NY State Senate Bill 2019-S5174

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 08, 2020	referred to insurance
Apr 12, 2019	referred to insurance

2019-S5174 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2015-2016: S5943
2017-2018: S704
2021-2022: S3649
2023-2024: S1315

2019-S5174 (ACTIVE) - Summary

Requires mandatory health insurance coverage for prosthetic devices; requires coverage where the model is determined to be medically necessary for rehabilitative and habilitative purposes.

2019-S5174 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S5174

SPONSOR: ORTT
 
TITLE OF BILL:  An act to amend the insurance law, in relation to
mandatory health insurance coverage for providing prosthetic devices

 
PURPOSE OR GENERAL IDEA OF THE BILL:

To ensure that coverage for rehabilitative and habilitative services,
including prosthetic devices, are available to military veteran s resid-
ing in NYS.

 
SUMMARY OF SPECIFIC PROVISIONS:

This bill would require that health insurers that provide medical, major
medical, or similar comprehensive type coverage include coverage for
prosthetic devices for veterans of the armed forces who are residents of
New York when such devices are deemed medically necessary for the
patient's rehabilitation.

JUSTIFICATION:

Two recent wars involving the United States, Iraq and Afghanistan has
left over 600 military men and women as amputees with lifelong injuries.
Each year 185,000 amputations occur in the US and there are nearly 2
million people living with limb loss in the US. Improving access to
quality and updated prosthetic devices will improve the quality of life
of veterans and other amputees, while helping to reduce other medical
costs related to lack of mobility and associated physical and emotional
health.

According to the Veterans Health Administration, approximately 6 percent
of wounded service members returning from Iraq are individuals with
amputations. As a society, we owe these veterans the best of our efforts
to help them live improved lives after their sacrifice for our nation.

 
PRIOR LEGISLATIVE HISTORY:

S. 704A of 2017-2018 Referred to Insurance
S. 5943A Passed Senate in 2015; Advanced to Third Reading in 2016.

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENT:

None

 
EFFECTIVE DATE:
This act shall take effect 180 days after becoming law.

2019-S5174 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5174
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                              April 12, 2019
                                ___________
 
 Introduced  by  Sen.  ORTT  --  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 providing 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 35 to read as follows:
   (35)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
 COMPREHENSIVE TYPE COVERAGE TO A POLICYHOLDER SHALL PROVIDE COVERAGE FOR
 PROSTHETIC DEVICES THAT ARE INTENDED FOR MEDICALLY NECESSARY REHABILITA-
 TIVE AND HABILITATIVE PURPOSES AS REQUIRED BY 42 U.S.C. § 18022.  COVER-
 AGE  SHALL  INCLUDE  THE  COST  OF  REPAIR  OR REPLACEMENT OF PROSTHETIC
 DEVICES DUE TO NORMAL WEAR AND TEAR, IF A  PROSTHETIC  DEVICE  HAS  BEEN
 OUTGROWN  OR  NO  LONGER FITS PROPERLY, OR WHERE A CHANGE IN THE MEDICAL
 CONDITION MAKES REPLACEMENT NECESSARY. COVERAGE SHALL  NOT  INCLUDE  THE
 COSTS  OF  REPAIR  OR REPLACEMENT OF A PROSTHETIC DEVICE THAT IS COVERED
 UNDER THE WARRANTY OF THE MANUFACTURE OR WHEN THE REPAIR OR  REPLACEMENT
 IS  NECESSARY  DUE TO MISUSE OR NEGLIGENCE. 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 SPECIFICALLY CONSTRUCTED. THE TERM  "POLICYHOLD-
 ER"  AS  USED IN THIS PARAGRAPH 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 WHILE ON ACTIVE DUTY
 SERVING IN THE ARMED FORCES. SUCH COVERAGE SHALL BE  SUBJECT  TO  ANNUAL
 DEDUCTIBLES AND COINSURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
 THE COVERAGE REQUIRED BY THIS PARAGRAPH SHALL BE IDENTICAL TO, AND SHALL
 NOT  ENHANCE OR INCREASE THE ESSENTIAL HEALTH BENEFIT COVERAGE CHOSEN BY
 THE STATE PURSUANT TO 45 CFR 156.100. NOTHING IN THIS PARAGRAPH SHALL BE
 CONSTRUED TO PREVENT THE MEDICAL MANAGEMENT  OR  UTILIZATION  REVIEW  OF
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD02354-01-9

 S. 5174                             2
 
 BENEFITS   FOR   MEDICALLY  NECESSARY  REHABILITATIVE  AND  HABILITATIVE
 PURPOSES.
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 21 to read as follows:
   (21)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
 COMPREHENSIVE TYPE COVERAGE TO A POLICYHOLDER SHALL PROVIDE COVERAGE FOR
 PROSTHETIC DEVICES THAT ARE INTENDED FOR MEDICALLY NECESSARY REHABILITA-
 TIVE AND HABILITATIVE PURPOSES AS REQUIRED BY 42 U.S.C. § 18022.  COVER-
 AGE  SHALL  INCLUDE  THE  COST  OF  REPAIR  OR REPLACEMENT OF PROSTHETIC
 DEVICES DUE TO NORMAL WEAR AND TEAR, IF A  PROSTHETIC  DEVICE  HAS  BEEN
 OUTGROWN  OR  NO  LONGER FITS PROPERLY, OR WHERE A CHANGE IN THE MEDICAL
 CONDITION MAKES REPLACEMENT NECESSARY. COVERAGE SHALL  NOT  INCLUDE  THE
 COSTS  OF  REPAIR  OR REPLACEMENT OF A PROSTHETIC DEVICE THAT IS COVERED
 UNDER THE WARRANTY OF THE MANUFACTURER OR WHEN THE REPAIR OR REPLACEMENT
 IS NECESSARY DUE TO MISUSE OR NEGLIGENCE. 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 SPECIFICALLY CONSTRUCTED. THE TERM "POLICYHOLD-
 ER" AS USED IN THIS PARAGRAPH 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 WHILE ON ACTIVE  DUTY
 SERVING  IN  THE ARMED FORCES.  SUCH COVERAGE SHALL BE SUBJECT TO ANNUAL
 DEDUCTIBLES AND COINSURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
 THE COVERAGE REQUIRED BY THIS PARAGRAPH SHALL BE IDENTICAL TO, AND SHALL
 NOT ENHANCE OR INCREASE THE ESSENTIAL HEALTH BENEFIT COVERAGE CHOSEN  BY
 THE STATE PURSUANT TO 45 CFR 156.100. NOTHING IN THIS PARAGRAPH SHALL BE
 CONSTRUED  TO  PREVENT  THE  MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF
 BENEFITS  FOR  MEDICALLY  NECESSARY  REHABILITATIVE   AND   HABILITATIVE
 PURPOSES.
   §  3.  Section  4303  of  the insurance law is amended by adding a new
 subsection (ss) to read as follows:
   (SS) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR  MEDICAL,  OR  SIMILAR
 COMPREHENSIVE TYPE COVERAGE TO A POLICYHOLDER SHALL PROVIDE COVERAGE FOR
 PROSTHETIC DEVICES THAT ARE INTENDED FOR MEDICALLY NECESSARY REHABILITA-
 TIVE  AND HABILITATIVE PURPOSES AS REQUIRED BY 42 U.S.C. § 18022. COVER-
 AGE SHALL INCLUDE THE  COST  OF  REPAIR  OR  REPLACEMENT  OF  PROSTHETIC
 DEVICES  DUE  TO  NORMAL  WEAR AND TEAR, IF A PROSTHETIC DEVICE HAS BEEN
 OUTGROWN OR NO LONGER FITS PROPERLY, OR WHERE A CHANGE  IN  THE  MEDICAL
 CONDITION  MAKES  REPLACEMENT  NECESSARY. COVERAGE SHALL NOT INCLUDE THE
 COSTS OF REPAIR OR REPLACEMENT OF A PROSTHETIC DEVICE  THAT  IS  COVERED
 UNDER THE WARRANTY OF THE MANUFACTURER OR WHEN THE REPAIR OR REPLACEMENT
 IS  NECESSARY  DUE TO MISUSE OR NEGLIGENCE. THE TERM "PROSTHETIC DEVICE"
 AS USED IN THIS SUBSECTION INCLUDES AN ARTIFICIAL LIMB,  BUT  SHALL  NOT
 INCLUDE  SHOES  OR  ANY  OTHER  ARTICLE  CONSIDERED  AS ORDINARY WEARING
 APPAREL, WHETHER OR NOT SPECIFICALLY CONSTRUCTED. THE TERM  "POLICYHOLD-
 ER"  AS USED IN THIS SUBSECTION 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 WHILE ON ACTIVE DUTY
 SERVING IN THE ARMED FORCES. SUCH COVERAGE SHALL BE  SUBJECT  TO  ANNUAL
 DEDUCTIBLES AND COINSURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
 THE  COVERAGE  REQUIRED  BY  THIS  SUBSECTION SHALL BE IDENTICAL TO, AND
 SHALL NOT ENHANCE OR INCREASE  THE  ESSENTIAL  HEALTH  BENEFIT  COVERAGE
 CHOSEN  BY  THE  STATE  PURSUANT  TO  45  CFR  156.100.  NOTHING IN THIS
 SUBSECTION SHALL BE CONSTRUED  TO  PREVENT  THE  MEDICAL  MANAGEMENT  OR
 UTILIZATION  REVIEW  OF  BENEFITS FOR MEDICALLY NECESSARY REHABILITATIVE
 AND HABILITATIVE PURPOSES.

 S. 5174                             3
 
   § 4. This act shall take effect on the one hundred eightieth day after
 it shall have become a law and shall apply  to  policies  and  contracts
 issued, renewed, modified, altered or amended on or after such effective
 date.

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Senate Bill S5174

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

2019-S5174 (ACTIVE) - Details

2019-S5174 (ACTIVE) - Summary

2019-S5174 (ACTIVE) - Sponsor Memo

2019-S5174 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S5174

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Sponsored By

Robert G. Ortt

Archive: Last Bill Status - In Senate Committee Insurance Committee

2019-S5174 (ACTIVE) - Details

2019-S5174 (ACTIVE) - Summary

2019-S5174 (ACTIVE) - Sponsor Memo

2019-S5174 (ACTIVE) - Bill Text download pdf

Comments