Bill Text: NY S08466 | 2023-2024 | General Assembly | Introduced
Bill Title: Provides for a minimum reimbursement rate for ambulatory behavioral health services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-02-01 - REFERRED TO INSURANCE [S08466 Detail]
Download: New_York-2023-S08466-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 8466 IN SENATE February 1, 2024 ___________ Introduced by Sen. BRESLIN -- 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 public health law, in relation to setting a minimum reimbursement rate for ambulatory behavioral health services The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 35 of subsection (i) of section 3216 of the 2 insurance law is amended by adding a new subparagraph (K) to read as 3 follows: 4 (K) Every policy which provides medical, major medical, or similar 5 comprehensive-type coverage shall reimburse in network, participating 6 providers licensed pursuant to article twenty-eight of the public health 7 law or article thirty-one or thirty-two of the mental hygiene law for 8 ambulatory behavioral health services provided to its insureds, at a 9 minimum, at a rate equivalent to the payments established for such 10 services under the ambulatory patient group (APG) rate-setting methodol- 11 ogy at the time of service, utilized by the department of health or by 12 the office of mental health or offices of addiction services and 13 supports for rate-setting purposes for ambulatory behavioral health 14 services provided to enrollees in the medical assistance program under 15 title eleven of article five of the social services law. Insurers and in 16 network, participating providers may negotiate different rates and meth- 17 ods of payments, however insurers shall pay no less than the equivalent 18 of rates that would be paid for ambulatory behavioral health services 19 pursuant to the medical assistance program under title eleven of article 20 five of the social services law. 21 § 2. Paragraph 5 of subsection (l) of section 3221 of the insurance 22 law is amended by adding a new subparagraph (K) to read as follows: 23 (K) Every insurer delivering a group or blanket policy or issuing a 24 group or blanket policy for delivery in this state that provides cover- 25 age for hospital, major medical, or similar comprehensive-type 26 coverage shall reimburse in network, participating providers licensed 27 pursuant to article twenty-eight of the public health law or article EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD13904-01-3S. 8466 2 1 thirty-one or thirty-two of the mental hygiene law for ambulatory behav- 2 ioral health services provided to its insureds, at a minimum, at a rate 3 equivalent to the payments established for such services under the ambu- 4 latory patient group (APG) rate-setting methodology at the time of 5 service, utilized by the department of health or by the office of mental 6 health or offices of addiction services and supports for rate-setting 7 purposes for ambulatory behavioral health services provided to enrollees 8 in the medical assistance program under title eleven of article five of 9 the social services law. Insurers and in network, participating provid- 10 ers may negotiate different rates and methods of payments, however 11 insurers shall pay no less than the equivalent of rates that would be 12 paid for ambulatory behavioral health services pursuant to the medical 13 assistance program under title eleven of article five of the social 14 services law. 15 § 3. Subsection (g) of section 4303 of the insurance law is amended by 16 adding a new paragraph 12 to read as follows: 17 (12) A medical expense indemnity corporation, a hospital service 18 corporation or a health service corporation that provides coverage for 19 medical, major medical, or similar comprehensive-type coverage shall 20 reimburse in network, participating providers licensed pursuant to arti- 21 cle twenty-eight of the public health law or article thirty-one or thir- 22 ty-two of the mental hygiene law for ambulatory behavioral health 23 services provided to its insureds, at a minimum, at a rate equivalent to 24 the payments established for such services under the ambulatory patient 25 group (APG) rate-setting methodology at the time of service, utilized by 26 the department of health or by the office of mental health or offices of 27 addiction services and supports for rate-setting purposes for ambulatory 28 behavioral health services provided to enrollees in the medical assist- 29 ance program under title eleven of article five of the social services 30 law. Insurers and in network, participating providers may negotiate 31 different rates and methods of payments, however insurers shall pay no 32 less than the equivalent of rates that would be paid for ambulatory 33 behavioral health services pursuant to the medical assistance program 34 under title eleven of article five of the social services law. 35 § 4. Section 4403 of the public health law is amended by adding a new 36 subdivision 10 to read as follows: 37 10. A health maintenance organization shall reimburse in network, 38 participating providers licensed pursuant to article twenty-eight of 39 this chapter or article thirty-one or thirty-two of the mental hygiene 40 law for ambulatory behavioral health services provided to its enrollees, 41 at a minimum, at a rate equivalent to the payments established for such 42 services under the ambulatory patient group (APG) rate-setting methodol- 43 ogy at the time of service, utilized by the department or by the office 44 of mental health or offices of addiction services and supports for rate- 45 setting purposes for ambulatory behavioral health services provided to 46 enrollees in the medical assistance program under title eleven of arti- 47 cle five of the social services law. Organizations and in network, 48 participating providers may negotiate different rates and methods of 49 payments, however organizations shall pay no less than the equivalent of 50 rates that would be paid for ambulatory behavioral health services 51 pursuant to the medical assistance program under title eleven of article 52 five of the social services law. 53 § 5. This act shall take effect September 1, 2024 and shall apply to 54 all policies and contracts issued, renewed, modified, altered or amended 55 on or after such date.
