Assembly Bill A10397

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10397
 
                           I N  A S S E M B L Y
 
                               March 3, 2026
                                ___________
 
 Introduced by M. of A. LUNSFORD -- read once and referred to the Commit-
   tee on Health
 
 AN  ACT  to  amend  the  public  health  law, in relation to the date of
   enrollment in the child health insurance plan program; and  to  repeal
   certain provisions of such law relating thereto
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph (g) of subdivision  2  of  section  2511  of  the
 public  health  law is REPEALED and a new paragraph (g) is added to read
 as follows:
   (G) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, RULE  OR  REGU-
 LATION:
   (I) A CHILD UNDER THE AGE OF NINETEEN WHO MEETS THE ELIGIBILITY CRITE-
 RIA  SET  FORTH IN THIS SUBDIVISION OR SUBDIVISION FIVE OF THIS SECTION,
 AS DETERMINED BY  AN  APPROVED  ORGANIZATION  OR  THE  HEALTH  INSURANCE
 EXCHANGE   MARKETPLACE,  WHICHEVER  IS  APPLICABLE,  SHALL  BE  ENROLLED
 RETROACTIVELY TO THE FIRST DAY OF THE MONTH IN WHICH THE CHILD IS DEEMED
 ELIGIBLE PURSUANT TO SUBPARAGRAPH (II) OF THIS PARAGRAPH, PROVIDED  THAT
 THE CHILD OR THE APPLICANT FOR INSURANCE ON THE CHILD'S BEHALF SUBMITS A
 COMPLETED AND SIGNED APPLICATION AND REQUIRED INFORMATION AND DOCUMENTA-
 TION.
   (II)  A CHILD UNDER THE AGE OF NINETEEN SHALL BE PRESUMED ELIGIBLE FOR
 SUBSIDY PAYMENTS UNDER THIS SUBDIVISION OR ELIGIBLE FOR  COVERAGE  UNDER
 SUBDIVISION  FIVE OF THIS SECTION, PROVIDED THAT THE CHILD OR THE APPLI-
 CANT FOR INSURANCE ON SUCH CHILD'S BEHALF SUBMITS A COMPLETED AND SIGNED
 APPLICATION. ONCE ELIGIBILITY IS DETERMINED BY THE APPROVED ORGANIZATION
 OR THE HEALTH INSURANCE EXCHANGE MARKETPLACE, WHICHEVER  IS  APPLICABLE,
 ON  THE  BASIS  OF  PRELIMINARY INFORMATION, THE CHILD SHALL BE ENROLLED
 RETROACTIVELY TO THE FIRST DAY OF THE MONTH IN WHICH THE CHILD IS DEEMED
 ELIGIBLE. SUCH RETROACTIVE ENROLLMENT SHALL  APPLY  NOTWITHSTANDING  THE
 TIMING  OF  ANY  ENROLLMENT  PERIOD.  ALL OTHER PROCEDURES AND STANDARDS
 REGARDING  PRESUMPTIVE  ENROLLMENT  APPLICABLE  TO   ELIGIBLE   CHILDREN
 ENROLLED UNDER THIS TITLE AND SPECIFIED IN STATE CONTRACTS WITH APPROVED
 ORGANIZATIONS  OR  IMPLEMENTED  BY THE HEALTH INSURANCE EXCHANGE MARKET-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD14659-01-6
 A. 10397                            2
 
 PLACE, WHICHEVER IS APPLICABLE, SHALL APPLY TO PRESUMPTIVE ENROLLMENT OF
 CHILDREN UNDER THE AGE OF NINETEEN.
   §  2.  Subdivision  3  of  section  2511  of the public health law, as
 amended by chapter 2 of the laws of 1998, is amended to read as follows:
   3. Subsidy payments shall be made, pursuant to  subdivision  eight  of
 this  section, to approved organizations for the purposes of subsidizing
 the entire cost of coverage for eligible children meeting  the  criteria
 of  subdivision  two  of  this section. Notwithstanding any inconsistent
 provision of this subdivision, the total annual  aggregate  cost-sharing
 with  respect  to  all  eligible children in a family under this section
 shall not exceed amounts provided pursuant to applicable federal law. In
 order to be eligible for a subsidy payment pursuant to this  subdivision
 a premium payment shall be paid for an eligible child in accordance with
 the provisions of subdivision nine of section twenty-five hundred ten of
 this  title.  Nothing  herein  shall  preclude payment of the premium on
 behalf of an eligible child on  a  monthly,  quarterly,  semi-annual  or
 annual  basis.  SUBSIDY PAYMENTS MADE PURSUANT TO THIS SUBDIVISION SHALL
 INCLUDE PAYMENT FOR COVERED HEALTH CARE  SERVICES  PROVIDED  DURING  ANY
 PERIOD  OF  RETROACTIVE  PRESUMPTIVE  ENROLLMENT  AUTHORIZED PURSUANT TO
 PARAGRAPH (G) OF SUBDIVISION TWO OF THIS SECTION.
   § 3. Subdivision 19 of section 2511 of the public health law, as added
 by chapter 451 of the laws of 2007, is amended to read as follows:
   19. Claims submitted to  an  approved  organization  for  payment  for
 medical  care,  services,  or  supplies  furnished  by an out-of-network
 health care provider must be submitted within fifteen months of the date
 the medical care, services, or supplies were furnished  to  an  eligible
 person to be valid and enforceable against the approved organization. If
 a claim by an out-of-network health care provider is not submitted with-
 in  fifteen  months  of  the  date  that  the  medical care, services or
 supplies were furnished and the claim  is  subsequently  denied  by  the
 approved  organization  for that reason, such out-of-network health care
 provider shall not seek payment  for  such  medical  care,  services  or
 supplies  from  the  enrollee. This deadline for claims submission shall
 not apply where the claims submission is warranted to  address  findings
 or  recommendations  identified in a state or federal audit except where
 such audit also indicates that an  inappropriate  provider  payment  was
 solely  the  fault  of  the  out-of-network  health  care  provider. FOR
 PURPOSES OF  THIS  SUBDIVISION,  MEDICAL  CARE,  SERVICES,  OR  SUPPLIES
 PROVIDED  DURING  A PERIOD OF RETROACTIVE PRESUMPTIVE ENROLLMENT AUTHOR-
 IZED PURSUANT TO PARAGRAPH (G) OF SUBDIVISION TWO OF THIS SECTION  SHALL
 BE DEEMED TO HAVE BEEN PROVIDED TO AN ELIGIBLE PERSON.
   § 4. This act shall take effect immediately.