S 10228 NY

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Bill No.: Summary Actions Committee&nbspVotes Floor&nbspVotes Memo Text LFIN Chamber&nbspVideo/Transcript S10228 Summary: BILL NO S10228 &nbsp SAME AS SAME AS A10397

&nbsp SPONSOR RYAN C &nbsp COSPNSR &nbsp MLTSPNSR &nbsp Rpld §2511 sub 2 ¶(g), amd §2511, Pub Health L &nbsp Eliminates the prospective enrollment waiting period for children under the age of nineteen enrolling in the child health insurance plan program by enrolling a child retroactively to the first day of the month in which they are approved for coverage under such program.

Go to top S10228 Text:

STATE OF NEW YORK ________________________________________________________________________

10228

IN SENATE

May 7, 2026 ___________

Introduced by Sen. C. RYAN -- read twice and ordered printed, and when printed to be committed to the Committee on Health

AN ACT to amend the public health law, in relation to the date of enrollment in the child health insurance plan program; and to repeal certain provisions of such law relating thereto

The People of the State of New York, represented in Senate and Assem- bly, do enact as follows:

1 Section 1. Paragraph (g) of subdivision 2 of section 2511 of the 2 public health law is REPEALED and a new paragraph (g) is added to read 3 as follows: 4 (g) Notwithstanding any inconsistent provision of law, rule or regu- 5 lation: 6 (i) A child under the age of nineteen who meets the eligibility crite- 7 ria set forth in this subdivision or subdivision five of this section, 8 as determined by an approved organization or the health insurance 9 exchange marketplace, whichever is applicable, shall be enrolled 10 retroactively to the first day of the month in which the child is deemed 11 eligible pursuant to subparagraph (ii) of this paragraph, provided that 12 the child or the applicant for insurance on the child's behalf submits a 13 completed and signed application and required information and documenta- 14 tion. 15 (ii) A child under the age of nineteen shall be presumed eligible for 16 subsidy payments under this subdivision or eligible for coverage under 17 subdivision five of this section, provided that the child or the appli- 18 cant for insurance on such child's behalf submits a completed and signed 19 application. Once eligibility is determined by the approved organization 20 or the health insurance exchange marketplace, whichever is applicable, 21 on the basis of preliminary information, the child shall be enrolled 22 retroactively to the first day of the month in which the child is deemed 23 eligible. Such retroactive enrollment shall apply notwithstanding the 24 timing of any enrollment period. All other procedures and standards 25 regarding presumptive enrollment applicable to eligible children 26 enrolled under this title and specified in state contracts with approved 27 organizations or implemented by the health insurance exchange market-

EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD14659-01-6

S. 10228 2

1 place, whichever is applicable, shall apply to presumptive enrollment of 2 children under the age of nineteen. 3 § 2. Subdivision 3 of section 2511 of the public health law, as 4 amended by chapter 2 of the laws of 1998, is amended to read as follows: 5 3. Subsidy payments shall be made, pursuant to subdivision eight of 6 this section, to approved organizations for the purposes of subsidizing 7 the entire cost of coverage for eligible children meeting the criteria 8 of subdivision two of this section. Notwithstanding any inconsistent 9 provision of this subdivision, the total annual aggregate cost-sharing 10 with respect to all eligible children in a family under this section 11 shall not exceed amounts provided pursuant to applicable federal law. In 12 order to be eligible for a subsidy payment pursuant to this subdivision 13 a premium payment shall be paid for an eligible child in accordance with 14 the provisions of subdivision nine of section twenty-five hundred ten of 15 this title. Nothing herein shall preclude payment of the premium on 16 behalf of an eligible child on a monthly, quarterly, semi-annual or 17 annual basis. Subsidy payments made pursuant to this subdivision shall 18 include payment for covered health care services provided during any 19 period of retroactive presumptive enrollment authorized pursuant to 20 paragraph (g) of subdivision two of this section. 21 § 3. Subdivision 19 of section 2511 of the public health law, as added 22 by chapter 451 of the laws of 2007, is amended to read as follows: 23 19. Claims submitted to an approved organization for payment for 24 medical care, services, or supplies furnished by an out-of-network 25 health care provider must be submitted within fifteen months of the date 26 the medical care, services, or supplies were furnished to an eligible 27 person to be valid and enforceable against the approved organization. If 28 a claim by an out-of-network health care provider is not submitted with- 29 in fifteen months of the date that the medical care, services or 30 supplies were furnished and the claim is subsequently denied by the 31 approved organization for that reason, such out-of-network health care 32 provider shall not seek payment for such medical care, services or 33 supplies from the enrollee. This deadline for claims submission shall 34 not apply where the claims submission is warranted to address findings 35 or recommendations identified in a state or federal audit except where 36 such audit also indicates that an inappropriate provider payment was 37 solely the fault of the out-of-network health care provider. For 38 purposes of this subdivision, medical care, services, or supplies 39 provided during a period of retroactive presumptive enrollment author- 40 ized pursuant to paragraph (g) of subdivision two of this section shall 41 be deemed to have been provided to an eligible person. 42 § 4. This act shall take effect immediately.

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