Requires health insurers to provide coverage for speech therapy for stuttering, the official text

S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7321--A
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 25, 2025
                                ___________
 
 Introduced by M. of A. WEPRIN -- read once and referred to the Committee
   on  Insurance -- committee discharged, bill amended, ordered reprinted
   as amended and recommitted to said committee
 
 AN ACT to amend the insurance  law,  in  relation  to  requiring  health
   insurers to provide coverage for speech therapy for stuttering

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
 amended by adding a new paragraph 41 to read as follows:
   (41)(A) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
 COMPREHENSIVE-TYPE  COVERAGE  SHALL,  UPON  THE REFERRAL OF A PHYSICIAN,
 PROVIDE COVERAGE FOR ALL COSTS FOR SPEECH THERAPY FOR  STUTTERING.  SUCH
 SPEECH THERAPY SHALL INCLUDE, BUT NOT BE LIMITED TO, HABILITATIVE SPEECH
 THERAPY  TREATMENT AND REHABILITATIVE SPEECH THERAPY TREATMENT FOR STUT-
 TERING, PROVIDED SUCH TREATMENT IS PERFORMED BY A  HEALTH  CARE  PROFES-
 SIONAL LICENSED PURSUANT TO TITLE EIGHT OF THE EDUCATION LAW.  NO INSUR-
 ER  SHALL  IMPOSE  UPON  ANY  PERSON RECEIVING BENEFITS PURSUANT TO THIS
 PARAGRAPH ANY DURATIONAL BENEFIT LIMITATION  OR  MAXIMUM  FOR  BENEFITS,
 SERVICES, OR VISITS PROVIDED UNDER THIS PARAGRAPH.
   (B)  NOTHING  IN  THIS  PARAGRAPH  SHALL  BE  CONSTRUED TO PREVENT THE
 MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF THE SERVICES  OR  PREVENT  A
 POLICY  FROM  REQUIRING  THAT  SERVICES BE PROVIDED THROUGH A NETWORK OF
 PARTICIPATING PROVIDERS.
   (C) COVERAGE MAY BE DENIED ON THE BASIS THAT SUCH TREATMENT  IS  BEING
 PROVIDED  TO  THE  INSURED  PURSUANT TO AN INDIVIDUALIZED FAMILY SERVICE
 PLAN UNDER SECTION TWENTY-FIVE HUNDRED FORTY-FIVE OF THE  PUBLIC  HEALTH
 LAW OR AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE EIGHTY-NINE OF THE
 EDUCATION  LAW.  THE PROVISION OF SERVICES PURSUANT TO AN INDIVIDUALIZED
 FAMILY SERVICE PLAN UNDER SECTION TWENTY-FIVE HUNDRED FORTY-FIVE OF  THE
 PUBLIC  HEALTH  LAW  OR  AN  INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE
 EIGHTY-NINE OF THE EDUCATION LAW SHALL NOT  AFFECT  COVERAGE  UNDER  THE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07423-03-5
 A. 7321--A                          2
 
 POLICY  FOR  SERVICES  PROVIDED  ON  A  SUPPLEMENTAL BASIS OUTSIDE OF AN
 EDUCATIONAL SETTING IF SUCH SERVICES ARE PROVIDED UPON THE REFERRAL OF A
 PHYSICIAN.
   § 2. Subsection (k) of section 3221 of the insurance law is amended by
 adding a new paragraph 24 to read as follows:
   (24)  (A) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIV-
 ERY IN THIS STATE WHICH PROVIDES  MEDICAL,  MAJOR  MEDICAL,  OR  SIMILAR
 COMPREHENSIVE-TYPE  COVERAGE  SHALL,  UPON  THE REFERRAL OF A PHYSICIAN,
 PROVIDE COVERAGE FOR ALL COSTS FOR SPEECH THERAPY FOR  STUTTERING.  SUCH
 SPEECH THERAPY SHALL INCLUDE, BUT NOT BE LIMITED TO, HABILITATIVE SPEECH
 THERAPY  TREATMENT AND REHABILITATIVE SPEECH THERAPY TREATMENT FOR STUT-
 TERING, PROVIDED SUCH TREATMENT IS PERFORMED BY A  HEALTH  CARE  PROFES-
 SIONAL LICENSED PURSUANT TO TITLE EIGHT OF THE EDUCATION LAW.  NO INSUR-
 ER  SHALL  IMPOSE  UPON  ANY  PERSON RECEIVING BENEFITS PURSUANT TO THIS
 PARAGRAPH ANY DURATIONAL BENEFIT LIMITATION  OR  MAXIMUM  FOR  BENEFITS,
 SERVICES, OR VISITS PROVIDED UNDER THIS PARAGRAPH.
   (B)  NOTHING  IN  THIS  PARAGRAPH  SHALL  BE  CONSTRUED TO PREVENT THE
 MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF THE SERVICES  OR  PREVENT  A
 POLICY  FROM  REQUIRING  THAT  SERVICES BE PROVIDED THROUGH A NETWORK OF
 PARTICIPATING PROVIDERS.
   (C) COVERAGE MAY BE DENIED ON THE BASIS THAT SUCH TREATMENT  IS  BEING
 PROVIDED  TO  THE  INSURED  PURSUANT TO AN INDIVIDUALIZED FAMILY SERVICE
 PLAN UNDER SECTION TWENTY-FIVE HUNDRED FORTY-FIVE OF THE  PUBLIC  HEALTH
 LAW OR AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE EIGHTY-NINE OF THE
 EDUCATION  LAW.  THE PROVISION OF SERVICES PURSUANT TO AN INDIVIDUALIZED
 FAMILY SERVICE PLAN UNDER SECTION TWENTY-FIVE HUNDRED FORTY-FIVE OF  THE
 PUBLIC  HEALTH  LAW  OR  AN  INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE
 EIGHTY-NINE OF THE EDUCATION LAW SHALL NOT  AFFECT  COVERAGE  UNDER  THE
 POLICY  FOR  SERVICES  PROVIDED  ON  A  SUPPLEMENTAL BASIS OUTSIDE OF AN
 EDUCATIONAL SETTING IF SUCH SERVICES ARE PROVIDED UPON THE REFERRAL OF A
 PHYSICIAN.
   § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (ww) to read as follows:
   (WW) (A) EVERY MEDICAL EXPENSE INDEMNITY CORPORATION, HOSPITAL SERVICE
 CORPORATION AND HEALTH SERVICE CORPORATION WHICH PROVIDES MEDICAL, MAJOR
 MEDICAL,  OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL, UPON REFERRAL OF
 A PHYSICIAN, PROVIDE COVERAGE FOR ALL COSTS FOR SPEECH THERAPY FOR STUT-
 TERING. SUCH SPEECH THERAPY SHALL INCLUDE, BUT NOT BE LIMITED TO,  HABI-
 LITATIVE  SPEECH  THERAPY  TREATMENT  AND  REHABILITATIVE SPEECH THERAPY
 TREATMENT FOR STUTTERING, PROVIDED SUCH  TREATMENT  IS  PERFORMED  BY  A
 HEALTH  CARE PROFESSIONAL LICENSED PURSUANT TO TITLE EIGHT OF THE EDUCA-
 TION LAW.  NO CORPORATION SHALL IMPOSE UPON ANY PERSON  RECEIVING  BENE-
 FITS  PURSUANT  TO  THIS SUBSECTION ANY DURATIONAL BENEFIT LIMITATION OR
 MAXIMUM  FOR  BENEFITS,  SERVICES,  OR  VISITS   PROVIDED   UNDER   THIS
 SUBSECTION.
   (B)  NOTHING  IN  THIS  SUBSECTION  SHALL  BE CONSTRUED TO PREVENT THE
 MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF THE SERVICES  OR  PREVENT  A
 POLICY  FROM  REQUIRING  THAT  SERVICES BE PROVIDED THROUGH A NETWORK OF
 PARTICIPATING PROVIDERS.
   (C) COVERAGE MAY BE DENIED ON THE BASIS THAT SUCH TREATMENT  IS  BEING
 PROVIDED  TO  THE  INSURED  PURSUANT TO AN INDIVIDUALIZED FAMILY SERVICE
 PLAN UNDER SECTION TWENTY-FIVE HUNDRED FORTY-FIVE OF THE  PUBLIC  HEALTH
 LAW OR AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE EIGHTY-NINE OF THE
 EDUCATION  LAW.  THE PROVISION OF SERVICES PURSUANT TO AN INDIVIDUALIZED
 FAMILY SERVICE PLAN UNDER SECTION TWENTY-FIVE HUNDRED FORTY-FIVE OF  THE
 PUBLIC  HEALTH  LAW  OR  AN  INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE
 A. 7321--A                          3
 
 EIGHTY-NINE OF THE EDUCATION LAW SHALL NOT  AFFECT  COVERAGE  UNDER  THE
 POLICY  FOR  SERVICES  PROVIDED  ON  A  SUPPLEMENTAL BASIS OUTSIDE OF AN
 EDUCATIONAL SETTING IF SUCH SERVICES ARE PROVIDED UPON THE REFERRAL OF A
 PHYSICIAN.
   §  4. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a  law  and  shall  apply  to
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such  effective  date.  Effective  immediately,  the  addition,
 amendment  and/or  repeal  of  any  rule or regulation necessary for the
 implementation of this act on its effective date are  authorized  to  be
 made and completed on or before such effective date.