What's happening
This bill requires insurance policies in New York to provide coverage for substance use disorders equal to other health conditions.
Why it matters
Ensures parity in insurance coverage. , meaning treatment for substance use disorders must be covered at the same level as other health conditions—this can help end discriminatory limits on addiction treatment.
Expands access to care. by requiring all group and school insurance policies to include broad-based coverage for the diagnosis and treatment of substance use disorders, not just mental and emotional disorders.
Allows flexibility in who provides care. coverage must include services provided by licensed psychiatrists, psychologists, and clinical social workers, making it easier for patients to find qualified providers.
Could reduce financial barriers. for individuals seeking help for substance use disorders, increasing the likelihood that people will access needed treatment and supporting broader public health goals.
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Who cares
People with substance use disorders covered by group or school blanket plans
The bill would require specified plans covering inpatient hospital care or physician services to cover substance use disorder diagnosis and treatment at least equally to other health conditions.
Insurers and health service corporations
The bill would add substance use disorders to the conditions subject to broad-based coverage requirements in specified group and school blanket policies and contracts.
Physicians, psychiatrists and certified and registered psychologists
For policies covered by the amended reimbursement provision, insured patients would be entitled to reimbursement for substance use disorder services provided within these practitioners’ lawful scope of practice.
Headline styles
Expand Coverage for Addiction
Plain English, a few words. Used as the page title.
Sponsors
Senator · Senate District 62
3 Co-sponsors
History
- Referred to insurance
- Delivered to assembly
- Passed senateVote 62–0
- Ordered to third reading cal.1848
- Committee discharged and committed to rules
- Referred to insurance
- Returned to senate
- Died in assembly
- Referred to insurance
- Delivered to assembly
- Passed senateVote 63–0
- Ordered to third reading cal.1582
Show 1 earlier action
- Referred to rules
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Expand Substance Use Coverage
In Assembly Committee · Insurance · Sponsor Aileen Gunther
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
6663
2017-2018 Regular Sessions
IN SENATE
June 9, 2017
Introduced by Sens. ORTT, AMEDORE -- read twice and ordered printed, and when printed to be committed to the Committee on Rules
AN ACT to amend the insurance law, in relation to substance use disorder coverage
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. The opening paragraph of subparagraph (A) of paragraph 5 of subsection (1) of section 3221 of the insurance law, as amended by chapter 502 of the laws of 2007, is amended to read as follows:
Every insurer delivering a group or school blanket policy or issuing a group or school blanket policy for delivery, in this state, which provides coverage for inpatient hospital care or coverage for physician services shall provide as part of such policy broad-based coverage for the diagnosis and treatment of mental, nervous [or], emotional, or substance use disorders or ailments, however defined in such policy, at least equal to the coverage provided for other health conditions and:
§ 2. The opening paragraph of subsection (g) of section 4303 of the insurance law, as amended by chapter 502 of the laws of 2007, is amended to read as follows:
A hospital service corporation or a health service corporation, which provides group, group remittance or school blanket coverage for inpatient hospital care, shall provide as part of its contract broad-based coverage for the diagnosis and treatment of mental, nervous [or], emotional, or substance use disorders or ailments, however defined in such contract, at least equal to the coverage provided for other health conditions and shall include:
§ 3. Paragraph 1 of subsection (h) of section 4303 of the insurance law, as amended by chapter 502 of the laws of 2007, is amended to read as follows:
(1) A medical expense indemnity corporation or a health service corporation, which provides group, group remittance or school blanket cover-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13169-01-7
S. 6663 2
age for physician services, shall provide as part of its contract broadbased coverage for the diagnosis and treatment of mental, nervous [or], emotional, or substance use disorders or ailments, however defined in such contract, at least equal to the coverage provided for other health conditions and shall include: benefits for outpatient care provided by a psychiatrist or psychologist licensed to practice in this state, a licensed clinical social worker who meets the requirements of subsection (n) of this section, or a professional corporation or university faculty practice corporation thereof, which benefits may be limited to not less than twenty visits in any contract year, plan year or calendar year. Such coverage may be provided on a contract year, plan year or calendar year basis and shall be consistent with the provision of other benefits under the contract. Such coverage may be subject to annual deductibles, co-pays and coinsurance as may be deemed appropriate by the superintendent and shall be consistent with those imposed on other benefits under the contract. In the event the group remittance group or contract holder is provided coverage provided under this paragraph and under subparagraph (B) of paragraph one of subsection (g) of this section from the same health service corporation, or under a contract which is jointly underwritten by two health service corporations or by a health service corporation and a medical expense indemnity corporation, the aggregate of the benefits for out-patient care obtained under subparagraph (B) of paragraph one of subsection (g) of this section and this paragraph may be limited to not less than twenty visits in any contract year, plan year or calendar year.
§ 4. Paragraph 4 of subsection (i) of section 3216 of the insurance law is amended to read as follows:
(4) If a policy provides for reimbursement for psychiatric or psychological services or for diagnosis and treatment of mental, nervous, [or] emotional, or substance use disorders or ailments, however defined in the policy, the insured shall be entitled to reimbursement for such services, diagnosis or treatment whether performed by a physician, psychiatrist or a certified and registered psychologist, when the services rendered are within the lawful scope of their practice.
§ 5. This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to substance use disorder coverage
Purpose or general idea of bill
This bill would amend the insurance law to align state law with current federal law on substance use disorders.
Summary of specific provisions
Section 1 would amend subparagraph (a) of paragraph 5 of subsection (1) of section 3221 of the insurance law to require every policy that provides coverage for hospital, surgical, or medical care to provide coverage for substance use disorder treatment and services.
Section 2 would amend subsection (g) of section 4303 of the insurance law to require every medical expense indemnity corporation, hospital service corporation or health service corporation that provides coverage for hospital, surgical or medical care to provide coverage for substance use disorder treatment and services.
Section 3 would amend subsection (h) of section 4303 of the insurance law to require every medical expense indemnity corporation, hospital service corporation or health service corporation that provides coverage for hospital, surgical or medical care to provide coverage for substance use disorder treatment and services.
Section 4 would amend paragraph 4 of subsection (i) of section 3216 of the insurance law to require every policy that provides coverage for hospital, surgical, or medical care to provide coverage for substance use disorder treatment and services.
Justification
Ensuring New Yorkers have access to care and treatment for mental illness and substance abuse disorders is critical and is the reason New York enacted one of the strongest mental health parity laws in the nation (Timothy's Law) in 2006 and made it permanent in 2009.
Unfortunately, at the time of enactment substance use disorders were not included in this landmark legislation. In 2008 Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). This bill prevents group health plans and health insurers that provide mental health or substance use disorder benefits from providing less coverage for behavioral health services than for general medical or surgical services.
This bill seeks to ensure that coverage for equal insurance coverage for substance use disorder treatment and recovery services by adding "substance use disorder" to the parity provisions of the insurance law.
Prior legislative history
New Bill.
Fiscal implications
To be determined.
Effective date
This act shall effect on the first of January next succeeding the date on which it shall have become a law and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.