Senate Bill S10228

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10228
 
                             I N  S E N A T E
 
                                May 7, 2026
                                ___________
 
 Introduced  by  Sen. C. RYAN -- read twice and ordered printed, and when
   printed to be committed to the Committee 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 public health law is REPEALED and a new paragraph (g) is added  to  read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
 S. 10228                            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.