Senate Bill S5332

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5332
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 20, 2025
                                ___________
 
 Introduced  by  Sen.  BAILEY -- 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 invoking coverage of a
   health insurance plan for long term care for an incapacitated individ-
   ual

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph 5 and subparagraph (D), the second undesignated
 paragraph and the closing paragraph of paragraph 6 of subsection (b)  of
 section 1117 of the insurance law, paragraph 5 as amended by chapter 572
 of  the laws of 2008 and subparagraph (D), the second undesignated para-
 graph and the closing paragraph of paragraph 6 as amended by chapter 424
 of the laws of 2016, are amended and a new paragraph 7 is added to  read
 as follows:
   (5)  the  authorized  insurer,  health  maintenance  organization,  or
 fraternal benefit society agrees to provide such reports of the  experi-
 ence  of  the plan as may be requested by the superintendent. The super-
 intendent may prepare abstracts and summaries of  such  reports  at  the
 request  of  other  government  agencies  for  purposes  of research and
 studies related to long term care financing, provided however  that  the
 insurer,  health  maintenance organization, or fraternal benefit society
 may request that specified information included in the report be consid-
 ered confidential; [and]
   (D) (i) If available and accessible by the  insurer  or  other  entity
 from  the  department  of  health,  the most recently-published average,
 statewide rate for care in a nursing home, as well as the average  rates
 for  care  in  nursing homes for both the New York city-metropolitan and
 upstate regions of the state; or
   (ii) If available and accessible by the insurer or other  entity  from
 the  department  of health, the most recently-published map of the esti-
 mated average regional rates in New York state for nursing home care;

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10012-01-5
              

 S. 5332                             2
 
   (III) FAILURE TO PROVIDE INFORMATION  REQUIRED  BY  THIS  SUBPARAGRAPH
 SHALL  NOT  BE CONSTRUED AS A VIOLATION OF THIS SECTION IF SUCH INFORMA-
 TION HAS NOT BEEN MADE AVAILABLE BY THE DEPARTMENT OF HEALTH;
 For  the  purpose of this paragraph, "home care services" shall have the
 same meaning as defined in subdivision one of section thirty-six hundred
 two of the public health law. The prospective insured, or [his  or  her]
 THEIR representative, shall acknowledge that the required disclosure has
 been  made by signing the disclosure statement prior to or contemporane-
 ously with the effective date of the policy or certificate[.
 Failure to provide information required  by  subparagraph  (D)  of  this
 paragraph  shall not be construed as a violation of this section if such
 information has not been made available by the department  of  health.];
 AND
   (7)  (A)  THE PLAN SHALL INCLUDE A PROVISION AUTHORIZING THE INSURED'S
 SPOUSE, IF NOT LEGALLY SEPARATED FROM THE INSURED, OR  DOMESTIC  PARTNER
 TO INVOKE INSURANCE COVERAGE BY THE PLAN WHERE THE INSURED DID NOT PROP-
 ERLY  EXECUTE  A  POWER  OF ATTORNEY ALLOWING FOR THE INVOCATION OF SUCH
 PLAN'S COVERAGE;
   (B) SUCH PROVISION SHALL PROVIDE THAT THE SPOUSE OR DOMESTIC PARTNER'S
 AUTHORITY SHALL COMMENCE UPON A DETERMINATION, MADE PURSUANT TO  SECTION
 TWENTY-NINE  HUNDRED  NINETY-FOUR-C  OF  THE PUBLIC HEALTH LAW, THAT THE
 INSURED LACKS DECISION-MAKING CAPACITY. IN THE EVENT AN ATTENDING PHYSI-
 CIAN OR NURSE PRACTITIONER DETERMINES  THAT  THE  INSURED  HAS  REGAINED
 DECISION-MAKING  CAPACITY, THE AUTHORITY OF THE SPOUSE OR DOMESTIC PART-
 NER SHALL CEASE.
   § 2. This act shall take effect on the one hundred eightieth day after
 it shall have become a law and shall apply to health insurance plans for
 long term care issued or renewed on or after such date.