This bill has been amended

Bill S5937-2013

Authorizes insurance coverage for equipment and supplies used for the treatment of ostomies

Authorizes insurance coverage for equipment and supplies used for the treatment of ostomies.

Details

Actions

  • Jan 8, 2014: REFERRED TO INSURANCE
  • Sep 18, 2013: REFERRED TO RULES

Memo

BILL NUMBER:S5937

TITLE OF BILL: An act to amend the insurance law, in relation to authorizing insurance coverage for equipment and supplies used for the treatment of ostomies

PURPOSE:

This bill would require every policy which provides medical, major medical, or similar comprehensive-type coverage to include equipment and supplies necessary for the treatment of ostomies.

SUMMARY OF PROVISIONS:

Section 1: Adds a new paragraph (30) to subsection (i) of § 3216 of the Insurance Law.

Section 2: Adds new paragraph (19) to subsection (k) § 3221 of the Insurance Law.

Section 3: Adds new subdivision (u-1) to § 4303 of the Insurance Law.

Section 4: Amends subsection (c) of § 4321 of the Insurance Law.

Section 5: Adds new paragraph (28) to subsection (b) of § 4322 of the Insurance Law.

Section 6: Amends subsection (c) of § 4322 of the Insurance Law.

Section 7: Establishes the Effective Date.

JUSTIFICATION:

Ostomies are a lifelong health condition and require equipment and supplies that can become costly. The current law allows for the full coverage of equipment and supplies used to treat other chronic conditions, such as diabetes. This legislation seeks to require health insurers and health maintenance organizations to include full coverage of equipment and supplies used to treat ostomies, in order to ease some of the burden associated with this condition

LEGISLATIVE HISTORY:

1999-00: A.6663; 2001-02: A.5638; 2003-04: A.3859; 2005-06: A.2824; 2007-8: S.2975; 2009-10; S.403

FISCAL IMPLICATIONS:

None to the State.

EFFECTIVE DATE:

This act shall take effect on the first of January next succeeding the date on which it shall have become a law.


Text

STATE OF NEW YORK ________________________________________________________________________ 5937 2013-2014 Regular Sessions IN SENATE September 18, 2013 ___________
Introduced by Sen. VALESKY -- read twice and ordered printed, and when printed to be committed to the Committee on Rules AN ACT to amend the insurance law, in relation to authorizing insurance coverage for equipment and supplies used for the treatment of ostomies 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 COVERAGE THAT INCLUDES COVER- AGE FOR PHYSICIAN SERVICES IN A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE COVERAGE FOR THE FOLLOWING EQUIPMENT AND SUPPLIES USED FOR THE TREATMENT OF OSTOMIES, IF RECOMMENDED OR PRESCRIBED BY A PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW: FLANGES, COLLECTION BAGS, CLAMPS, IRRIGATION DEVICES, SANITIZING PRODUCTS, OSTOMY RINGS AND OSTOMY BELTS. IN ADDITION, THE COMMISSIONER OF THE DEPARTMENT OF HEALTH SHALL PROVIDE AND PERIODICALLY UPDATE BY RULE OR REGULATION A LIST OF ADDI- TIONAL OSTOMY EQUIPMENT AND RELATED SUPPLIES SUCH AS ARE MEDICALLY NECESSARY FOR THE TREATMENT OF OSTOMIES FOR WHICH THERE SHALL ALSO BE COVERAGE. S 2. Subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 19 to read as follows: (19) EVERY GROUP OR BLANKET ACCIDENT AND HEALTH INSURANCE POLICY ISSUED OR ISSUED FOR DELIVERY IN THIS STATE WHICH PROVIDES MEDICAL COVERAGE THAT INCLUDES COVERAGE FOR PHYSICIAN SERVICES IN A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR MEDICAL OR SIMILAR COMPRE- HENSIVE-TYPE COVERAGE SHALL INCLUDE COVERAGE FOR THE FOLLOWING EQUIPMENT AND SUPPLIES USED FOR THE TREATMENT OF OSTOMIES, IF RECOMMENDED OR PRESCRIBED BY A PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW: FLANGES,
COLLECTION BAGS, CLAMPS, IRRIGATION DEVICES, SANITIZING PRODUCTS, OSTOMY RINGS AND OSTOMY BELTS. IN ADDITION, THE COMMISSIONER OF THE DEPARTMENT OF HEALTH SHALL PROVIDE AND PERIODICALLY UPDATE BY RULE OR REGULATION A LIST OF ADDITIONAL OSTOMY EQUIPMENT AND RELATED SUPPLIES SUCH AS ARE MEDICALLY NECESSARY FOR THE TREATMENT OF OSTOMIES FOR WHICH THERE SHALL ALSO BE COVERAGE. S 3. Section 4303 of the insurance law is amended by adding a new subsection (u-1) to read as follows: (U-1)(1) A MEDICAL EXPENSE INDEMNITY CORPORATION OR A HEALTH SERVICE CORPORATION WHICH PROVIDES MEDICAL COVERAGE THAT INCLUDES COVERAGE FOR PHYSICIAN SERVICES IN A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE COVERAGE FOR THE FOLLOWING EQUIPMENT AND SUPPLIES USED FOR THE TREATMENT OF OSTOMIES, IF RECOMMENDED OR PRESCRIBED BY A PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW: FLANGES, COLLECTION BAGS, CLAMPS, IRRIGATION DEVICES, SANITIZING PRODUCTS, OSTOMY RINGS AND OSTOMY BELTS. IN ADDITION, THE COMMISSIONER OF THE DEPARTMENT OF HEALTH SHALL PROVIDE AND PERIODICALLY UPDATE BY RULE OR REGULATION A LIST OF ADDI- TIONAL OSTOMY EQUIPMENT AND RELATED SUPPLIES SUCH AS ARE MEDICALLY NECESSARY FOR THE TREATMENT OF OSTOMIES FOR WHICH THERE SHALL ALSO BE COVERAGE. (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. (3) THIS SUBSECTION SHALL NOT APPLY TO A POLICY WHICH COVERS PERSONS EMPLOYED IN MORE THAN ONE STATE OR THE BENEFIT STRUCTURE OF WHICH WAS THE SUBJECT OF COLLECTIVE BARGAINING AFFECTING PERSONS EMPLOYED IN MORE THAN ONE STATE. S 4. Subsection (c) of section 4321 of the insurance law, as amended by chapter 219 of the laws of 2011, is amended to read as follows: (c) The health maintenance organization shall impose a fifteen dollar copayment on all visits to a physician or other provider with the excep- tion of visits for pre-natal and post-natal care, well child visits provided pursuant to paragraph two of subsection (j) of section four thousand three hundred three of this article, preventive health services provided pursuant to subparagraph (F) of paragraph four of subsection (b) of section four thousand three hundred twenty-two of this article, or items or services for bone mineral density provided pursuant to subparagraph (D) of paragraph twenty-six of subsection (b) of section four thousand three hundred twenty-two of this article for which no copayment shall apply. A copayment of fifteen dollars shall be imposed on equipment, supplies and self-management education for the treatment of diabetes. A COPAYMENT OF FIFTEEN DOLLARS SHALL BE IMPOSED ON EQUIP- MENT AND SUPPLIES USED FOR THE TREATMENT OF OSTOMIES. A fifty dollar copayment shall be imposed on emergency services rendered in the emer- gency room of a hospital; however, this copayment must be waived if hospital admission results. Surgical services shall be subject to a copayment of the lesser of twenty percent of the cost of such services or two hundred dollars per occurrence. A five hundred dollar copayment shall be imposed on inpatient hospital services per continuous hospital confinement. Ambulatory surgical services shall be subject to a facility copayment charge of seventy-five dollars. Coinsurance of ten percent shall apply to visits for the diagnosis and treatment of mental, nervous or emotional disorders or ailments.
S 5. Subsection (b) of section 4322 of the insurance law is amended by adding a new paragraph 28 to read as follows: (28) EQUIPMENT AND SUPPLIES USED FOR THE TREATMENT OF OSTOMIES. S 6. Subsection (c) of section 4322 of the insurance law, as amended by chapter 219 of the laws of 2011, is amended to read as follows: (c) The in-plan benefit system shall impose a ten dollar copayment on all visits to a physician or other provider with the exception of visits for pre-natal and post-natal care, well child visits provided pursuant to paragraph two of subsection (j) of section four thousand three hundred three of this article, preventive health services provided pursuant to subparagraph (F) of paragraph four of subsection (b) of this section or items or services for bone mineral density provided pursuant to subparagraph (D) of paragraph twenty-six of subsection (b) of this section for which no copayment shall apply. A copayment of ten dollars shall be imposed on equipment, supplies and self-management education for the treatment of diabetes. A COPAYMENT OF TEN DOLLARS SHALL BE IMPOSED ON EQUIPMENT AND SUPPLIES USED FOR THE TREATMENT OF OSTOMIES. Coinsurance of ten percent shall apply to visits for the diagnosis and treatment of mental, nervous or emotional disorders or ailments. A thir- ty-five dollar copayment shall be imposed on emergency services rendered in the emergency room of a hospital; however, this copayment must be waived if hospital admission results. S 7. This act shall take effect on the first of January next succeed- ing the date on which it shall have become a law and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such effective date.

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