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LYMPHEDEMA LEGISLATION NEW YORK

-------------------------------------------------------------

                            STATE OF NEW YORK 

                                         9208--A 

                               2003-2004 Regular Sessions 

                                   IN ASSEMBLY 

                                    October 31, 2003

                                       ___________ 

        Introduced  by  COMMITTEE  ON RULES -- (at request of M. of A. A. Cohen,

          Greene,  Millman,  Robinson,  Sweeney,  Grodenchik,  Sidikman,  Clark,

          Dinowitz,  Norman,  Bradley,  Colton,  Galef,  Glick,  Gordon,  Green,

          Gromack, McEneny, Pheffer, Seddio, Tocci, Towns, Weisenberg)  --  read

          once  and referred to the Committee on Insurance -- recommitted to the

          Committee on Insurance in accordance with Assembly Rule 3, sec.  2  --

          committee  discharged,  bill amended, ordered reprinted as amended and

          recommitted to said committee 

        AN ACT to amend the insurance law,  in  relation  to  requiring  certain

          health insurance coverage for lymphedema 

          The People of the State of New York, represented in Senate and Assem-

        bly, do enact as follows: 

     1    Section 1. Subsection (i) of section 3216  of  the  insurance  law  is

     2  amended by adding a new paragraph 25 to read as follows:

     3    (25) Every policy which provides hospital, surgical, medical or major

     4  medical coverage shall provide coverage for the diagnosis and treatment

     5  of lymphedema. Such coverage shall include benefits for equipment,

     6  supplies, devices, complex decongestive therapy, and out-patient self-

     7  management training and education for the treatment of lymphedema, if

     8  prescribed by a health care professional legally authorized to prescribe

     9  or provide such items under title eight of the education law. Such

    10  equipment, supplies or devices shall include, but not be limited to,

    11  bandages, compression garments, pads and devices.

    12    (A) A policy which is a managed health care product may require such

    13  health care professional be a member of such managed health care plan's

    14  provider network, provided that such network includes sufficient health

    15  care professionals who are qualified by specific education, experience

    16  and credentials to provide the covered benefits described in this para-

    17  graph.

    18    (B) No insurer, corporation, or health maintenance organization shall

    19  impose upon any person receiving benefits pursuant to this paragraph any 

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets

                              [] is old law to be omitted.

                                                                   LBD15511-04-4 

        A. 9208--A                          (2) 

     1   copayment, fee, policy year or calendar year, or durational benefit

     2  limitation or maximum for benefits or services that is not equally

     3  imposed upon all individuals in the same benefit category.

     4    (C) This paragraph shall not apply to short-term travel, accident

     5  only, limited or specified disease, or individual conversion policies or

     6  contracts, nor to policies or contracts designed for issuance to persons

     7  eligible for coverage under Title XVIII of the Social Security Act,

     8  known as Medicare, or any other similar coverage under state or federal

     9  governmental plans.

    10    (D) For purposes of this paragraph, a "managed care product" shall

    11  mean a policy which requires that medical or other health care services

    12  covered under the policy, other than emergency care services, be

    13  provided by, or pursuant to a referral from a primary care provider, and

    14  that services provided pursuant to such a referral be rendered by a

    15  health care provider participating in the insurer's managed care provid-

    16  er network. In addition, a managed care product shall also mean the

    17  in-network portion of a contract which requires that medical or other

    18  health care services covered under the contract, other than emergency

    19  care services, be provided by, or pursuant to a referral from a primary

    20  care provider, and that services provided pursuant to such a referral be

    21  rendered by a health care provider participating in the insurer's

    22  managed care provider network, in order for the insured to be entitled

    23  to the maximum reimbursement under the contract.

    24    ¤ 2. Subsection (k) of section 3221 of the insurance law is amended by

    25  adding a new paragraph 14 to read as follows:

    26    (14) Every group policy issued or issued for delivery in this state

    27  which provides hospital, surgical, medical or major medical coverage

    28  shall provide coverage for the diagnosis and treatment of lymphedema.

    29  Such coverage shall include benefits for equipment, supplies, devices,

    30  complex decongestive therapy, and out-patient self-management training

    31  and education for the treatment of lymphedema, if prescribed by a health

    32  care professional legally authorized to prescribe or provide such items

    33  under title eight of the education law. Such equipment, supplies or

    34  devices shall include, but not be limited to, bandages, compression

    35  garments, pads and devices.

    36    (A) A policy which is a managed health care product may require such

    37  health care professional be a member of such managed health care plan's

    38  provider network, provided that such network includes sufficient health

    39  care professionals who are qualified by specific education, experience

    40  and credentials to provide the covered benefits described in this para-

    41  graph.

    42    (B) No insurer, corporation, or health maintenance organization shall

    43  impose upon any person receiving benefits pursuant to this paragraph any

    44  copayment, fee, policy year or calendar year, or durational benefit

    45  limitation or maximum for benefits or services that is not equally

    46  imposed upon all individuals in the same benefit category.

    47    (C) This paragraph shall not apply to short-term travel, accident

    48  only, limited or specified disease, or individual conversion policies or

    49  contracts, nor to policies or contracts designed for issuance to persons

    50  eligible for coverage under Title XVIII of the Social Security Act,

    51  known as Medicare, or any other similar coverage under state or federal

    52  governmental plans.

    53    (D) For purposes of this paragraph, a "managed care product" shall

    54  mean a policy which requires that medical or other health care services

    55  covered under the policy, other than emergency care services, be

    56  provided by, or pursuant to a referral from a primary care provider, and 

        A. 9208--A                         ( 3) 

     1  that services provided pursuant to such a referral be rendered by a

     2  health care provider participating in the insurer's managed care provid-

     3  er network. In addition, a managed care product shall also mean the

     4  in-network portion of a contract which requires that medical or other

     5  health care services covered under the contract, other than emergency

     6  care services, be provided by, or pursuant to a referral from a primary

     7  care provider, and that services provided pursuant to such a referral be

     8  rendered by a health care provider participating in the insurer's

     9  managed care provider network, in order for the insured to be entitled

    10  to the maximum reimbursement under the contract.

    11    ¤ 3. Section 4303 of the insurance law is  amended  by  adding  a  new

    12  subsection (dd) to read as follows:

    13    (dd) Every contract issued by a hospital service corporation or health

    14  service corporation which provides hospital, surgical, medical or major

    15  medical coverage shall provide coverage for the diagnosis and treatment

    16  of lymphedema. Such coverage shall include benefits for equipment,

    17  supplies, devices, complex decongestive therapy, and out-patient self-

    18  management training and education for the treatment of lymphedema, if

    19  prescribed by a health care professional legally authorized to prescribe

    20  or provide such items under title eight of the education law. Such

    21  equipment, supplies or devices shall include, but not be limited to,

    22  bandages, compression garments, pads and devices.

    23    (1) A policy which is a managed health care product may require such

    24  health care professional be a member of such managed health care plan's

    25  provider network, provided that such network includes sufficient health

    26  care professionals who are qualified by specific education, experience

    27  and credentials to provide the covered benefits described in this

    28  subsection.

    29    (2) No insurer, corporation, or health maintenance organization shall

    30  impose upon any person receiving benefits pursuant to this subsection

    31  any copayment, fee, policy year or calendar year, or durational benefit

    32  limitation or maximum for benefits or services that is not equally

    33  imposed upon all individuals in the same benefit category.

    34    (3) This subsection shall not apply to short-term travel, accident

    35  only, limited or specified disease, or individual conversion policies or

    36  contracts, nor to policies or contracts designed for issuance to persons

    37  eligible for coverage under Title XVIII of the Social Security Act,

    38  known as Medicare, or any other similar coverage under state or federal

    39  governmental plans.

    40    (4) For purposes of this subsection, a "managed care product" shall

    41  mean a policy which requires that medical or other health care services

    42  covered under the policy, other than emergency care services, be

    43  provided by, or pursuant to a referral from a primary care provider, and

    44  that services provided pursuant to such a referral be rendered by a

    45  health care provider participating in the insurer's managed care provid-

    46  er network. In addition, a managed care product shall also mean the

    47  in-network portion of a contract which requires that medical or other

    48  health care services covered under the contract, other than emergency

    49  care services, be provided by, or pursuant to a referral from a primary

    50  care provider, and that services provided pursuant to such a referral be

    51  rendered by a health care provider participating in the insurer's

    52  managed care provider network, in order for the insured to be entitled

    53  to the maximum reimbursement under the contract.

    54    ¤ 4. This act shall take effect January 1, 2005 and shall apply to all

    55  insurance policies,  contracts  and  plans  issued,  renewed,  modified,

    56  altered or amended on or after such date.

   

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Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

http://health.groups.yahoo.com/group/AdvocatesforLymphedema/

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Pat O'Connor

Lymphedema People / Advocates for Lymphedema

===========================

Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet?  Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more.  Come and take a stroll! 

Lymphedema Glossary 

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing 

Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema 

Arm Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema 

Leg Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema 

Acute Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema 

The Lymphedema Diet 

http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet 

Exercises for Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema 

Diuretics are not for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=diuretics_are_not_for_lymphedema 

Lymphedema People Online Support Groups 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_people_online_support_groups 

Lipedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema 

Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment 

Lymphedema and Pain Management 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pain_management 

Manual Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)

http://www.lymphedemapeople.com/wiki/doku.php?id=manual_lymphatic_drainage_mld_complex_decongestive_therapy_cdt 

Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema 

How to Treat a Lymphedema Wound 

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound 

Fungal Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=fungal_infections_associated_with_lymphedema 

Lymphedema in Children 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children 

Lymphoscintigraphy 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Extraperitoneal para-aortic lymph node dissection (EPLND) 

http://www.lymphedemapeople.com/wiki/doku.php?id=extraperitoneal_para-aortic_lymph_node_dissection_eplnd 

Axillary node biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy

Sentinel Node Biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy

 Small Needle Biopsy - Fine Needle Aspiration 

http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Lymphedema Gene FOXC2

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_foxc2

 Lymphedema Gene VEGFC

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_vegfc

 Lymphedema Gene SOX18

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_sox18

 Lymphedema and Pregnancy

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pregnancy

Home page: Lymphedema People

http://www.lymphedemapeople.com

Page Updated: May 8, 2008