STATE OF NEW YORK ________________________________________________________________________ 1096 2023-2024 Regular Sessions IN ASSEMBLY January 13, 2023 ___________ Introduced by M. of A. BICHOTTE HERMELYN, SILLITTI, STIRPE, COLTON, CRUZ, JACKSON -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to requiring insurance policies to provide coverage for pre-term labor hospitalizations, home visits to monitor pre-term labor patients and counseling The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Item (i) of subparagraph (A) of paragraph 10 of subsection 2 (i) of section 3216 of the insurance law, as amended by chapter 238 of 3 the laws of 2010, is amended and two new subparagraphs (C) and (D) are 4 added to read as follows: 5 (i) Every policy which provides hospital, surgical or medical coverage 6 shall provide coverage for maternity care, including hospital, surgical 7 or medical care to the same extent that hospital, surgical or medical 8 coverage is provided for illness or disease under the policy. Such 9 maternity care coverage, other than coverage for perinatal compli- 10 cations, shall include inpatient hospital coverage for expectant mothers 11 in pre-term labor, inpatient hospital coverage for mother and for 12 newborn for at least forty-eight hours after childbirth for any delivery 13 other than a caesarean section, and for at least ninety-six hours after 14 a caesarean section. Such coverage for maternity care shall include the 15 services of a midwife licensed pursuant to article one hundred forty of 16 the education law, practicing consistent with section sixty-nine hundred 17 fifty-one of the education law and affiliated or practicing in conjunc- 18 tion with a facility licensed pursuant to article twenty-eight of the 19 public health law, but no insurer shall be required to pay for duplica- 20 tive routine services actually provided by both a licensed midwife and a 21 physician. 22 (C) Coverage provided under this subsection for care and treatment 23 during pregnancy shall include provision for part-time or intermittent 24 home nursing care by or under the supervision of a registered profes- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01144-01-3
A. 1096 2 1 sional nurse to monitor expectant mothers who have been diagnosed by a 2 physician as having experienced pre-term labor, and for the adminis- 3 tration of Makena (17-alpha hydroxyprogesterone) by such nurse. As used 4 in this subsection, "pre-term labor" means the commencement of regular 5 contractions of the uterus causing palpable changes in the cervix that 6 start between twenty weeks and thirty-six weeks and six days of pregnan- 7 cy, including, but not limited to, effacement and dilation. 8 (D) Coverage provided under this subsection for care and treatment 9 during pregnancy shall include provisions for visits with a physician, 10 psychiatrist or psychologist or a licensed clinical social worker within 11 the lawful scope of his or her practice who provides psychiatric or 12 psychological services or for the diagnosis and treatment of mental, 13 nervous or emotional disorders and ailments for assistance with 14 emotional issues experienced by an expectant mother and the family of an 15 expectant mother who has: 16 (i) lost a fetus through miscarriage or stillbirth; 17 (ii) lost a child within a month after the birth of the child; or 18 (iii) been diagnosed by a physician as having experienced pre-term 19 labor. 20 § 2. Item (i) of subparagraph (A) of paragraph 5 of subsection (k) of 21 section 3221 of the insurance law, as amended by chapter 238 of the laws 22 of 2010, is amended and two new subparagraphs (C) and (D) are added to 23 read as follows: 24 (i) Every group or blanket policy delivered or issued for delivery in 25 this state which provides hospital, surgical or medical coverage shall 26 include coverage for maternity care, including hospital, surgical or 27 medical care to the same extent that coverage is provided for illness or 28 disease under the policy. Such maternity care coverage, other than 29 coverage for perinatal complications, shall include inpatient hospital 30 coverage for expectant mothers in pre-term labor, inpatient hospital 31 coverage for mother and newborn for at least forty-eight hours after 32 childbirth for any delivery other than a caesarean section, and for at 33 least ninety-six hours after a caesarean section. Such coverage for 34 maternity care shall include the services of a midwife licensed pursuant 35 to article one hundred forty of the education law, practicing consistent 36 with section sixty-nine hundred fifty-one of the education law and 37 affiliated or practicing in conjunction with a facility licensed pursu- 38 ant to article twenty-eight of the public health law, but no insurer 39 shall be required to pay for duplicative routine services actually 40 provided by both a licensed midwife and a physician. 41 (C) Coverage provided under this subsection for care and treatment 42 during pregnancy shall include provision for part-time or intermittent 43 home nursing care by or under the supervision of a registered profes- 44 sional nurse to monitor expectant mothers who have been diagnosed by a 45 physician as having experienced pre-term labor, and for the adminis- 46 tration of Makena (17-alpha hydroxyprogesterone) by such nurse. As used 47 in this subsection, "pre-term labor" means the commencement of regular 48 contractions of the uterus causing palpable changes in the cervix that 49 start between twenty weeks and thirty-six weeks and six days of pregnan- 50 cy, including, but not limited to, effacement and dilation. 51 (D) Coverage provided under this subsection for care and treatment 52 during pregnancy shall include provisions for visits with a physician, 53 psychiatrist or psychologist or a licensed clinical social worker within 54 the lawful scope of his or her practice who provides psychiatric or 55 psychological services or for the diagnosis and treatment of mental, 56 nervous or emotional disorders and ailments for assistance with
A. 1096 3 1 emotional issues experienced by an expectant mother and the family of an 2 expectant mother who has: 3 (i) lost a fetus through miscarriage or stillbirth; 4 (ii) lost a child within a month after the birth of the child; or 5 (iii) been diagnosed by a physician as having experienced pre-term 6 labor. 7 § 3. Subparagraph (A) of paragraph 1 of subsection (c) of section 4303 8 of the insurance law, as amended by chapter 238 of the laws of 2010, is 9 amended and two new paragraphs 3 and 4 are added to read as follows: 10 (A) Every contract issued by a corporation subject to the provisions 11 of this article which provides hospital service, medical expense indem- 12 nity or both shall provide coverage for maternity care including hospi- 13 tal, surgical or medical care to the same extent that hospital service, 14 medical expense indemnity or both are provided for illness or disease 15 under the contract. Such maternity care coverage, other than coverage 16 for perinatal complications, shall include inpatient hospital coverage 17 for expectant mothers in pre-term labor, inpatient hospital coverage for 18 mother and for newborn for at least forty-eight hours after childbirth 19 for any delivery other than a caesarean section, and for at least nine- 20 ty-six hours following a caesarean section. Such coverage for maternity 21 care shall include the services of a midwife licensed pursuant to arti- 22 cle one hundred forty of the education law, practicing consistent with 23 section sixty-nine hundred fifty-one of the education law and affiliated 24 or practicing in conjunction with a facility licensed pursuant to arti- 25 cle twenty-eight of the public health law, but no insurer shall be 26 required to pay for duplicative routine services actually provided by 27 both a licensed midwife and a physician. 28 (3) Coverage provided under this subsection for care and treatment 29 during pregnancy shall include provision for part-time or intermittent 30 home nursing care by or under the supervision of a registered profes- 31 sional nurse to monitor expectant mothers who have been diagnosed by a 32 physician as having experienced pre-term labor, and for the adminis- 33 tration of Makena (17-alpha hydroxyprogesterone) by such nurse. As used 34 in this subsection, "pre-term labor" means the commencement of regular 35 contractions of the uterus causing palpable changes in the cervix that 36 start between twenty weeks and thirty-six weeks and six days of pregnan- 37 cy, including, but not limited to, effacement and dilation. 38 (4) Coverage provided under this subsection for care and treatment 39 during pregnancy shall include provisions for visits with a physician, 40 psychiatrist or psychologist or a licensed clinical social worker within 41 the lawful scope of his or her practice who provides psychiatric or 42 psychological services or for the diagnosis and treatment of mental, 43 nervous or emotional disorders and ailments for assistance with 44 emotional issues experienced by an expectant mother and the family of an 45 expectant mother who has: 46 (A) lost a fetus through miscarriage or stillbirth; 47 (B) lost a child within a month after the birth of the child; or 48 (C) been diagnosed by a physician as having experienced pre-term 49 labor. 50 § 4. This act shall take effect on the sixtieth day after it shall 51 have become a law. Effective immediately the addition, amendment and/or 52 repeal of any rule or regulation necessary for the implementation of 53 this act on its effective date are authorized to be made and completed 54 on or before such date.