Bill S36-2009

Requires mandatory health insurance coverage for cerebral palsy

Requires health insurers to provide coverage for cerebral palsy.

Details

Actions

  • Jan 6, 2010: REFERRED TO INSURANCE
  • Jan 7, 2009: REFERRED TO INSURANCE

Memo

 BILL NUMBER:  S36

TITLE OF BILL : An act to amend the insurance law, in relation to mandatory health insurance coverage for cerebral palsy

PURPOSE : To provide that various health insurance policies must include coverage for treatment for cerebral palsy including coverage for therapeutic evaluations and various therapies that may be needed by an individual who has cerebral palsy.

SUMMARY OF PROVISIONS : This bill would add a new paragraph 25 to subsection (i) of section 32 16 of the insurance law to require coverage for cerebral palsy including therapeutic evaluations and interventions, such as speech therapy, occupational therapy, physical therapy, intensive early intervention and behavioral and educational intervention programs for individual accident and health insurance policy provisions which provide hospital, surgical, or medical care coverage. Such coverage would be subject to annual deductibles and coinsurance payments as are consistent with those necessary for other benefits within a given policy.

This bill would also add a new paragraph 17 to subsection (1) of section 3221 and a new subsection (dd) of section 4303 of the insurance law to require similar coverage for group blanket accident and health insurance policies and for contracts issued by a hospital service corporation or health service corporation which provide coverage for in-patient hospital care.

JUSTIFICATION : According to United Cerebral Palsy (UCP), Cerebral Palsy is a term used to describe a group of chronic conditions affecting body movement and muscle coordination. While the damage to motor areas in the brain that disrupt the brain's ability to control movement and posture may not necessarily worsen, secondary conditions, such as muscle spasticity, can get better, get worse or stay the same over time. UCP states that while Cerebral Palsy is not curable, training and therapy can help improve function.

While some insurance carriers provide coverage for therapy related to cerebral palsy it is sometimes limited because the underlying condition is not acute and cannot therefore be fully cured by the proposed treatment. Individuals with Cerebral Palsy should be able to continue to receive treatment and therapy that will help to improve nerve and muscle coordination and prevent or minimize dysfunction.

LEGISLATIVE HISTORY : 2007-2008 Insurance Committee (S.4724). 2005-2006 Insurance Committee (S.1130). 2004 Insurance Committee (S.7006).

FISCAL IMPLICATIONS : To be determined.

EFFECTIVE DATE : This act shall take effect on the one hundred twentieth day after it shall have become a law and shall apply to all policies issued, renewed, modified, or altered on or after such date.

Text

STATE OF NEW YORK ________________________________________________________________________ 36 2009-2010 Regular Sessions IN SENATE (PREFILED) January 7, 2009 ___________
Introduced by Sen. FUSCHILLO -- 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 mandatory health insurance coverage for cerebral palsy 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 26 to read as follows: (26)(A) EVERY POLICY WHICH PROVIDES HOSPITAL, SURGICAL, OR MEDICAL CARE COVERAGE SHALL PROVIDE COVERAGE FOR CEREBRAL PALSY AND SHALL NOT EXCLUDE COVERAGE PRESCRIBED BY THE REFERRING PHYSICIAN FOR THE TREATMENT OF CEREBRAL PALSY, INCLUDING, BUT NOT LIMITED TO, COVERAGE FOR THERAPEU- TIC EVALUATIONS AND INTERVENTIONS, SUCH AS SPEECH THERAPY, OCCUPATIONAL THERAPY, PHYSICAL THERAPY, INTENSIVE EARLY INTERVENTION, AND BEHAVIORAL AND EDUCATIONAL INTERVENTION PROGRAMS. (B) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY. S 2. Subsection (l) of section 3221 of the insurance law is amended by adding a new paragraph 18 to read as follows: (18)(A) EVERY POLICY WHICH PROVIDES HOSPITAL, SURGICAL, OR MEDICAL CARE COVERAGE SHALL PROVIDE COVERAGE FOR CEREBRAL PALSY AND SHALL NOT EXCLUDE COVERAGE PRESCRIBED BY THE REFERRING PHYSICIAN FOR THE TREATMENT OF CEREBRAL PALSY, INCLUDING, BUT NOT LIMITED TO, COVERAGE FOR THERAPEU- TIC EVALUATIONS AND INTERVENTIONS, SUCH AS SPEECH THERAPY, OCCUPATIONAL THERAPY, PHYSICAL THERAPY, INTENSIVE EARLY INTERVENTION, AND BEHAVIORAL AND EDUCATIONAL INTERVENTION PROGRAMS. (B) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
S 3. Section 4303 of the insurance law is amended by adding a new subsection (ff) to read as follows: (FF)(1) EVERY POLICY WHICH PROVIDES COVERAGE FOR HOSPITAL, SURGICAL, OR MEDICAL COVERAGE SHALL PROVIDE COVERAGE FOR CEREBRAL PALSY AND SHALL NOT EXCLUDE COVERAGE PRESCRIBED BY THE REFERRING PHYSICIAN FOR THE TREATMENT OF CEREBRAL PALSY, INCLUDING, BUT NOT LIMITED TO, COVERAGE FOR THERAPEUTIC EVALUATIONS AND INTERVENTIONS, SUCH AS SPEECH THERAPY, OCCU- PATIONAL THERAPY, PHYSICAL THERAPY, INTENSIVE EARLY INTERVENTION, AND BEHAVIORAL AND EDUCATIONAL INTERVENTION PROGRAMS. (2) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY. S 4. This act shall take effect on the one hundred twentieth day after it shall have become a law and shall apply to all policies issued, renewed, modified, or altered on or after such date.

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