STATE OF NEW YORK
        ________________________________________________________________________

                                           498

                               2023-2024 Regular Sessions

                    IN SENATE

                                     January 4, 2023
                                       ___________

        Introduced  by  Sen.  STEC  --  read twice and ordered printed, and when
          printed to be committed to the Committee on Insurance

        AN ACT to amend the insurance  law  and  the  social  services  law,  in
          relation  to  requiring  insurance and Medicaid coverage for inpatient
          and outpatient substance abuse treatment for a period of not less than
          forty-five days

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

     1    Section  1.  Subparagraph  (A)  of  paragraph  30 of subsection (i) of
     2  section 3216 of the insurance law, as amended by section 5 of subpart  A
     3  of  part  BB  of  chapter  57 of the laws of 2019, is amended to read as
     4  follows:
     5    (A) Every policy that provides  hospital,  major  medical  or  similar
     6  comprehensive  coverage shall provide inpatient coverage for the diagno-
     7  sis and treatment of substance use  disorder,  including  detoxification
     8  and  rehabilitation  services,  for a period of not less than forty-five
     9  days. Such inpatient coverage shall include unlimited  medically  neces-
    10  sary treatment for substance use disorder treatment services provided in
    11  residential  settings.  Further, such inpatient coverage shall not apply
    12  financial requirements or treatment limitations,  including  utilization
    13  review  requirements,  to inpatient substance use disorder benefits that
    14  are more restrictive than the  predominant  financial  requirements  and
    15  treatment  limitations applied to substantially all medical and surgical
    16  benefits covered by the policy.
    17    § 2. Subparagraph (A) of paragraph 31 of  subsection  (i)  of  section
    18  3216  of the insurance law, as amended by section 6 of subpart A of part
    19  BB of chapter 57 of the laws of 2019, is amended to read as follows:
    20    (A) Every policy that  provides  medical,  major  medical  or  similar
    21  comprehensive-type  coverage  shall  provide outpatient coverage for the
    22  diagnosis and treatment of substance use disorder, including detoxifica-
    23  tion and rehabilitation services, for a period of not less  than  forty-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02918-01-3

        S. 498                              2

     1  five  days.  Such  coverage  shall  not  apply financial requirements or
     2  treatment limitations to outpatient substance use disorder benefits that
     3  are more restrictive than the  predominant  financial  requirements  and
     4  treatment  limitations applied to substantially all medical and surgical
     5  benefits covered by the policy.
     6    § 3. Subparagraph (A) of paragraph 6 of subsection (l) of section 3221
     7  of the insurance law, as amended by section 15 of subpart A of  part  BB
     8  of chapter 57 of the laws of 2019, is amended to read as follows:
     9    (A)  Every  policy  that  provides  hospital, major medical or similar
    10  comprehensive coverage shall provide inpatient coverage for the  diagno-
    11  sis  and  treatment  of substance use disorder, including detoxification
    12  and rehabilitation services, for a period of not  less  than  forty-five
    13  days.  Such  inpatient coverage shall include unlimited medically neces-
    14  sary treatment for substance use disorder treatment services provided in
    15  residential settings. Further, such inpatient coverage shall  not  apply
    16  financial  requirements  or treatment limitations, including utilization
    17  review requirements, to inpatient substance use disorder  benefits  that
    18  are  more  restrictive  than  the predominant financial requirements and
    19  treatment limitations applied to substantially all medical and  surgical
    20  benefits covered by the policy.
    21    § 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221
    22  of  the  insurance law, as amended by section 16 of subpart A of part BB
    23  of chapter 57 of the laws of 2019, is amended to read as follows:
    24    (A) Every policy that  provides  medical,  major  medical  or  similar
    25  comprehensive-type  coverage  shall  provide outpatient coverage for the
    26  diagnosis and treatment of substance use disorder, including detoxifica-
    27  tion and rehabilitation services, for a period of not less  than  forty-
    28  five  days.  Such  coverage  shall  not  apply financial requirements or
    29  treatment limitations to outpatient substance use disorder benefits that
    30  are more restrictive than the  predominant  financial  requirements  and
    31  treatment  limitations applied to substantially all medical and surgical
    32  benefits covered by the policy.
    33    § 5. Paragraph 1 of subsection (k) of section 4303  of  the  insurance
    34  law,  as  amended by section 26 of subpart A of part BB of chapter 57 of
    35  the laws of 2019, is amended to read as follows:
    36    (1) Every contract that provides hospital, major  medical  or  similar
    37  comprehensive  coverage shall provide inpatient coverage for the diagno-
    38  sis and treatment of substance use  disorder,  including  detoxification
    39  and  rehabilitation  services,  for a period of not less than forty-five
    40  days. Such inpatient coverage shall include unlimited  medically  neces-
    41  sary treatment for substance use disorder treatment services provided in
    42  residential  settings.  Further, such inpatient coverage shall not apply
    43  financial requirements or treatment limitations,  including  utilization
    44  review  requirements,  to inpatient substance use disorder benefits that
    45  are more restrictive than the  predominant  financial  requirements  and
    46  treatment  limitations applied to substantially all medical and surgical
    47  benefits covered by the contract.
    48    § 6. Paragraph 1 of subsection (l) of section 4303  of  the  insurance
    49  law,  as  amended by section 27 of subpart A of part BB of chapter 57 of
    50  the laws of 2019, is amended to read as follows:
    51    (1) Every contract that provides medical,  major  medical  or  similar
    52  comprehensive-type  coverage  shall  provide outpatient coverage for the
    53  diagnosis and treatment of substance use disorder, including detoxifica-
    54  tion and rehabilitation services, for a period of not less  than  forty-
    55  five  days.  Such  coverage  shall  not  apply financial requirements or
    56  treatment limitations to outpatient substance use disorder benefits that

        S. 498                              3

     1  are more restrictive than the  predominant  financial  requirements  and
     2  treatment  limitations applied to substantially all medical and surgical
     3  benefits covered by the contract.
     4    §  7.  Paragraph  (c)  of subdivision 2 of section 365-a of the social
     5  services law, as amended by section 12-a of part C of chapter 60 of  the
     6  laws of 2014, is amended to read as follows:
     7    (c)  out-patient hospital or clinic services in facilities operated in
     8  compliance with applicable provisions of this chapter, the public health
     9  law, the mental hygiene law and other  laws,  including  any  provisions
    10  thereof requiring an operating certificate or license, including facili-
    11  ties  authorized by the appropriate licensing authority to provide inte-
    12  grated mental health services, and/or  alcoholism  and  substance  abuse
    13  services,  and/or  physical  health services, and/or services to persons
    14  with developmental disabilities, when such services are  provided  at  a
    15  single  location  or  service  site,  or  where  such facilities are not
    16  conveniently accessible, in any hospital located within  the  state  and
    17  care  and services in a day treatment program operated by the department
    18  of mental hygiene or by a voluntary agency under an agreement with  such
    19  department  in  that  part of a public institution operated and approved
    20  pursuant to law as an intermediate care facility for persons with devel-
    21  opmental disabilities; and provided, that alcoholism and substance abuse
    22  services shall be covered for a period of not less than forty-five days;
    23  and provided further, that the commissioners of health,  mental  health,
    24  alcoholism  and  substance abuse services and the office for people with
    25  developmental disabilities may issue  regulations,  including  emergency
    26  regulations  promulgated  prior  to  October first, two thousand fifteen
    27  that are required to facilitate the establishment of integrated services
    28  clinics. Any such regulations promulgated under this paragraph shall  be
    29  described in the annual report required pursuant to section forty-five-c
    30  of part A of chapter fifty-six of the laws of two thousand thirteen;
    31    §  8.  Paragraph  (n)  of subdivision 2 of section 365-a of the social
    32  services law, as amended by chapter 558 of the laws of 1999, is  amended
    33  to read as follows:
    34    (n)  care,  treatment,  maintenance  and  rehabilitation services that
    35  would otherwise qualify for reimbursement pursuant to  this  chapter  to
    36  persons  suffering  from alcoholism in alcoholism facilities or chemical
    37  dependence, as such term is  defined  in  section  1.03  of  the  mental
    38  hygiene  law,  in inpatient chemical dependence facilities, services, or
    39  programs operated in compliance with applicable provisions of this chap-
    40  ter and the mental hygiene law, and certified by the office of  alcohol-
    41  ism  and  substance  abuse services, provided however that such services
    42  shall be limited to such periods of time as may be determined  necessary
    43  in  accordance  with  a  utilization review procedure established by the
    44  commissioner of the office of alcoholism and  substance  abuse  services
    45  and  that  such  services shall be covered for a period of not less than
    46  forty-five days, and provided further, that  this  paragraph  shall  not
    47  apply  to  any  hospital or part of a hospital as defined in section two
    48  thousand eight hundred one of the public health law.
    49    § 9. This act shall take effect immediately and  shall  apply  to  all
    50  policies  and contracts issued, renewed, modified, altered or amended on
    51  or after such date.