Bill S5390C-2013

Requires mandatory health insurance coverage for prosthetic devices

Requires mandatory health insurance coverage for certain individuals with prosthetic limbs; requires coverage where the model is determined to adequately meet the medical needs of the policy holder.

Details

Actions

  • Jun 11, 2014: PRINT NUMBER 5390C
  • Jun 11, 2014: AMEND AND RECOMMIT TO INSURANCE
  • Jun 9, 2014: PRINT NUMBER 5390B
  • Jun 9, 2014: AMEND AND RECOMMIT TO INSURANCE
  • Jan 29, 2014: PRINT NUMBER 5390A
  • Jan 29, 2014: AMEND AND RECOMMIT TO INSURANCE
  • Jan 8, 2014: REFERRED TO INSURANCE
  • May 16, 2013: REFERRED TO INSURANCE

Memo

BILL NUMBER:S5390C

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

PURPOSE OR GENERAL IDEA OF THE BILL:

To ensure that coverage for rehabilitative and habilitative services, including prosthetic devices, are available to military veterans residing in NYS.

SUMMARY OF SPECIFIC PROVISIONS:

This bill would require that health insurers that provide medical, major, medical, or similar comprehensive type coverage and cover durable medical equipment include coverage for prosthetic devices for veterans of the armed forces who are residents of New York on parity with the coverage for durable medical, equipment.

JUSTIFICATION:

Two recent wars involving the United States, Iraq and Afghanistan has left over 600 military men and women as amputees with life-long injuries. Each year 185,000 amputations occur in the US and there are nearly 2 million people living with limb loss in the US. Improving access to quality and updated prosthetic devices will improve the quality of life of veterans and other amputees, while helping to reduce other medical costs related to lack of mobility and associated physical and emotional health.

According to the Veterans Health Administration, approximately 6 percent of wounded service members returning from Iraq are individuals with amputations. As a society, we owe these veterans the best of our efforts to help them live improved lives after their sacrifice for our nation.

PRIOR LEGISLATIVE HISTORY:

New Bill

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENT:

None

EFFECTIVE DATE:

This act shall take effect May 1, 2015.


Text

STATE OF NEW YORK ________________________________________________________________________ 5390--C 2013-2014 Regular Sessions IN SENATE May 16, 2013 ___________
Introduced by Sen. PARKER -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said commit- tee -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to mandatory health insurance coverage for prosthetic devices 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 30 to read as follows: (30) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR COMPREHENSIVE TYPE COVERAGE AND PROVIDES COVERAGE FOR DURABLE MEDICAL EQUIPMENT SHALL PROVIDE COVERAGE FOR PROSTHETIC DEVICES THAT ARE INTENDED FOR MEDICALLY NECESSARY REHABILITATIVE AND HABILITATIVE PURPOSES AS REQUIRED BY 42 U.S.C. S 18022 THAT IS EQUIVALENT TO THE COVERAGE PROVIDED FOR DURABLE MEDICAL EQUIPMENT. COVERAGE SHALL NOT BE DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC DEVICE IS THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL NEEDS OF THE POLICY HOLDER. THE TERM "PROSTHETIC DEVICE" AS USED IN THIS PARA- GRAPH INCLUDES AN ARTIFICIAL LIMB BUT SHALL NOT INCLUDE SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED. THE TERM "POLICY HOLDER" AS USED IN THIS PARA- GRAPH SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES IN THE STATE OF NEW YORK AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE RESULTED FROM AN INJURY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN THE ARMED FORCES.
S 2. Subsection (l) of section 3221 of the insurance law is amended by adding a new paragraph 19 to read as follows: (19) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR COMPREHENSIVE TYPE COVERAGE AND PROVIDES COVERAGE FOR DURABLE MEDICAL EQUIPMENT SHALL PROVIDE COVERAGE FOR PROSTHETIC DEVICES THAT ARE INTENDED FOR MEDICALLY NECESSARY REHABILITATIVE AND HABILITATIVE PURPOSES AS REQUIRED BY 42 U.S.C. S 18022 THAT IS EQUIVALENT TO THE COVERAGE PROVIDED FOR DURABLE MEDICAL EQUIPMENT. COVERAGE SHALL NOT BE DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC DEVICE IS THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL NEEDS OF THE POLICY HOLDER. THE TERM "PROSTHETIC DEVICE" AS USED IN THIS PARA- GRAPH INCLUDES AN ARTIFICIAL LIMB BUT SHALL NOT INCLUDE SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED. THE TERM "POLICY HOLDER" AS USED IN THIS PARA- GRAPH SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES IN THE STATE OF NEW YORK AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE RESULTED FROM AN INJURY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN THE ARMED FORCES. S 3. Section 4303 of the insurance law is amended by adding a new subsection (oo) to read as follows: (OO) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR COMPREHENSIVE TYPE COVERAGE AND PROVIDES COVERAGE FOR DURABLE MEDICAL EQUIPMENT SHALL PROVIDE COVERAGE FOR PROSTHETIC DEVICES THAT ARE INTENDED FOR MEDICALLY NECESSARY REHABILITATIVE AND HABILITATIVE PURPOSES AS REQUIRED BY 42 U.S.C. S 18022 THAT IS EQUIVALENT TO THE COVERAGE PROVIDED FOR DURABLE MEDICAL EQUIPMENT. COVERAGE SHALL NOT BE DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC DEVICE IS THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL NEEDS OF THE POLICY HOLDER. THE TERM "PROSTHETIC DEVICE" AS USED IN THIS SUBSECTION INCLUDES AN ARTIFICIAL LIMB BUT SHALL NOT INCLUDE SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED. THE TERM "POLICY HOLDER" AS USED IN THIS SUBSECTION SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES IN THE STATE OF NEW YORK AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE RESULTED FROM AN INJURY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN THE ARMED FORCES. S 4. This act shall take effect May 1, 2015 and shall apply to all policies and contracts issued, renewed, altered, or amended on or after such effective date.

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