  insurance
 law,  as  amended by chapter 502 of the laws of 2007, is amended to read
 as follows:
   (2) (A) A hospital service corporation  or  a  health  service  corpo-
 ration,  which provides group, group remittance or school blanket cover-
 age for inpatient hospital care, shall provide comparable  coverage  for
 adults  and children with biologically based mental illness OR AN EATING
 DISORDER. Such hospital service corporation  or  health  service  corpo-
 ration  shall  also  provide  such comparable coverage for children with
 serious emotional disturbances. Such coverage shall  be  provided  under
 the  terms  and  conditions  otherwise  applicable  under  the contract,
 including network limitations or variations, exclusions, co-pays,  coin-
 surance, deductibles or other specific cost sharing mechanisms. Provided
 further,  where  a  contract provides both in-network and out-of-network
 benefits, the out-of-network benefits may  have  different  coinsurance,
 co-pays,  or  deductibles,  than  the in-network benefits, regardless of
 whether the contract is written under one license or two licenses.
   (B) For purposes of this  subsection,  the  term  "biologically  based
 mental  illness" means a mental, nervous, or emotional condition that is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the functioning of the person with the illness. Such biologically  based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression, bipolar disorder, delusional disorders, panic disorder[,] OR
 obsessive compulsive disorders[, anorexia, and bulimia].
   (C)  FOR PURPOSES OF THIS SUBSECTION, THE TERM "EATING DISORDER" MEANS
 PICA, RUMINATION DISORDER, AVOIDANT/RESTRICTIVE  FOOD  INTAKE  DISORDER,
 ANOREXIA  NERVOSA,  BULIMIA NERVOSA, BINGE EATING DISORDER, OTHER SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN THE MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL  MANUAL  OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION.
   §  3.  Paragraph  2 of subsection (h) of section 4303 of the insurance
 law, as amended by chapter 502 of the laws of 2007, is amended  to  read
 as follows:
   (2)  (A)  A  medical expense indemnity corporation or a health service
 corporation, which provides group, group remittance  or  school  blanket
 coverage  for  physician services, shall provide comparable coverage for
 adults and children with biologically based mental illness OR AN  EATING
 DISORDER.  Such  medical expense indemnity corporation or health service
 corporation shall also provide such  comparable  coverage  for  children
 with  serious  emotional  disturbances.  Such coverage shall be provided
 under the terms and conditions otherwise applicable under the  contract,
 including  network limitations or variations, exclusions, co-pays, coin-
 surance, deductibles or other specific cost sharing mechanisms. Provided
 further, where a contract provides both  in-network  and  out-of-network
 benefits,  the  out-of-network  benefits may have different coinsurance,

 S. 6045--A                          3
 
 co-pays, or deductibles, than the  in-network  benefits,  regardless  of
 whether the contract is written under one license or two licenses.
   (B)  For  purposes  of  this  subsection, the term "biologically based
 mental illness" means a mental, nervous, or emotional condition that  is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the  functioning of the person with the illness. Such biologically based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression, bipolar disorder, delusional disorders, panic disorder[,] OR
 obsessive compulsive disorder[, anorexia, and bulimia].
   (C) FOR PURPOSES OF THIS SUBSECTION, THE TERM "EATING DISORDER"  MEANS
 PICA,  RUMINATION  DISORDER,  AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER,
 ANOREXIA NERVOSA, BULIMIA NERVOSA, BINGE EATING DISORDER,  OTHER  SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN  THE  MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION.
   § 4. This act shall take effect on the ninetieth day  after  it  shall
 have  become  a  law; provided, however, that the provisions of this act
 shall apply to policies and contracts issued, renewed, modified, altered
 or amended on or after such effective date.

co-Sponsors

View additional co-sponsors

2017-S6045B - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3221 & 4303, Ins L
Versions Introduced in 2019-2020 Legislative Session:: S3101

2017-S6045B - Summary

Relates to coverage for eating disorders; requires comparable coverage for adults and children with eating disorders; defines eating disorder.

2017-S6045B - Sponsor Memo

                                 BILL NUMBER:  S6045B

 TITLE OF BILL :  An act to amend the insurance law, in relation to
coverage for eating disorders

 PURPOSE :

This legislation closes a gap in coverage by requiring insurance
companies to provide full coverage for all the aspects of eating
disorders treatment.

 SUMMARY OF PROVISIONS :

Sections I amends subparagraph (b) of paragraph 5 of subsection (1) of
section 3221 of the insurance law to require insurers in the state to
provide coverage for inpatient hospital care and physician services
for eating disorders. The term "eating disorder" is defined.

Section II amends paragraph 2 of subsection (g) of section 4303 of the
insurance law to require hospital service and health service
corporations to provide coverage for eating disorders. The term
"eating disorder" is defined.

Section III amends paragraph 2 of subsection (h) of section 4303 to
require medical expense indemnity corporations and health service
corporations which provide group, group remittance, or school blanket

coverage for physician services to provide coverage for eating
disorders. The term "eating disorder" is defined.

Section IV sets forth the effective date.

 JUSTIFICATION :

In the United States, 30 million women and men will suffer from a
clinically significant eating disorder at some time in their life,
including anorexia nervosa, bulimia nervosa, binge eating disorder, or
other specified feeding or eating disorder (OSFED).  Eating disorders
are real, complex, and devastating conditions that can have serious
consequences for health, productivity, and relationships, and can
impact every organ system in the body. Eating disorders are serious,
potentially life-threatening conditions that affect a person's
emotional and physical health. They are not a fad, phase or lifestyle
choice.

People struggling with an eating disorder need to seek professional
help. Eating Disorders have the highest mortality rate of any mental
illness. For females between fifteen to twenty-four years old who
suffer from anorexia nervosa, the mortality rate associated with the
illness is twelve times higher than the death rate of all other causes
of death. However, with proper medical care, eating disorders are
highly treatable. The earlier a person with an eating disorder
receives treatment, the greater the likelihood of physical and
emotional recovery.

Treatment for an eating disorder can cost up to $30,000 per month.
Despite the severity of these conditions, insurance coverage can be
difficult to obtain, and many families are often forced to choose
between bankruptcy and saving a loved one's life. Despite mental
health parity laws, many insurance companies continue to deny coverage
for an eating disorder, often times because they do not have a solid
understanding of what kind of care a patient requires in order to
reach full recovery. The proposed legislation would help ensure New
York residents have access to adequate healthcare coverage for eating
disorders, decreasing the chance of chronic illness and death.

 LEGISLATIVE HISTORY :
This is a new bill in the Senate.

 FISCAL IMPACT TO THE STATE :

To be determined.

 EFFECTIVE DATE :
This act shall take effect on the ninetieth day after it shall have
become a law; provided, however, that the provisions of this act shall
apply to policies and contracts issued, renewed, modified, altered, or
amended on or after such effective date.

2017-S6045B - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6045--B
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                               May 10, 2017
                                ___________
 
 Introduced  by  Sens.  MARCHIONE,  RANZENHOFER -- read twice and ordered
   printed, and when printed to be committed to the Committee  on  Insur-
   ance  --  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
   committee
 
 AN ACT to amend the insurance law, in relation to  coverage  for  eating
   disorders
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (B)  of  paragraph  5  of  subsection  (1)  of
 section 3221 of the insurance law, as amended by chapter 502 of the laws
 of 2007, is amended to read as follows:
   (B)  (i)  Every insurer delivering a group or school blanket policy or
 issuing a group or school blanket policy for delivery,  in  this  state,
 which  provides  coverage  for  inpatient  hospital care or coverage for
 physician services, shall provide comparable  coverage  for  adults  and
 children  with  biologically based mental illness OR AN EATING DISORDER.
 Such group policies issued or delivered in this state shall also provide
 such comparable coverage for children with  serious  emotional  disturb-
 ances.  Such  coverage  shall be provided under the terms and conditions
 otherwise applicable under the policy, including network limitations  or
 variations,  exclusions,  co-pays,  coinsurance,  deductibles  or  other
 specific cost sharing  mechanisms.  Provided  further,  where  a  policy
 provides both in-network and out-of-network benefits, the out-of-network
 benefits  may  have different coinsurance, co-pays, or deductibles, than
 the in-network benefits, regardless of whether  the  policy  is  written
 under one license or two licenses.
   (ii)  For  purposes  of  this  paragraph, the term "biologically based
 mental illness" means a mental, nervous, or emotional condition that  is
 caused by a biological disorder of the brain and results in a clinically

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

                                                            LBD06526-05-7

 S. 6045--B                          2
 
 significant, psychological syndrome or pattern that substantially limits
 the  functioning of the person with the illness. Such biologically based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression,  bipolar  disorder,  delusional  disorders,  panic disorder,
 obsessive compulsive disorders[, bulimia, and  anorexia]  OR  AN  EATING
 DISORDER.
   (III) FOR PURPOSES OF THIS PARAGRAPH, THE TERM "EATING DISORDER" MEANS
 PICA,  RUMINATION  DISORDER,  AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER,
 ANOREXIA NERVOSA, BULIMIA NERVOSA, BINGE EATING DISORDER,  OTHER  SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN  THE  MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION.
   § 2. Paragraph 2 of subsection (g) of section 4303  of  the  insurance
 law,  as  amended by chapter 502 of the laws of 2007, is amended to read
 as follows:
   (2) (A) A hospital service corporation  or  a  health  service  corpo-
 ration,  which provides group, group remittance or school blanket cover-
 age for inpatient hospital care, shall provide comparable  coverage  for
 adults  and children with biologically based mental illness OR AN EATING
 DISORDER. Such hospital service corporation  or  health  service  corpo-
 ration  shall  also  provide  such comparable coverage for children with
 serious emotional disturbances. Such coverage shall  be  provided  under
 the  terms  and  conditions  otherwise  applicable  under  the contract,
 including network limitations or variations, exclusions, co-pays,  coin-
 surance, deductibles or other specific cost sharing mechanisms. Provided
 further,  where  a  contract provides both in-network and out-of-network
 benefits, the out-of-network benefits may  have  different  coinsurance,
 co-pays,  or  deductibles,  than  the in-network benefits, regardless of
 whether the contract is written under one license or two licenses.
   (B) For purposes of this  subsection,  the  term  "biologically  based
 mental  illness" means a mental, nervous, or emotional condition that is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the functioning of the person with the illness. Such biologically  based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression,  bipolar  disorder,  delusional  disorders,  panic disorder,
 obsessive compulsive disorders[, anorexia, and  bulimia]  OR  AN  EATING
 DISORDER.
   (C)  FOR PURPOSES OF THIS SUBSECTION, THE TERM "EATING DISORDER" MEANS
 PICA, RUMINATION DISORDER, AVOIDANT/RESTRICTIVE  FOOD  INTAKE  DISORDER,
 ANOREXIA  NERVOSA,  BULIMIA NERVOSA, BINGE EATING DISORDER, OTHER SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN THE MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL  MANUAL  OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION.
   §  3.  Paragraph  2 of subsection (h) of section 4303 of the insurance
 law, as amended by chapter 502 of the laws of 2007, is amended  to  read
 as follows:
   (2)  (A)  A  medical expense indemnity corporation or a health service
 corporation, which provides group, group remittance  or  school  blanket
 coverage  for  physician services, shall provide comparable coverage for
 adults and children with biologically based mental illness OR AN  EATING
 DISORDER.  Such  medical expense indemnity corporation or health service
 corporation shall also provide such  comparable  coverage  for  children
 with  serious  emotional  disturbances.  Such coverage shall be provided
 under the terms and conditions otherwise applicable under the  contract,
 including  network limitations or variations, exclusions, co-pays, coin-

 S. 6045--B                          3
 
 surance, deductibles or other specific cost sharing mechanisms. Provided
 further, where a contract provides both  in-network  and  out-of-network
 benefits,  the  out-of-network  benefits may have different coinsurance,
 co-pays,  or  deductibles,  than  the in-network benefits, regardless of
 whether the contract is written under one license or two licenses.
   (B) For purposes of this  subsection,  the  term  "biologically  based
 mental  illness" means a mental, nervous, or emotional condition that is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the functioning of the person with the illness. Such biologically  based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression,  bipolar  disorder,  delusional  disorders,  panic disorder,
 obsessive compulsive disorder[, anorexia,  and  bulimia]  OR  AN  EATING
 DISORDER.
   (C)  FOR PURPOSES OF THIS SUBSECTION, THE TERM "EATING DISORDER" MEANS
 PICA, RUMINATION DISORDER, AVOIDANT/RESTRICTIVE  FOOD  INTAKE  DISORDER,
 ANOREXIA  NERVOSA,  BULIMIA NERVOSA, BINGE EATING DISORDER, OTHER SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN THE MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL  MANUAL  OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION.
   §  4.  This  act shall take effect on the ninetieth day after it shall
 have become a law; provided, however, that the provisions  of  this  act
 shall apply to policies and contracts issued, renewed, modified, altered
 or amended on or after such effective date.

co-Sponsors

View additional co-sponsors

2017-S6045C (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3221 & 4303, Ins L
Versions Introduced in 2019-2020 Legislative Session:: S3101

2017-S6045C (ACTIVE) - Summary

Relates to coverage for eating disorders; requires comparable coverage for adults and children with eating disorders; defines eating disorder.

2017-S6045C (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S6045C

SPONSOR: MARCHIONE
 
TITLE OF BILL:  An act to amend the insurance law, in relation to
coverage for eating disorders

 
PURPOSE:

This legislation closes a gap in coverage by requiring insurance compa-
nies to provide full coverage for all the aspects of eating disorders
treatment.

 
SUMMARY OF PROVISIONS:

Sections I amends subparagraph (b) of paragraph 5 of subsection (1) of
section 3221 of the insurance law to require insurers in the state to
provide coverage for inpatient hospital care and physician services for
eating disorders. The term "eating disorder" is defined.

Section II amends paragraph 2 of subsection (g) of section 4303 of the
insurance law to require hospital service and health service corpo-

rations to provide coverage for eating disorders. The term "eating
disorder" is defined.

Section III amends paragraph 2 of subsection (h) of section 4303 to
require medical expense indemnity corporations and health service corpo-
rations which provide group, group remittance, or school blanket cover-
age for physician services to provide coverage for eating disorders. The
term "eating disorder" is defined.

Section IV sets forth the effective date.

 
JUSTIFICATION:

In the United States, 30 million women and men will suffer from a clin-
ically significant eating disorder at some time in their life, including
anorexia nervosa, bulimia nervosa, binge eating disorder, or other spec-
ified feeding or eating disorder (OSFED). Eating disorders are real,
complex, and devastating conditions that can have serious consequences
for health, productivity, and relationships, and can impact every organ
system in the body. Eating disorders are serious, potentially life-
threatening conditions that affect a person's emotional and physical
health. They are not a fad, phase or lifestyle choice.

People struggling with an eating disorder need to seek professional
help. Eating Disorders have the highest mortality rate of any mental
illness. For females between fifteen to twenty-four years old who suffer
from anorexia nervosa, the mortality rate associated with the illness is
twelve times higher than the death rate of all other causes of death.
However, with proper medical care, eating disorders are highly treata-
ble. The earlier a person with an eating disorder receives treatment,
the greater the likelihood of physical and emotional recovery.

Treatment for an eating disorder can cost up to $30,000 per month.
Despite the severity of these conditions, insurance coverage can be
difficult to obtain, and many families are often forced to choose
between bankruptcy and saving a loved one's life. Despite mental health
parity laws, many insurance companies continue to deny coverage for an
eating disorder, often times because they do not have a solid under-
standing of what kind of care a patient requires in order to reach full
recovery. The proposed legislation would help ensure New York residents
have access to adequate healthcare coverage for eating disorders,
decreasing the chance of chronic illness and death.

 
LEGISLATIVE HISTORY:

2017: A06396B (Rozic) - Passed Assembly

 
FISCAL IMPACT TO THE STATE:

To be determined.

 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become a law; provided, however, that the provisions of this act shall
apply to policies and contracts issued, renewed, modified, altered, or
amended on or after such effective date.

2017-S6045C (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6045--C
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                               May 10, 2017
                                ___________
 
 Introduced  by  Sens.  MARCHIONE,  ALCANTARA,  BRESLIN, CARLUCCI, FUNKE,
   HOYLMAN, KAMINSKY, LANZA, RANZENHOFER -- read twice and ordered print-
   ed, and when printed to be committed to the Committee on Insurance  --
   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 committee --
   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  coverage  for  eating
   disorders
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (B)  of  paragraph  5  of  subsection  (1)  of
 section 3221 of the insurance law, as amended by chapter 502 of the laws
 of 2007, is amended to read as follows:
   (B)  (i)  Every insurer delivering a group or school blanket policy or
 issuing a group or school blanket policy for delivery,  in  this  state,
 which  provides  coverage  for  inpatient  hospital care or coverage for
 physician services, shall provide comparable  coverage  for  adults  and
 children  with  biologically  based  mental illness. Such group policies
 issued or delivered in this state shall  also  provide  such  comparable
 coverage for children with serious emotional disturbances. Such coverage
 shall  be  provided  under the terms and conditions otherwise applicable
 under the policy, including network limitations  or  variations,  exclu-
 sions,  co-pays, coinsurance, deductibles or other specific cost sharing
 mechanisms. Provided further, where a policy  provides  both  in-network
 and  out-of-network  benefits,  the  out-of-network  benefits  may  have
 different coinsurance, co-pays,  or  deductibles,  than  the  in-network
 benefits,  regardless of whether the policy is written under one license
 or two licenses.

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

                                                            LBD06526-07-8

 S. 6045--C                          2
 
   (ii) For purposes of this  paragraph,  the  term  "biologically  based
 mental  illness" means a mental, nervous, or emotional condition that is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the  functioning of the person with the illness. Such biologically based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression, bipolar  disorder,  delusional  disorders,  panic  disorder,
 obsessive  compulsive  disorders[,  bulimia,  and anorexia] OR AN EATING
 DISORDER.
   (III) FOR PURPOSES OF THIS PARAGRAPH, THE TERM "EATING DISORDER" MEANS
 PICA, RUMINATION DISORDER, AVOIDANT/RESTRICTIVE  FOOD  INTAKE  DISORDER,
 ANOREXIA  NERVOSA,  BULIMIA NERVOSA, BINGE EATING DISORDER, OTHER SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN THE MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL  MANUAL  OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION.
   §  2.  Paragraph  2 of subsection (g) of section 4303 of the insurance
 law, as amended by chapter 502 of the laws of 2007, is amended  to  read
 as follows:
   (2)  (A)  A  hospital  service  corporation or a health service corpo-
 ration, which provides group, group remittance or school blanket  cover-
 age  for  inpatient hospital care, shall provide comparable coverage for
 adults and children with biologically based mental illness. Such  hospi-
 tal service corporation or health service corporation shall also provide
 such  comparable  coverage  for children with serious emotional disturb-
 ances. Such coverage shall be provided under the  terms  and  conditions
 otherwise  applicable  under the contract, including network limitations
 or variations, exclusions, co-pays, coinsurance,  deductibles  or  other
 specific  cost  sharing  mechanisms.  Provided further, where a contract
 provides both in-network and out-of-network benefits, the out-of-network
 benefits may have different coinsurance, co-pays, or  deductibles,  than
 the  in-network  benefits, regardless of whether the contract is written
 under one license or two licenses.
   (B) For purposes of this  subsection,  the  term  "biologically  based
 mental  illness" means a mental, nervous, or emotional condition that is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the functioning of the person with the illness. Such biologically  based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression,  bipolar  disorder,  delusional  disorders,  panic disorder,
 obsessive compulsive disorders[, anorexia, and  bulimia]  OR  AN  EATING
 DISORDER.
   (C)  FOR PURPOSES OF THIS SUBSECTION, THE TERM "EATING DISORDER" MEANS
 PICA, RUMINATION DISORDER, AVOIDANT/RESTRICTIVE  FOOD  INTAKE  DISORDER,
 ANOREXIA  NERVOSA,  BULIMIA NERVOSA, BINGE EATING DISORDER, OTHER SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN THE MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL  MANUAL  OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION.
   §  3.  Paragraph  2 of subsection (h) of section 4303 of the insurance
 law, as amended by chapter 502 of the laws of 2007, is amended  to  read
 as follows:
   (2)  (A)  A  medical expense indemnity corporation or a health service
 corporation, which provides group, group remittance  or  school  blanket
 coverage  for  physician services, shall provide comparable coverage for
 adults and children with biologically based mental illness. Such medical
 expense indemnity corporation or health service corporation  shall  also
 provide  such  comparable  coverage  for children with serious emotional

 S. 6045--C                          3
 
 disturbances. Such coverage shall be provided under the terms and condi-
 tions otherwise applicable under the contract, including network limita-
 tions or variations, exclusions, co-pays,  coinsurance,  deductibles  or
 other  specific  cost  sharing  mechanisms.  Provided  further,  where a
 contract provides both in-network and out-of-network benefits, the  out-
 of-network  benefits may have different coinsurance, co-pays, or deduct-
 ibles, than the in-network benefits, regardless of whether the  contract
 is written under one license or two licenses.
   (B)  For  purposes  of  this  subsection, the term "biologically based
 mental illness" means a mental, nervous, or emotional condition that  is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the  functioning of the person with the illness. Such biologically based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression, bipolar  disorder,  delusional  disorders,  panic  disorder,
 obsessive  compulsive  disorder[,  anorexia,  and  bulimia] OR AN EATING
 DISORDER.
   (C) FOR PURPOSES OF THIS SUBSECTION, THE TERM "EATING DISORDER"  MEANS
 PICA,  RUMINATION  DISORDER,  AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER,
 ANOREXIA NERVOSA, BULIMIA NERVOSA, BINGE EATING DISORDER,  OTHER  SPECI-
 FIED FEEDING OR EATING DISORDER, AND ANY OTHER EATING DISORDER CONTAINED
 IN  THE  MOST RECENT VERSION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF
 MENTAL DISORDERS PUBLISHED BY THE AMERICAN PSYCHIATRIC ASSOCIATION.
   § 4. This act shall take effect on the ninetieth day  after  it  shall
 have  become  a  law; provided, however, that the provisions of this act
 shall apply to policies and contracts issued, renewed, modified, altered
 or amended on or after such effective date.

Senate Bill S6045B

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

Bill Amendments

2017-S6045 - Details

2017-S6045 - Summary

2017-S6045 - Sponsor Memo

2017-S6045 - Bill Text download pdf

co-Sponsors

2017-S6045A - Details

2017-S6045A - Summary

2017-S6045A - Sponsor Memo

2017-S6045A - Bill Text download pdf

co-Sponsors

2017-S6045B - Details

2017-S6045B - Summary

2017-S6045B - Sponsor Memo

2017-S6045B - Bill Text download pdf

co-Sponsors

2017-S6045C (ACTIVE) - Details

2017-S6045C (ACTIVE) - Summary

2017-S6045C (ACTIVE) - Sponsor Memo

2017-S6045C (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S6045B

Share this bill

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

Bill Amendments

2017-S6045 - Details

2017-S6045 - Summary

2017-S6045 - Sponsor Memo

2017-S6045 - Bill Text download pdf

co-Sponsors

2017-S6045A - Details

2017-S6045A - Summary

2017-S6045A - Sponsor Memo

2017-S6045A - Bill Text download pdf

co-Sponsors

2017-S6045B - Details

2017-S6045B - Summary

2017-S6045B - Sponsor Memo

2017-S6045B - Bill Text download pdf

co-Sponsors

2017-S6045C (ACTIVE) - Details

2017-S6045C (ACTIVE) - Summary

2017-S6045C (ACTIVE) - Sponsor Memo

2017-S6045C (ACTIVE) - Bill Text download pdf

Comments