N.Y. Insurance Law § 4805: Access to end of life care

§ 4805. Access to end of life care. (a) Every contract issued by an

insurer that provides coverage for hospital, surgical or medical care

that includes coverage for acute care services shall provide coverage

for an insured diagnosed with advanced cancer (with no hope of reversal

of primary disease and fewer than sixty days to live, as certified by

the patient's attending health care practitioner) for acute care

services at an acute care facility licensed pursuant to article

twenty-eight of the public health law specializing in the treatment of

terminally ill patients if the patient's attending health care

practitioner, in consultation with the medical director of the facility

determines that the insured's care would appropriately be provided by

such a facility.

(b) Notwithstanding the provisions of article forty-nine of this

chapter, if the insurer disagrees with the admission of or provision or

continuation of care for the insured by the facility, the insurer shall

initiate an expedited external appeal in accordance with the provisions

of paragraph three of subsection (b) of section four thousand nine

hundred fourteen of this chapter, provided further, that until such

decision is rendered, the admission of or provision or continuation of

the care by the facility shall not be denied by the insurer and the

insurer shall provide coverage and reimburse the facility for services

provided subject to the provisions of this section and other limitations

otherwise applicable under the insured's contract. The decision of the

external appeal agent shall be binding on all parties. If the insurer

does not initiate an expedited external appeal the insurer shall

reimburse the facility for services provided subject to the provisions

of this section and other limitations otherwise applicable under the

insured's contract.

(c) An insurer shall provide reimbursement for those services

prescribed by this section at rates negotiated between the insurer and

the facility. In the absence of agreed upon rates, an insurer shall pay

for acute care at the facility's acute care rate under the Medicare

program (Title XVIII of the federal Social Security Act), including the

Part A rate for Part A services and the Part B rate for Part B services,

and shall pay for alternate level care days at seventy-five percent of

the acute care rate, including the Part A rate for Part A services and

the Part B rate for Part B services.

(d) Payment by an insurer pursuant to this section shall be payment in

full for the services provided to the insured. An acute care facility

reimbursed pursuant to this section shall not charge or seek any

reimbursement from, or have any recourse against an insured for the

services provided by the acute care facility pursuant to this section,

except for the collection of copayments, coinsurance or visit fees, or

deductibles for which the insured is responsible under the terms of the

applicable contract.

(e) No provision of this section shall be construed to require an

insurer to provide coverage for benefits not otherwise covered under the

insured's contract.