S T A T E O F N E W Y O R K
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9140
I N A S S E M B L Y
January 31, 2022
___________
Introduced by M. of A. SOLAGES -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the public health law, in relation to universal newborn
nurse home visiting services; to amend the insurance law, in relation
to requiring health insurance coverage for universal newborn nurse
home visiting services; authorizing the department of health to apply
for certain waivers; and directing the superintendent of financial
services to require an insurer, health carrier or health benefit plan
to notify enrollees annually of universal newborn nurse home visiting
services
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. The public health law is amended by adding a new section to
read as follows:
§ 2500-L. UNIVERSAL NEWBORN NURSE HOME VISITING SERVICES. 1. AS USED
IN THIS SECTION, "COMMUNITY" MEANS A GEOGRAPHIC REGION, COUNTY, TRIBE OR
OTHER GROUP OF INDIVIDUALS LIVING IN PROXIMITY AS DEFINED BY THE DEPART-
MENT BY RULE.
2. (A) THE COMMISSIONER SHALL DESIGN, IMPLEMENT AND MAINTAIN A VOLUN-
TARY STATEWIDE PROGRAM TO PROVIDE UNIVERSAL NEWBORN NURSE HOME VISITING
SERVICES TO ALL FAMILIES WITH NEWBORNS RESIDING IN THIS STATE TO SUPPORT
HEALTHY CHILD DEVELOPMENT AND STRENGTHEN FAMILIES. THE COMMISSIONER
SHALL DESIGN THE UNIVERSAL NEWBORN NURSE HOME VISITING PROGRAM TO BE
FLEXIBLE SO AS TO MEET THE NEEDS OF THE COMMUNITIES WHERE THE PROGRAM
OPERATES.
(B) IN DESIGNING THE PROGRAM DESCRIBED IN PARAGRAPH (A) OF THIS SUBDI-
VISION, THE COMMISSIONER SHALL CONSULT, COORDINATE AND COLLABORATE, AS
NECESSARY, WITH INSURERS THAT OFFER HEALTH BENEFIT PLANS IN THIS STATE,
HOSPITALS, LOCAL PUBLIC HEALTH AUTHORITIES, THE EARLY INTERVENTION
PROGRAM, EXISTING EARLY CHILDHOOD HOME VISITING PROGRAMS, COMMUNITY-
BASED ORGANIZATIONS AND SOCIAL SERVICE PROVIDERS.
3. THE PROGRAM SHALL PROVIDE NURSE HOME VISITING SERVICES THAT ARE:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD14370-01-2
A. 9140 2
(A) BASED ON CRITERIA ESTABLISHED BY THE UNITED STATES DEPARTMENT OF
HEALTH AND HUMAN SERVICES FOR AN EVIDENCE-BASED EARLY CHILDHOOD HOME
VISITING SERVICE DELIVERY MODEL;
(B) PROVIDED BY REGISTERED NURSES LICENSED IN THIS STATE TO FAMILIES
CARING FOR NEWBORNS UP TO THE AGE OF SIX MONTHS, INCLUDING FOSTER AND
ADOPTIVE NEWBORNS;
(C) PROVIDED IN THE FAMILY'S HOME; AND
(D) AIMED AT IMPROVING OUTCOMES IN ONE OR MORE OF THE FOLLOWING
DOMAINS:
(I) CHILD HEALTH;
(II) CHILD DEVELOPMENT AND SCHOOL READINESS;
(III) FAMILY ECONOMIC SELF-SUFFICIENCY;
(IV) MATERNAL HEALTH;
(V) POSITIVE PARENTING;
(VI) REDUCING CHILD MISTREATMENT;
(VII) REDUCING JUVENILE DELINQUENCY;
(VIII) REDUCING FAMILY VIOLENCE; OR
(IX) REDUCING CRIME.
4. THE SERVICES PROVIDED IN THE PROGRAM MUST:
(A) BE VOLUNTARY AND CARRY NO NEGATIVE CONSEQUENCES FOR A FAMILY THAT
DECLINES TO PARTICIPATE;
(B) BE OFFERED IN EVERY COMMUNITY IN THIS STATE;
(C) INCLUDE AN EVIDENCE-BASED ASSESSMENT OF THE PHYSICAL, SOCIAL AND
EMOTIONAL FACTORS AFFECTING THE FAMILY;
(D) BE OFFERED TO ALL FAMILIES WITH NEWBORNS RESIDING IN THE COMMUNITY
WHERE THE PROGRAM OPERATES;
(E) INCLUDE AT LEAST ONE VISIT DURING A NEWBORN'S FIRST THREE MONTHS
OF LIFE WITH THE OPPORTUNITY FOR THE FAMILY TO CHOOSE UP TO THREE ADDI-
TIONAL VISITS;
(F) INCLUDE A FOLLOW-UP VISIT NO LATER THAN THREE MONTHS AFTER THE
LAST VISIT; AND
(G) PROVIDE INFORMATION AND REFERRALS TO ADDRESS EACH FAMILY'S IDENTI-
FIED NEEDS.
5. THE AUTHORITY SHALL COLLECT AND ANALYZE DATA GENERATED BY THE
PROGRAM TO ASSESS THE EFFECTIVENESS OF THE PROGRAM IN MEETING THE AIMS
DESCRIBED IN PARAGRAPH (D) OF SUBDIVISION THREE OF THIS SECTION AND
SHALL WORK WITH OTHER STATE AGENCIES TO DEVELOP PROTOCOLS FOR SHARING
DATA, INCLUDING THE TIMELY SHARING OF DATA WITH PRIMARY CARE PROVIDERS
OF CARE TO THE FAMILIES WITH NEWBORNS RECEIVING THE SERVICES.
6. THE COMMISSIONER SHALL ADOPT BY RULE, CONSISTENT WITH THE
PROVISIONS OF THIS SECTION, CRITERIA FOR UNIVERSAL NEWBORN NURSE HOME
VISITING SERVICES THAT MUST BE COVERED BY HEALTH BENEFIT PLANS.
§ 2. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 36 to read as follows:
(36)(A) EVERY POLICY WHICH PROVIDES HOSPITAL, SURGICAL OR MEDICAL
COVERAGE SHALL PROVIDE COVERAGE FOR UNIVERSAL NEWBORN NURSE HOME VISIT-
ING SERVICES AS PRESCRIBED BY THE DEPARTMENT OF HEALTH BY RULE UNDER
SECTION TWENTY-FIVE HUNDRED-L OF THE PUBLIC HEALTH LAW. THE COVERAGE
MUST BE PROVIDED WITHOUT ANY COST-SHARING, COINSURANCE OR DEDUCTIBLE
APPLICABLE TO THE SERVICES.
(B) INSURERS MUST OFFER UNIVERSAL NEWBORN NURSE HOME VISITING SERVICES
IN THEIR HEALTH BENEFIT PLANS BUT AN INDIVIDUAL ENROLLED IN THE PLAN IS
NOT REQUIRED TO RECEIVE THE SERVICES AS A CONDITION OF COVERAGE AND MAY
NOT BE PENALIZED OR IN ANY WAY DISCOURAGED FROM DECLINING THE SERVICES.
A. 9140 3
(C) AN INSURER MUST NOTIFY AN INDIVIDUAL ENROLLED IN THE PLAN ABOUT
THE UNIVERSAL NEWBORN NURSE HOME VISITING SERVICES WHENEVER SUCH INDI-
VIDUAL ADDS A NEWBORN TO COVERAGE UNDER THE PLAN.
(D) AN INSURER MAY USE IN-NETWORK PROVIDERS OR MAY CONTRACT WITH LOCAL
PUBLIC HEALTH AUTHORITIES TO PROVIDE THE SERVICES.
(E) THIS PARAGRAPH DOES NOT REQUIRE AN INSURER TO REIMBURSE THE COST
OF THE SERVICES IN ANY SPECIFIC MANNER. THE SERVICES MAY BE REIMBURSED
USING:
(I) A VALUE-BASED PAYMENT METHODOLOGY;
(II) A CLAIM INVOICING PROCESS;
(III) CAPITATED PAYMENTS;
(IV) A PAYMENT METHODOLOGY THAT TAKES INTO ACCOUNT THE NEED FOR A
COMMUNITY-BASED ENTITY PROVIDING THE SERVICES TO EXPAND ITS CAPACITY TO
PROVIDE THE SERVICES AND ADDRESS HEALTH DISPARITIES; OR
(V) ANY OTHER METHODOLOGY AGREED TO BY THE INSURER AND THE PROVIDER OF
THE SERVICES.
(F) INSURERS SHALL REPORT TO THE DEPARTMENT OF PUBLIC HEALTH, IN THE
FORM AND MANNER PRESCRIBED BY THE DEPARTMENT OF PUBLIC HEALTH, DATA
REGARDING CLAIMS SUBMITTED FOR SERVICES COVERED UNDER THIS PARAGRAPH TO
MONITOR THE PROVISION OF THE UNIVERSAL NEWBORN NURSE HOME VISITING
SERVICES.
§ 3. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 22 to read as follows:
(22)(A) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIV-
ERY IN THIS STATE WHICH PROVIDES HOSPITAL, SURGICAL OR MEDICAL
COVERAGE SHALL INCLUDE COVERAGE FOR UNIVERSAL NEWBORN NURSE HOME VISIT-
ING SERVICES AS PRESCRIBED BY THE DEPARTMENT OF HEALTH BY RULE UNDER
SECTION TWENTY-FIVE HUNDRED-L OF THE PUBLIC HEALTH LAW. THE COVERAGE
MUST BE PROVIDED WITHOUT ANY COST-SHARING, COINSURANCE OR DEDUCTIBLE
APPLICABLE TO THE SERVICES.
(B) INSURERS MUST OFFER UNIVERSAL NEWBORN NURSE HOME VISITING SERVICES
IN THEIR HEALTH BENEFIT PLANS BUT AN INDIVIDUAL ENROLLED IN THE PLAN IS
NOT REQUIRED TO RECEIVE THE SERVICES AS A CONDITION OF COVERAGE AND MAY
NOT BE PENALIZED OR IN ANY WAY DISCOURAGED FROM DECLINING THE SERVICES.
(C) AN INSURER MUST NOTIFY AN INDIVIDUAL ENROLLED IN THE PLAN ABOUT
THE UNIVERSAL NEWBORN NURSE HOME VISITING SERVICES WHENEVER SUCH INDI-
VIDUAL ADDS A NEWBORN TO COVERAGE UNDER THE PLAN.
(D) AN INSURER MAY USE IN-NETWORK PROVIDERS OR MAY CONTRACT WITH LOCAL
PUBLIC HEALTH AUTHORITIES TO PROVIDE THE SERVICES.
(E) THIS PARAGRAPH DOES NOT REQUIRE AN INSURER TO REIMBURSE THE COST
OF THE SERVICES IN ANY SPECIFIC MANNER. THE SERVICES MAY BE REIMBURSED
USING:
(I) A VALUE-BASED PAYMENT METHODOLOGY;
(II) A CLAIM INVOICING PROCESS;
(III) CAPITATED PAYMENTS;
(IV) A PAYMENT METHODOLOGY THAT TAKES INTO ACCOUNT THE NEED FOR A
COMMUNITY-BASED ENTITY PROVIDING THE SERVICES TO EXPAND ITS CAPACITY TO
PROVIDE THE SERVICES AND ADDRESS HEALTH DISPARITIES; OR
(V) ANY OTHER METHODOLOGY AGREED TO BY THE INSURER AND THE PROVIDER OF
THE SERVICES.
(F) INSURERS SHALL REPORT TO THE DEPARTMENT OF PUBLIC HEALTH, IN THE
FORM AND MANNER PRESCRIBED BY THE DEPARTMENT OF PUBLIC HEALTH, DATA
REGARDING CLAIMS SUBMITTED FOR SERVICES COVERED UNDER THIS PARAGRAPH TO
MONITOR THE PROVISION OF THE UNIVERSAL NEWBORN NURSE HOME VISITING
SERVICES.
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§ 4. Section 4303 of the insurance law is amended by adding a new
subsection (ss) to read as follows:
(SS)(1) A MEDICAL EXPENSE INDEMNITY CORPORATION, A HOSPITAL SERVICE
CORPORATION OR A HEALTH SERVICE CORPORATION THAT PROVIDES COVERAGE FOR
HOSPITAL, SURGICAL OR MEDICAL CARE SHALL INCLUDE COVERAGE FOR UNIVERSAL
NEWBORN NURSE HOME VISITING SERVICES AS PRESCRIBED BY THE DEPARTMENT OF
HEALTH BY RULE UNDER SECTION TWENTY-FIVE HUNDRED-L OF THE PUBLIC HEALTH
LAW. THE COVERAGE MUST BE PROVIDED WITHOUT ANY COST-SHARING, COINSURANCE
OR DEDUCTIBLE APPLICABLE TO THE SERVICES.
(2) INSURERS MUST OFFER UNIVERSAL NEWBORN NURSE HOME VISITING SERVICES
IN THEIR HEALTH BENEFIT PLANS BUT AN INDIVIDUAL ENROLLED IN THE PLAN IS
NOT REQUIRED TO RECEIVE THE SERVICES AS A CONDITION OF COVERAGE AND MAY
NOT BE PENALIZED OR IN ANY WAY DISCOURAGED FROM DECLINING THE SERVICES.
(3) AN INSURER MUST NOTIFY AN INDIVIDUAL ENROLLED IN THE PLAN ABOUT
THE UNIVERSAL NEWBORN NURSE HOME VISITING SERVICES WHENEVER SUCH INDI-
VIDUAL ADDS A NEWBORN TO COVERAGE UNDER THE PLAN.
(4) AN INSURER MAY USE IN-NETWORK PROVIDERS OR MAY CONTRACT WITH LOCAL
PUBLIC HEALTH AUTHORITIES TO PROVIDE THE SERVICES.
(5) THIS PARAGRAPH DOES NOT REQUIRE AN INSURER TO REIMBURSE THE COST
OF THE SERVICES IN ANY SPECIFIC MANNER. THE SERVICES MAY BE REIMBURSED
USING:
(A) A VALUE-BASED PAYMENT METHODOLOGY;
(B) A CLAIM INVOICING PROCESS;
(C) CAPITATED PAYMENTS;
(D) A PAYMENT METHODOLOGY THAT TAKES INTO ACCOUNT THE NEED FOR A
COMMUNITY-BASED ENTITY PROVIDING THE SERVICES TO EXPAND ITS CAPACITY TO
PROVIDE THE SERVICES AND ADDRESS HEALTH DISPARITIES; OR
(E) ANY OTHER METHODOLOGY AGREED TO BY THE INSURER AND THE PROVIDER OF
THE SERVICES.
(6) INSURERS SHALL REPORT TO THE DEPARTMENT OF PUBLIC HEALTH, IN THE
FORM AND MANNER PRESCRIBED BY THE DEPARTMENT OF PUBLIC HEALTH, DATA
REGARDING CLAIMS SUBMITTED FOR SERVICES COVERED UNDER THIS PARAGRAPH TO
MONITOR THE PROVISION OF THE UNIVERSAL NEWBORN NURSE HOME VISITING
SERVICES.
§ 5. The department of health may request a waiver for state inno-
vation under 42 U.S.C. 18052 to obtain federal financial participation
in the cost of services provided under sections two, three and four of
this act.
§ 6. The superintendent of financial services shall require an insur-
er, health carrier or health benefit plan to notify enrollees annually
of universal newborn nurse home visiting services covered by such enrol-
lees' health benefit plan. The notice shall be delivered by mail unless
the enrollee and health carrier have agreed on another method of notifi-
cation. The superintendent of financial services is authorized to
promulgate necessary rules and regulations for the purposes of providing
such notification.
§ 7. This act shall take effect on the ninetieth day after it shall
have become a law and shall apply to any policy issued, delivered,
renewed, and/or modified on or after the effective date of this act.
Effective immediately, the addition, amendment and/or repeal of any rule
or regulation necessary for the implementation of this act on its effec-
tive date are authorized to be made and completed on or before such
effective date.