What's happening
The bill requires health insurance policies in New York to cover medically necessary treatment for craniofacial musculoskeletal disorders.
Why it matters
Expands insurance coverage for craniofacial musculoskeletal disorders. ensures that treatment for disorders affecting bones or joints in the face, neck, or head (from causes like accidents, congenital, developmental issues, or disease) is covered at the same level as other musculoskeletal conditions, reducing disparities in care.
Includes both surgical and nonsurgical treatments. coverage must extend to all medically necessary interventions, not just surgery, potentially allowing patients access to a broader range of therapies and improving outcomes.
Allows treatment to be prescribed by dentists as well as physicians. recognizes that dentists often diagnose or manage such conditions, making it easier for patients to get timely and appropriate care.
Specifically excludes routine dental services. clarifies that insurance is not required to cover treatments for issues primarily affecting the gums, teeth, or alveolar ridge, focusing coverage on true musculoskeletal disorders and not general dental work.
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
Patients with face, head or neck musculoskeletal disorders
The bill would require covered health plans to cover diagnosis and medically necessary surgical and nonsurgical treatment on the same basis as other musculoskeletal disorders.
Health insurers and health service corporations
The bill would impose coverage requirements on specified individual, group and blanket policies, while allowing plans to require a referral from a contracted provider.
Physicians and dentists
Required coverage could include treatment they prescribe or administer for qualifying bone or joint disorders resulting from accident, trauma, congenital or developmental defects, or pathology.
Patients seeking dental care
The bill would not require coverage for dental services addressing disorders or pathology primarily affecting the gums, teeth or alveolar ridge.
Headline styles
Cover Craniofacial Disorders
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
6460
2019-2020 Regular Sessions
IN ASSEMBLY
March 7, 2019
Introduced by M. of A. FAHY -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to health insurance coverage for craniofacial disorders
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 35 to read as follows:
(35)(A) Every policy delivered 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 comprehensive-type coverage shall provide coverage for diagnosis and medically necessary treatment, including surgical and nonsurgical procedures, for a musculoskeletal disorder that affects any bone or joint in the face, neck or head and is the result of accident, trauma, congenital defect, developmental defect, or pathology. Subject to subparagraph (B) of this paragraph, this coverage shall be the same as that provided under the health insurance plan for any other musculoskeletal disorder in the body and may be provided when prescribed or administered by a physician or a dentist. This paragraph shall not be construed to require coverage for dental services for the diagnosis or treatment of dental disorders or dental pathology primarily affecting the gums, teeth, or alveolar ridge.
(B) A referral from a health care provider under contract with the policy may be required.
§ 2. Subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 22 to read as follows:
(22)(A) Every group or blanket policy delivered or issued for delivery in this state which provides medical coverage that includes coverage for physician services in a physician's office or major medical or similar comprehensive-type coverage shall provide coverage for diagnosis and
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10293-01-9
A. 6460 2
medically necessary treatment, including surgical and nonsurgical procedures, for a musculoskeletal disorder that affects any bone or joint in the face, neck or head and is the result of accident, trauma, congenital defect, developmental defect, or pathology. Subject to subparagraph (B) of this paragraph, this coverage shall be the same as that provided under the health insurance plan for any other musculoskeletal disorder in the body and may be provided when prescribed or administered by a physician or a dentist. This paragraph shall not be construed to require coverage for dental services for the diagnosis or treatment of dental disorders or dental pathology primarily affecting the gums, teeth, or alveolar ridge.
(B) A referral from a health care provider under contract with the policy may be required.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (ss) to read as follows:
(ss)(1) A hospital service corporation, medical expense indemnity corporation or health service corporation which provides medical coverage that includes coverage for physician services in a physician's office or major medical or similar comprehensive-type coverage shall provide coverage for diagnosis and medically necessary treatment, including surgical and nonsurgical procedures, for a musculoskeletal disorder that affects any bone or joint in the face, neck or head and is the result of accident, trauma, congenital defect, developmental defect, or pathology. Subject to paragraph two of this subsection, this coverage shall be the same as that provided under the health insurance plan for any other musculoskeletal disorder in the body and may be provided when prescribed or administered by a physician or a dentist. This subsection shall not be construed to require coverage for dental services for the diagnosis or treatment of dental disorders or dental pathology primarily affecting the gums, teeth, or alveolar ridge.
(2) A referral from a health care provider under contract with the policy may be required.
§ 4. This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to all policies issued, renewed, altered or modified on or after such date.
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.