Requires mandatory health insurance coverage for cerebral palsy

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.