Bill Text: NY A05834 | 2019-2020 | General Assembly | Introduced
Bill Title: Requires health insurance coverage for substance use disorder treatment services.
Spectrum: Strong Partisan Bill (Republican 15-1)
Status: (Introduced - Dead) 2020-07-14 - held for consideration in insurance [A05834 Detail]
Download: New_York-2019-A05834-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 5834 2019-2020 Regular Sessions IN ASSEMBLY February 19, 2019 ___________ Introduced by M. of A. GIGLIO, DeSTEFANO, KOLB, LAWRENCE, McDONOUGH, MIKULIN, B. MILLER, MORINELLO, RA, REILLY, SMITH, WALSH -- Multi-Spon- sored by -- M. of A. SAYEGH, TAGUE -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to requiring health insurance coverage for substance use disorder treatment services The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 30 of subsection (i) of section 3216 of the 2 insurance law, as amended by section 1 of part B of chapter 71 of the 3 laws of 2016, is amended by adding a new subparagraph (E) to read as 4 follows: 5 (E) Coverage provided under this paragraph for detoxification, shall 6 be at a minimum, seven days. Rehabilitation services shall be, at a 7 minimum, thirty days. 8 § 2. Subparagraphs (D) and (E) of paragraph 31 of subsection (i) of 9 section 3216 of the insurance law are relettered subparagraphs (E) and 10 (F) and a new subparagraph (D) is added to read as follows: 11 (D) Coverage provided under this paragraph for detoxification, shall 12 be at a minimum, seven days. Rehabilitation services shall be, at a 13 minimum, thirty days. 14 § 3. Paragraph 6 of subsection (l) of section 3221 of the insurance 15 law is amended by adding a new subparagraph (E) to read as follows: 16 (E) Coverage provided under this paragraph for detoxification, shall 17 be at a minimum, seven days. Rehabilitation services shall be, at a 18 minimum, thirty days. 19 § 4. Subparagraphs (D) and (E) of paragraph 7 of subsection (l) of 20 section 3221 of the insurance law are relettered subparagraphs (E) and 21 (F) and a new subparagraph (D) is added to read as follows: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD06860-01-9A. 5834 2 1 (D) Coverage provided under this paragraph for detoxification, shall 2 be at a minimum, seven days. Rehabilitation services shall be, at a 3 minimum, thirty days. 4 § 5. Paragraph 3 of subsection (k) of section 4303 of the insurance 5 law is renumbered paragraph 5 and a new paragraph 3 is added to read as 6 follows: 7 (3) Coverage provided under this paragraph for detoxification, shall 8 be at a minimum, seven days. Rehabilitation services shall be, at a 9 minimum, thirty days. 10 § 6. Paragraphs 3, 4 and 5 of subsection (l) of section 4303 of the 11 insurance law, paragraphs 3 and 4 as amended by chapter 41 of the laws 12 of 2014 and paragraph 5 as added by section 5 of part MM of chapter 57 13 of the laws of 2018, are amended to read as follows: 14 (3) Coverage provided under this paragraph for detoxification, shall 15 be at a minimum, seven days. Rehabilitation services shall be, at a 16 minimum, thirty days. 17 (4) Coverage provided under this subsection may be subject to annual 18 deductibles and co-insurance as deemed appropriate by the superintendent 19 and that are consistent with those imposed on other benefits within a 20 given contract. 21 [(4)] (5) A contract providing coverage for substance use disorder 22 services pursuant to this subsection shall provide up to twenty outpa- 23 tient visits per contract or calendar year to an individual who identi- 24 fies him or herself as a family member of a person suffering from 25 substance use disorder and who seeks treatment as a family member who is 26 otherwise covered by the applicable contract pursuant to this 27 subsection. The coverage required by this subsection shall include 28 treatment as a family member pursuant to such family member's own 29 contract provided such family member: 30 (A) does not exceed the allowable number of family visits provided by 31 the applicable contract pursuant to this subsection; and 32 (B) is otherwise entitled to coverage pursuant to this subsection and 33 such family member's applicable contract. 34 [(5)] (6) This paragraph shall apply to facilities in this state 35 certified by the office of alcoholism and substance abuse services for 36 the provision of outpatient, intensive outpatient, outpatient rehabili- 37 tation and opioid treatment that are participating in the corporation's 38 provider network. Coverage provided under this subsection shall not be 39 subject to preauthorization. Coverage provided under this subsection 40 shall not be subject to concurrent review for the first two weeks of 41 continuous treatment, not to exceed fourteen visits, provided the facil- 42 ity notifies the corporation of both the start of treatment and the 43 initial treatment plan within forty-eight hours. The facility shall 44 perform clinical assessment of the patient at each visit, including the 45 periodic consultation with the corporation to ensure that the facility 46 is using the evidence-based and peer reviewed clinical review tool 47 utilized by the corporation which is designated by the office of alco- 48 holism and substance abuse services and appropriate to the age of the 49 patient, to ensure that the outpatient treatment is medically necessary 50 for the patient. Any utilization review of the treatment provided under 51 this paragraph may include a review of all services provided during such 52 outpatient treatment, including all services provided during the first 53 two weeks of continuous treatment, not to exceed fourteen visits, of 54 such outpatient treatment. Provided, however, the corporation shall only 55 deny coverage for any portion of the initial two weeks of continuous 56 treatment, not to exceed fourteen visits, for outpatient treatment onA. 5834 3 1 the basis that such treatment was not medically necessary if such outpa- 2 tient treatment was contrary to the evidence-based and peer reviewed 3 clinical review tool utilized by the corporation which is designated by 4 the office of alcoholism and substance abuse services. A subscriber 5 shall not have any financial obligation to the facility for any treat- 6 ment under this paragraph other than any copayment, coinsurance, or 7 deductible otherwise required under the contract. 8 § 7. This act shall take effect on the thirtieth day after it shall 9 have become a law.