Bill Text: NY A02621 | 2011-2012 | General Assembly | Introduced
Bill Title: Requires health insurance policy standard provisions to cover annual audiological examinations and evaluations and, if needed, speech-language pathology examinations and evaluations, prescribed by licensed physicians, audiologists, or speech-language pathologists.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2012-01-04 - referred to insurance [A02621 Detail]
Download: New_York-2011-A02621-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
2621
2011-2012 Regular Sessions
I N A S S E M B L Y
January 19, 2011
___________
Introduced by M. of A. JACOBS -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to health insurance stan-
dard provisions for audiological and speech-language pathology exam-
inations and evaluations
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Paragraph 16 of subsection (i) of section 3216 of the
2 insurance law, as added by chapter 456 of the laws of 1993, is amended
3 to read as follows:
4 (16) EVERY POLICY WHICH PROVIDES COVERAGE FOR HOSPITAL, SURGICAL OR
5 MEDICAL CARE SHALL PROVIDE COVERAGE FOR AUDIOLOGICAL EXAMINATIONS AND
6 EVALUATIONS, AND SHALL ALSO PROVIDE COVERAGE FOR SPEECH-LANGUAGE PATHOL-
7 OGY EXAMINATIONS AND EVALUATIONS WHICH ARE RECOMMENDED BY A LICENSED
8 PHYSICIAN, A LICENSED AUDIOLOGIST OR A LICENSED SPEECH-LANGUAGE PATHOLO-
9 GIST AFTER COMPLETION OF AN AUDIOLOGICAL EXAMINATION AND EVALUATION, IN
10 ACCORDANCE WITH THIS PARAGRAPH. SUCH POLICY SHALL PROVIDE COVERAGE FOR
11 SUCH NUMBER OF SPEECH-LANGUAGE PATHOLOGY EXAMINATIONS AND EVALUATIONS AS
12 ARE SO RECOMMENDED. SUCH POLICY SHALL PROVIDE COVERAGE FOR ANNUAL AUDIO-
13 LOGICAL TESTING AND EVALUATION BY A LICENSED PHYSICIAN OR LICENSED
14 AUDIOLOGIST AND FOR SUCH ADDITIONAL NUMBER OF AUDIOLOGICAL TESTS AND
15 EVALUATIONS AS ARE REQUIRED BY THE LICENSED PHYSICIAN OR LICENSED
16 AUDIOLOGIST WHO COMPLETED A PRIOR EVALUATION. SUCH COVERAGES MAY BE
17 SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS MAY BE DEEMED APPROPRI-
18 ATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT WITH THOSE ESTABLISHED
19 FOR OTHER BENEFITS WITHIN A GIVEN POLICY. If a policy provides for
20 reimbursement for speech-language pathology or audiology service which
21 is within the lawful scope of practice of a duly licensed speech-lan-
22 guage pathologist or audiologist, an insured shall be entitled to
23 reimbursement for such service whether the said service is performed by
24 a physician or duly licensed speech-language pathologist or audiolo-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04282-01-1
A. 2621 2
1 gist[, provided however, that nothing contained herein shall be
2 construed to impair any terms of such policy which may require said
3 service to be performed pursuant to a medical order, or a similar or
4 related service of a physician, in which case coverage need not be
5 provided for any tests, evaluations or diagnoses if such tests, evalu-
6 ations or diagnoses have already been provided by or through a physician
7 within twelve months of the referral or order from the physician].
8 [However, nothing herein] NOTHING IN THIS PARAGRAPH shall be construed
9 as preventing an insurer from covering more than one test or evaluation
10 provided by a speech-language pathologist or audiologist within a
11 twelve-month period where such test or evaluation is ordered by a physi-
12 cian as medically necessary[. Nor shall anything herein be construed as
13 prohibiting the limitation of such services, where covered, to specified
14 settings other than offices, such as hospitals or to services provided
15 by such professionals as part of a home care agency's services] OR WHERE
16 SUCH TEST OR EVALUATION IS ORDERED BY A SPEECH-LANGUAGE PATHOLOGIST OR
17 AUDIOLOGIST WHO CONDUCTED SUCH A TEST OR EVALUATION WITHIN THE
18 TWELVE-MONTH PERIOD.
19 S 2. Subsection (l) of section 3221 of the insurance law is amended by
20 adding a new paragraph 18 to read as follows:
21 (18) EVERY INSURER DELIVERING A GROUP OR BLANKET POLICY OR ISSUING A
22 GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE WHICH PROVIDES COVER-
23 AGE FOR HOSPITAL, SURGICAL OR MEDICAL CARE SHALL PROVIDE COVERAGE FOR
24 AUDIOLOGICAL EXAMINATIONS AND EVALUATIONS, AND SHALL ALSO PROVIDE COVER-
25 AGE FOR SPEECH-LANGUAGE PATHOLOGY EXAMINATIONS AND EVALUATIONS WHICH ARE
26 RECOMMENDED BY A LICENSED PHYSICIAN, A LICENSED AUDIOLOGIST OR A
27 LICENSED SPEECH-LANGUAGE PATHOLOGIST AFTER COMPLETION OF AN AUDIOLOGICAL
28 EXAMINATION AND EVALUATION, IN ACCORDANCE WITH THIS PARAGRAPH. SUCH
29 POLICY SHALL PROVIDE COVERAGE FOR SUCH NUMBER OF SPEECH-LANGUAGE PATHOL-
30 OGY EXAMINATIONS AND EVALUATIONS AS ARE SO RECOMMENDED. SUCH POLICY
31 SHALL PROVIDE COVERAGE FOR ANNUAL AUDIOLOGICAL TESTING AND EVALUATION BY
32 A LICENSED PHYSICIAN OR LICENSED AUDIOLOGIST AND FOR SUCH ADDITIONAL
33 NUMBER OF AUDIOLOGICAL TESTS AND EVALUATIONS AS ARE REQUIRED BY THE
34 LICENSED PHYSICIAN OR LICENSED AUDIOLOGIST WHO COMPLETED A PRIOR EVALU-
35 ATION. SUCH COVERAGES MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSU-
36 RANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE
37 CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN
38 POLICY.
39 S 3. Subparagraph (F) of paragraph 4 of subsection (f) of section 4235
40 of the insurance law, as added by chapter 456 of the laws of 1993, is
41 amended to read as follows:
42 (F) any speech-language pathology or audiology service which is within
43 the lawful scope of practice of a duly licensed speech-language patholo-
44 gist or audiologist, a subscriber to such policy shall be entitled to
45 reimbursement for such service whether the said service is performed by
46 a physician or duly licensed speech-language pathologist or audiolo-
47 gist[, provided however, that nothing contained herein shall be
48 construed to impair any terms of such policy which may require said
49 service to be performed pursuant to a medical order, or a similar or
50 related service of a physician, in which case coverage need not be
51 provided for any tests, evaluations or diagnoses if such tests, evalu-
52 ations or diagnoses have already been provided by or through a physician
53 within twelve months of the referral or order from the physician].
54 [However, nothing herein] NOTHING IN THIS SUBPARAGRAPH shall be
55 construed as preventing an insurer from covering more than one test or
56 evaluation provided by a speech-language pathologist or audiologist
A. 2621 3
1 within a twelve-month period where such test or evaluation is ordered by
2 a physician as medically necessary[. Nor shall anything herein be
3 construed as prohibiting the limitation of such services, where covered,
4 to specified settings other than offices, such as hospitals or to
5 services provided by such professionals as part of a home care agency's
6 services; and when] OR WHERE SUCH TEST OR EVALUATION IS ORDERED BY A
7 SPEECH-LANGUAGE PATHOLOGIST OR AUDIOLOGIST WHO CONDUCTED SUCH A TEST OR
8 EVALUATION WITHIN THE TWELVE-MONTH PERIOD. WHEN such policy or any
9 certificate issued thereunder is delivered or issued for delivery with-
10 out the state by an authorized insurer, covered persons residing in this
11 state shall be entitled to reimbursement for speech-language pathology
12 or audiology service as herein provided.
13 S 4. Subparagraph (I) of paragraph 1 of subsection (b) of section 4301
14 of the insurance law, as added by chapter 456 of the laws of 1993, is
15 amended to read as follows:
16 (I) speech-language pathology or audiology services provided through
17 licensed speech-language pathologists or audiologists[, provided howev-
18 er, that nothing contained herein shall be construed to prohibit a
19 contract from requiring said service from being performed pursuant to a
20 medical order or similar or related service of a physician, in which
21 case coverage need not be provided for any tests, evaluations or diag-
22 noses if such tests, evaluations or diagnoses have already been provided
23 by or through a physician within twelve months of the referral or order
24 from the physician]. [However, nothing herein] NOTHING IN THIS SUBPARA-
25 GRAPH shall be construed as preventing a corporation from covering more
26 than one test or evaluation provided by a speech-language pathologist or
27 audiologist within a twelve-month period where such [tests] TEST or
28 [evaluations] EVALUATION is ordered by a physician as medically neces-
29 sary[. Nor shall anything herein be construed as prohibiting the limita-
30 tion of such services, where covered, to specified settings other than
31 offices, such as hospitals or to services provided by such professionals
32 as part of a home care agency's services] OR WHERE SUCH TEST OR EVALU-
33 ATION IS ORDERED BY A SPEECH-LANGUAGE PATHOLOGIST OR AUDIOLOGIST WHO
34 CONDUCTED SUCH A TEST OR EVALUATION WITHIN THE TWELVE-MONTH PERIOD,
35 S 5. Paragraph 3 of subsection (b) of section 4301 of the insurance
36 law, as amended by chapter 593 of the laws of 2000, is amended to read
37 as follows:
38 (3) Every medical expense indemnity corporation shall be open to the
39 participation of licensed physicians, podiatrists, chiropractors, opto-
40 metrists, physical and occupational therapists, speech-language patholo-
41 gists, audiologists, and dentists, certified and registered psychol-
42 ogists without discrimination against schools of medical practice,
43 podiatry practice, chiropractic practice, optometric practice, physical
44 and occupational therapy practice, dental practice, speech-language
45 pathology practice [(subject to the permitted limitations of paragraph
46 one of this subsection)], audiology practice [(subject to the permitted
47 limitations of paragraph one of this subsection)], and psychological
48 training as defined in the education law.
49 S 6. Section 4303 of the insurance law is amended by adding a new
50 subsection (hh) to read as follows:
51 (HH) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION,
52 A HOSPITAL SERVICE CORPORATION OR A HEALTH SERVICE CORPORATION WHICH
53 PROVIDES COVERAGE FOR HOSPITAL, SURGICAL OR MEDICAL CARE SHALL PROVIDE
54 COVERAGE FOR AUDIOLOGICAL EXAMINATIONS AND EVALUATIONS, AND SHALL ALSO
55 PROVIDE COVERAGE FOR SPEECH-LANGUAGE PATHOLOGY EXAMINATIONS AND EVALU-
56 ATIONS WHICH ARE RECOMMENDED BY A LICENSED PHYSICIAN, A LICENSED AUDIOL-
A. 2621 4
1 OGIST OR A LICENSED SPEECH-LANGUAGE PATHOLOGIST AFTER COMPLETION OF AN
2 AUDIOLOGICAL EXAMINATION AND EVALUATION, IN ACCORDANCE WITH THIS
3 SUBSECTION. SUCH CONTRACT SHALL PROVIDE COVERAGE FOR SUCH NUMBER OF
4 SPEECH-LANGUAGE PATHOLOGY EXAMINATIONS AND EVALUATIONS AS ARE SO RECOM-
5 MENDED. SUCH CONTRACT SHALL PROVIDE COVERAGE FOR ANNUAL AUDIOLOGICAL
6 TESTING AND EVALUATION BY A LICENSED PHYSICIAN OR LICENSED AUDIOLOGIST
7 AND FOR SUCH ADDITIONAL NUMBER OF AUDIOLOGICAL TESTS AND EVALUATIONS AS
8 ARE REQUIRED BY THE LICENSED PHYSICIAN OR LICENSED AUDIOLOGIST WHO
9 COMPLETED A PRIOR EVALUATION. SUCH COVERAGES MAY BE SUBJECT TO ANNUAL
10 DEDUCTIBLES AND COINSURANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPER-
11 INTENDENT AND AS ARE CONSISTENT WITH THOSE ESTABLISHED FOR OTHER BENE-
12 FITS WITHIN A GIVEN POLICY.
13 S 7. This act shall take effect on the first of January next succeed-
14 ing the date on which it shall have become a law and shall apply to all
15 policies and contracts issued, renewed, modified, altered or amended on
16 or after such date.
