The New York State Senate

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    877
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 6, 2021
                                ___________
 
 Introduced  by  M.  of  A.  JONES,  GALEF,  SIMON, LUPARDO, ENGLEBRIGHT,
   MAGNARELLI, RICHARDSON, MONTESANO, COLTON, BLANKENBUSH  --  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 36 to read as follows:
   (36)(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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD05446-01-1

 A. 877                              2
 
 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 (ss) to read as follows:
   (SS)(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  SUBSECTION,  THE  TERM "PEDIATRIC ACUTE-ONSET
 NEUROPSYCHIATRIC 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.