STATE OF NEW YORK
________________________________________________________________________
5426
2019-2020 Regular Sessions
IN SENATE
April 30, 2019
___________
Introduced by Sen. HARCKHAM -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to mandating commercial
insurance coverage of peer support services as part of treatment for
substance use disorder
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 31 of subsection (i) of
2 section 3216 of the insurance law, as added by chapter 41 of the laws of
3 2014, is amended to read as follows:
4 (A) Every policy that provides medical, major medical or similar
5 comprehensive-type coverage must provide outpatient coverage for the
6 diagnosis and treatment of substance use disorder, including detoxifica-
7 tion and rehabilitation services and also including peer support
8 services provided by a certified recovery peer advocate as defined by
9 the office of alcoholism and substance abuse services. Such coverage
10 shall not apply financial requirements or treatment limitations to
11 outpatient substance use disorder benefits that are more restrictive
12 than the predominant financial requirements and treatment limitations
13 applied to substantially all medical and surgical benefits covered by
14 the policy. Further, such coverage shall be provided consistent with
15 the federal Paul Wellstone and Pete Domenici Mental Health Parity and
16 Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
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 and also including peer support
24 services provided by a certified recovery peer advocate as defined by
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11397-01-9
S. 5426 2
1 the office of alcoholism and substance abuse services. Such coverage
2 shall not apply financial requirements or treatment limitations to
3 outpatient substance use disorder benefits that are more restrictive
4 than the predominant financial requirements and treatment limitations
5 applied to substantially all medical and surgical benefits covered by
6 the policy.
7 § 3. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221
8 of the insurance law, as amended by chapter 41 of the laws of 2014, is
9 amended to read as follows:
10 (A) Every policy that provides medical, major medical or similar
11 comprehensive-type coverage must provide outpatient coverage for the
12 diagnosis and treatment of substance use disorder, including detoxifica-
13 tion and rehabilitation services and also including peer support
14 services provided by a certified recovery peer advocate as defined by
15 the office of alcoholism and substance abuse services. Such coverage
16 shall not apply financial requirements or treatment limitations to
17 outpatient substance use disorder benefits that are more restrictive
18 than the predominant financial requirements and treatment limitations
19 applied to substantially all medical and surgical benefits covered by
20 the policy. Further, such coverage shall be provided consistent with
21 the federal Paul Wellstone and Pete Domenici Mental Health Parity and
22 Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
23 § 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221
24 of the insurance law, as amended by section 16 of subpart A of part BB
25 of chapter 57 of the laws of 2019, is amended to read as follows:
26 (A) Every policy that provides medical, major medical or similar
27 comprehensive-type coverage shall provide outpatient coverage for the
28 diagnosis and treatment of substance use disorder, including detoxifica-
29 tion and rehabilitation services and also including peer support
30 services provided by a certified recovery peer advocate as defined by
31 the office of alcoholism and substance abuse services. Such coverage
32 shall not apply financial requirements or treatment limitations to
33 outpatient substance use disorder benefits that are more restrictive
34 than the predominant financial requirements and treatment limitations
35 applied to substantially all medical and surgical benefits covered by
36 the policy.
37 § 5. Paragraph 1 of subsection (l) of section 4303 of the insurance
38 law, as amended by chapter 41 of the laws of 2014, is amended to read as
39 follows:
40 (1) Every contract that provides medical, major medical or similar
41 comprehensive-type coverage must provide outpatient coverage for the
42 diagnosis and treatment of substance use disorder, including detoxifica-
43 tion and rehabilitation services and also including peer support
44 services provided by a certified recovery peer advocate as defined by
45 the office of alcoholism and substance abuse services. Such coverage
46 shall not apply financial requirements or treatment limitations to
47 outpatient substance use disorder benefits that are more restrictive
48 than the predominant financial requirements and treatment limitations
49 applied to substantially all medical and surgical benefits covered by
50 the contract. Further, such coverage shall be provided consistent with
51 the federal Paul Wellstone and Pete Domenici Mental Health Parity and
52 Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
53 § 6. Paragraph 1 of subsection (l) of section 4303 of the insurance
54 law, as amended by section 27 of subpart A of part BB of chapter 57 of
55 the laws of 2019, is amended to read as follows:
S. 5426 3
1 (1) Every contract that provides medical, major medical or similar
2 comprehensive-type coverage shall provide outpatient coverage for the
3 diagnosis and treatment of substance use disorder, including detoxifica-
4 tion and rehabilitation services and also including peer support
5 services provided by a certified recovery peer advocate as defined by
6 the office of alcoholism and substance abuse services. Such coverage
7 shall not apply financial requirements or treatment limitations to
8 outpatient substance use disorder benefits that are more restrictive
9 than the predominant financial requirements and treatment limitations
10 applied to substantially all medical and surgical benefits covered by
11 the contract.
12 § 7. This act shall take effect on the thirtieth day after it shall
13 have become a law; provided that the amendments to subparagraph (A) of
14 paragraph (31) of subsection (i) of section 3216 of the insurance law
15 made by section two of this act, the amendments to subparagraph (A) of
16 paragraph (7) of subsection (l) of section 3221 of the insurance law
17 made by section four of this act and the amendments to paragraph (1) of
18 subsection (l) of section 4303 of the insurance law made by section six
19 of this act shall take effect on the same date and in the same manner as
20 subpart A of part BB of chapter 57 of the laws of 2019, takes effect.