Healthcare (Children's Health)

This bill requires health insurance plans to cover annual electrocardiogram (EKG) tests and their interpretation for children under 19 years old. It directly affects insured children and their families by mandating this specific preventive heart screening as part of standard pediatric care. The key provision adds EKG coverage as a required service at each well-child visit, with more frequent testing allowed if a physician orders it based on clinical judgment. This policy change ensures insurance coverage for this heart screening without requiring additional patient costs, applying to all policies issued after the bill's effective date.

This bill creates a New York State 1332 innovation program under a federal waiver, providing health insurance coverage for New Yorkers under age 65 with household incomes between 133% and 250% of the federal poverty level who don't qualify for Medicaid or employer-sponsored insurance. It requires coverage for essential health services, including access to cancer centers (at Medicaid reimbursement rates), dental, vision, and support for chronic illnesses. Eligibility excludes those eligible for Medicaid, the Child Health Insurance Program, or affordable employer coverage. The program is subject to federal approval and aims to fill coverage gaps for this specific income group.

Prohibits approved organizations providing coverage under the child health insurance plan from discriminating against health care providers which do not participate in the organization's health care network.

This bill requires health insurers to review coverage requests for medically fragile children differently, considering their unique medical needs rather than using standard adult guidelines. It mandates case-by-case decisions for services like skilled nursing, therapy, and home health care to help these children reach age-appropriate functional capacity. Insurers must pay for inpatient hospital or residential care days when specialized home services aren't available or when waiting for a residential facility bed. The law directly affects children with complex medical conditions requiring 24/7 care, their families, and health insurers managing Medicaid or private plans.