Relates to ensuring continued access to backup devices for patients with cochlear implants, the official text

S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  8265--A
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               May 28, 2025
                                ___________
 
 Introduced  by  Sens.  SUTTON, GOUNARDES, MYRIE, WEBER -- read twice and
   ordered printed, and when printed to be committed 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  ensuring  continued
   access to backup devices for patients with cochlear implants
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Legislative intent. The  legislature  finds  that  cochlear
 implants  are  critical  for  patients with hearing loss to maintain the
 ability to hear. These devices, which  are  often  life-changing,  allow
 individuals to improve their quality of life, integrate fully into their
 communities, and perform daily activities. It is essential that individ-
 uals  who rely on cochlear implants have continuous access to the neces-
 sary backup equipment to  ensure  uninterrupted  use,  including  during
 device upgrades and replacements. Currently, backup devices are provided
 only  with  the  initial  implantation,  but  are  not made available to
 patients upon the upgrade or replacement of the implant after 3-5 years.
 This bill seeks to address this gap in  coverage  and  ensure  that  all
 patients  requiring  cochlear  implants  have  a backup device available
 throughout the duration of their treatment.
   § 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  LARGE  GROUP  POLICY  WHICH  PROVIDES MEDICAL, MAJOR
 MEDICAL, OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE THE COVER-
 AGE FOR A BACKUP COCHLEAR IMPLANT DEVICE WHEN  PRESCRIBED  BY  A  HEALTH
 CARE  PRACTITIONER  LICENSED, CERTIFIED, OR AUTHORIZED UNDER TITLE EIGHT
 OF THE EDUCATION LAW, AND ACTING WITHIN THEIR LAWFUL SCOPE OF PRACTICE.
   (B) COVERAGE OF THE BACKUP DEVICE SHALL BE PROVIDED  AS  LONG  AS  THE
 INSURED  IS ACTIVELY USING THE COCHLEAR IMPLANT, AND FOR THE DURATION OF
 THE INSURED'S NEED FOR THE DEVICE, INCLUDING ANY NECESSARY UPGRADES.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10291-03-5
 S. 8265--A                          2
 
   (C) THE COVERAGE PROVIDED UNDER THIS PARAGRAPH MAY BE SUBJECT TO ANNU-
 AL DEDUCTIBLES, COPAYMENTS AND COINSURANCE AS MAY BE DEEMED  APPROPRIATE
 BY  THE  SUPERINTENDENT  AND  SHALL  BE CONSISTENT WITH THOSE IMPOSED ON
 OTHER SIMILAR BENEFITS UNDER THE POLICY.
   (D) FOR THE PURPOSES OF THIS PARAGRAPH:
   (I)  "COCHLEAR IMPLANT" MEANS A MEDICAL DEVICE SURGICALLY IMPLANTED TO
 PROVIDE HEARING TO INDIVIDUALS WITH  SEVERE  TO  PROFOUND  SENSORINEURAL
 HEARING LOSS; AND
   (II)  "BACKUP  COCHLEAR  IMPLANT  DEVICE"  MEANS  AN ADDITIONAL SET OF
 EXTERNAL COMPONENTS OF THE COCHLEAR IMPLANT, INCLUDING A  PROCESSOR,  IN
 THE EVENT THAT THE PRIMARY DEVICE FAILS OR REQUIRES MAINTENANCE.
   §  3.  Section  4303  of  the insurance law is amended by adding a new
 subsection (ww) to read as follows:
   (WW) (1) EVERY  LARGE  GROUP  POLICY  WHICH  PROVIDES  MEDICAL,  MAJOR
 MEDICAL, OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE THE COVER-
 AGE  FOR  A  BACKUP  COCHLEAR IMPLANT DEVICE WHEN PRESCRIBED BY A HEALTH
 CARE PRACTITIONER LICENSED, CERTIFIED, OR AUTHORIZED UNDER  TITLE  EIGHT
 OF THE EDUCATION LAW, AND ACTING WITHIN THEIR LAWFUL SCOPE OF PRACTICE.
   (2)  COVERAGE  OF  THE  BACKUP DEVICE SHALL BE PROVIDED AS LONG AS THE
 INSURED IS ACTIVELY USING THE COCHLEAR IMPLANT, AND FOR THE DURATION  OF
 THE INSURED'S NEED FOR THE DEVICE, INCLUDING ANY NECESSARY UPGRADES.
   (3)  THE  COVERAGE  REQUIRED UNDER THIS SUBSECTION SHALL BE SUBJECT TO
 ANNUAL DEDUCTIBLES, COPAYMENTS AND COINSURANCE AS MAY BE  DEEMED  APPRO-
 PRIATE  BY THE SUPERINTENDENT AND SHALL BE CONSISTENT WITH THOSE IMPOSED
 ON OTHER SIMILAR BENEFITS UNDER THE CONTRACT.
   (4) FOR THE PURPOSES OF THIS SUBSECTION:
   (A) "COCHLEAR IMPLANT" MEANS A MEDICAL DEVICE SURGICALLY IMPLANTED  TO
 PROVIDE  HEARING  TO  INDIVIDUALS  WITH SEVERE TO PROFOUND SENSORINEURAL
 HEARING LOSS; AND
   (B) "BACKUP COCHLEAR  IMPLANT  DEVICE"  MEANS  AN  ADDITIONAL  SET  OF
 EXTERNAL  COMPONENTS  OF THE COCHLEAR IMPLANT, INCLUDING A PROCESSOR, IN
 THE EVENT THAT THE PRIMARY DEVICE FAILS OR REQUIRES MAINTENANCE.
   § 4. Severability. If any clause,  sentence,  paragraph,  subdivision,
 section  or part of this act shall be adjudged by any court of competent
 jurisdiction to be invalid, such judgment shall not affect,  impair,  or
 invalidate the remainder thereof, but shall be confined in its operation
 to the clause, sentence, paragraph, subdivision, section or part thereof
 directly  involved  in the controversy in which such judgment shall have
 been rendered. It is hereby declared to be the intent of the legislature
 that this act would have been enacted even if  such  invalid  provisions
 had not been included herein.
   § 5. This act shall take effect January 1, 2027 and shall apply to all
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date.