Requires insurance companies to provide at least ninety days of rehabilitation services to an insured upon a doctor's prescription

Section 2 amends § 3221(1)(6) of the Insurance Law to provide that group or blanket accident and health insurance policies providing medical coverage for the diagnosis and treatment of substance use disorder shall include coverage for at least ninety days at an inpatient rehabilitation facility when prescribed by a doctor.

Section 3 amends § 4303(k) of the Insurance Law to provide that every contract issued by a hospital service corporation or health service corporation which provides coverage for in-patient hospital care shall also provide coverage for the diagnosis and treatment of substance use disorder shall include coverage for at least ninety days at a rehabilitation facility when prescribed by a doctor.

Section 4 provides the effective date.

Existing law

Section 3216 of the Insurance Law relates to individual accident and health insurance policy provisions. Paragraph 30 of subsection (i) of this section provides, every policy that provides medical, major medical, or similar comprehensive-type coverage must provide inpatient coverage for the diagnosis and treatment of substance abuse disorder, including detoxification and rehabilitation services.

Section 3221 of the Insurance Law relates to group or blanket accident and health insurance policies. Paragraph (6) of subsection (1) of this section provides, every policy that provides medical, major medical, or similar comprehensive-type coverage must provide inpatient coverage for the diagnosis and treatment of substance abuse disorder, including detoxification and rehabilitation services.

Section 4303 of the Insurance Law relates to contracts issued by a hospital service corporation or health service corporation. Subsection (k) of this section provides, every policy that provides medical, major medical, or similar comprehensive-type coverage must provide inpatient coverage for the diagnosis and treatment of substance abuse disorder, including detoxification and rehabilitation services.

Justification

Heroin use has increased significantly across the United States and in New York among all demographics, including gender, age, and income level. All communities are susceptible to heroin or prescription opioid addiction and the use or misuse of these drugs is a problem in rural, suburban and urban communities across our state. Public awareness and community involvement are key factors in addressing this problem. But the expansion of access to effective treatments for those who are addicted is paramount in preventing the continued development of heroin and opioid addiction. By legislatively requiring insurance coverage for at least ninety days of inpatient rehabilitation services for substance abuse disorders upon a doctor's prescription, New York promotes public health in every community and makes a serious effort in reversing the national trend toward increased heroin and opioid use.

The Centers for Disease Control reports that the greatest increases in heroin and opioid use have occurred in groups with historically lower rates of heroin use, including women and people with private insurance and higher incomes. In its most recent report the CDC found that nearly all individuals using heroin also use or misuse other substances, but the strongest risk factor for heroin use disorder is a prescription opioid use disorder. Increased use has also lead to increased deaths associated to heroin overdose. Heroin-related deaths increased a dramatic 39% between 2012 and 2013, while the rate of heroin-related overdose deaths nearly quadrupled over the past decade.

Increased use of naloxone, or Narcan, the antidote used to reverse overdoses, has had an acute effect on saving lives from heroin overdose. But reversing overdoses is insufficient in combating and overcoming the heroin problem in New York State. Connecting overdose victims and those individuals struggling with prescription drug and heroin use disorders to treatment facilities is vital to the success of correcting heroin addiction in our state. Ensuring that insurance providers actually provide a minimum of 90 days of substance abuse inpatient rehabilitation services pursuant to a doctor's order is an integral component to making the connection between victims and users and treatment facilities effective and successful. For all of the aforementioned reasons it is imperative that this legislation is enacted.

Legislative history

New bill.

Fiscal implications

To be determined.

Effective date

This act shall take effect ninety days after is shall become law.