Requires blanket health insurance policies to provide coverage for outpatient treatment by mental health practitioners

BILL NUMBER:S4756

Title of bill

An act to amend the insurance law, in relation to health insurance coverage of outpatient care provided by a mental health practitioner

Purpose

The purpose of this bill is to require blanket health insurance policies to provide coverage for outpatient treatment by mental health practitioners.

Summary of provisions

Section (1) would amend item (ii) of subparagraph (A) of paragraph 5 of subsection 1 of section 3221 of the insurance law to provide that a group or accident and health insurance policy which provides coverage for physician services must also provide coverage for outpatient care by a mental health counselor, marriage and family therapist, creative arts therapist or psychoanalyst licensed under article one hundred sixty three of the education law.

Section 2 would amend paragraph 1 of subsection (h) of section 4303 of the insurance law to require that a medical expense indemnity corporation or health service corporation must provide coverage for outpatient care by a mental health counselor, marriage and family therapist, creative arts therapist or psychoanalyst licensed under article one hundred sixty-three of the education law.

Section 3 states the enactment date.

Existing law

Timothy's law currently requires an insurer to provide benefits for the diagnosis and treatment of mental, nervous or emotional disorders provided by a psychiatrist, psychologist or a licensed clinical social worker.

Justification

Current law does not explicitly include mental health practitioners as allowable providers of outpatient mental health services, thereby allowing insurers to deny coverage for the valuable services these practitioners can provide.

Mental health practitioners licensed by the New York State Department of Education face strict requirements for licensure, including the requirement that they obtain a Master's degree or higher in a mental health course of study. These requirements ensure that such practitioner is fully capable of providing mental health therapy.

This bill would require insurers to reimburse mental health practitioners, in addition to psychiatrists, psychologists or licensed clinical social workers. This change will continue to serve

the intent of Timothy's Law by making needed mental health services available to more patients. It will benefit rural areas especially, where a patient may have limited access to a psychiatrist, psychologist or a licensed clinical social worker. This amendment will ensure that a patient is not denied mental health services because the currently enumerated providers are located too far from the patients home, or the patient is unable to afford the out of pocket expense of a mental health practitioner. In addition, this bill would amplify patient choice by increasing the variety and number of reimbursable providers available to treat mental health disorders.

Legislative history

This is a new bill.

Fiscal implications

None.

Effective date

This act shall take effect on the first of January next succeeding the date on which it shall have become law and shall apply to policies and contracts issued, renewed, modified, altered or amended on or after such effective date.