What's happening
Writing a plain-English summary… Track this bill to get it by email.
Why it matters
Albany, before your first meeting.
Every bill that moved yesterday, summarized in a sentence and ranked by impact. The Albany Scorecard follows on Sundays.
Free. Unsubscribe in one click. Want alerts on specific bills? Create an account.
Who cares
Headline styles
Sponsors
No co-sponsors yet.
History
- Referred to health
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
BILL NUMBER:S7502
Title of bill
An act to amend the public health law, in relation to requiring health maintenance organizations to cover court ordered health care services
Purpose
This bill amends the public health law related to health plan coverage of court ordered services.
Summary of provisions
Section 1 amends section 4406-c of the public health law to require that a health care plan cover health care services ordered by a court of competent jurisdiction if an evaluation is performed by a plan's partic- ipating provider who certifies that further services are necessary, the health care services are a covered benefit of the health care plan, and the services are provided by a participating health care provider.
Section 2 - Effective date.
Justification
This bill brings commercial plans into alignment with the requirement for Medicaid managed care plans. Under the New York State Medicaid Managed Care (MAMC) and Family Health Plus (FHPLus) Model Contract, managed care plans are required to honor court orders for covered services and they may not apply their own medical necessity or prior approval review criteria.
Plans should not be able to deny court ordered coverage on the basis that they are not medically necessary, where a plan physician has certi- fied the need for further services. Such denials of coverage then leave either the individual responsible for paying for the service, or the provider responsible for the costs, increasing uncompensated care.
Prior legislative history
New bill
Fiscal implications
None
Effective date
This act shall take effect July 1, 2015.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.