What's happening
This bill requires health insurance policies to cover early intervention services for children and removes certain restrictions on coverage and payment.
Why it matters
Removes previous exclusions that allowed insurers to deny coverage specifically because services were classified as early intervention, meaning more children should get needed therapies or supports covered.
Streamlines insurance approval by allowing the child's individualized family services plan (IFSP), once certified by an early intervention official, to automatically satisfy insurance requirements for precertification, preauthorization, and medical necessity, reducing paperwork and delays for families.
Requires insurers to pay for covered early intervention services at rates set by the health commissioner, establishing more predictable and potentially fairer reimbursement for providers.
Prevents insurers from denying early intervention claims based on where services are delivered, how long a child’s condition is expected to last or improve, or whether the provider is in-network, broadening access to care for children with developmental needs.
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Who cares
Headline styles
Cover Early Intervention Services
Plain English, a few words. Used as the page title.
Sponsors
12 Co-sponsors
3 Multi-sponsors
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Cover Early Intervention Therapy
In Senate Committee · Insurance · Sponsor Neil D. Breslin
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2962
2019-2020 Regular Sessions
IN ASSEMBLY
January 28, 2019
Introduced by M. of A. PAULIN, COLTON, CAHILL, ABINANTI, JAFFEE, GALEF, PRETLOW, WEPRIN, ORTIZ, RIVERA, GOODELL, MAGNARELLI, GUNTHER -- Multi-Sponsored by -- M. of A. ENGLEBRIGHT, GOTTFRIED, PERRY -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to coverage of early intervention services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (a) of section 3235-a of the insurance law, as added by section 3 of part C of chapter 1 of the laws of 2002, is amended and two new subsections (e) and (f) are added to read as follows:
(a) No policy of accident and health insurance, including contracts issued pursuant to article forty-three of this chapter, shall exclude coverage for otherwise covered services [solely on the basis that the services constitute early intervention program services] that are provided under title two-A of article twenty-five of the public health law.
(e) Where a service provided to an insured under the early intervention program is a covered service under the insurer's policy or contract, the individualized family services plan, upon certification by the early intervention official, as defined in section twenty-five hundred forty-one of the public health law, or such official's designee, shall be deemed to meet any precertification, preauthorization, and medical necessity requirements imposed on benefits under the policy or contract; provided, however, that the provider shall remove or redact any information contained in the insured's individualized family services plan that is not required by the insurer for payment purposes. Payment for a service covered under the policy or contract that is provided under the early intervention program shall be at rates estab-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00618-01-9
A. 2962 2
lished by the commissioner of health for such service pursuant to regulations.
(f) No insurer, including a health maintenance organization issued a certificate of authority under article forty-four of the public health law and a corporation organized under article forty-three of this chapter, shall deny payment of an early intervention claim based on the following:
(1) the location where services are provided;
(2) the duration of the child's condition and/or that the child's condition is not amenable to significant improvement within a certain period of time as specified in the policy; or
(3) that the provider of services is not a network or participating provider.
§ 2. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.