What's happening
This bill requires New York to create an ombudsman to help resolve insurance coverage issues related to substance use disorder treatment.
Why it matters
Creates a dedicated advocate with expertise in both substance use treatment and insurance. , aiming to bridge gaps between patients, providers, and insurance companies—potentially reducing delays and denials that worsen health outcomes.
Empowers the ombudsman to directly investigate and resolve complaints from both patients and providers. about denied, delayed, or insufficient insurance coverage for substance use disorder care, including both inpatient and outpatient treatment and medication-assisted therapies.
Addresses broader systemic issues by requiring the ombudsman to report to state officials every two years. with recommendations for legal or regulatory changes, potentially influencing future policy and improving access to care.
Lays groundwork for possible future expansion. , as the ombudsman’s role could be broadened to cover wider behavioral health insurance issues if ongoing recommendations show a need—signaling a path toward more comprehensive mental health advocacy.
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Who cares
Headline styles
Create Addiction Coverage Ombudsman
Plain English, a few words. Used as the page title.
Sponsors
3 Co-sponsors
History
- Referred to alcoholism and drug abuse
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
8002
IN SENATE
March 19, 2018
Introduced by Sens. AMEDORE, HANNON, AKSHAR, JACOBS -- read twice and ordered printed, and when printed to be committed to the Committee on Alcoholism and Drug Abuse
AN ACT to amend the mental hygiene law, in relation to directing the office of alcoholism and substance abuse services to provide an ombudsman for substance use disorder insurance coverage
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 19.07 of the mental hygiene law is amended by adding a new subdivision (l) to read as follows:
(l) (1) The office shall establish, either directly or through contract, an ombudsman for substance use disorder insurance coverage. Such ombudsman shall have expertise in substance use disorder treatment and advocacy, experience with insurance coverage requirements, and such other qualifications as shall be determined by the commissioner, in consultation with the superintendent of financial services.
(2) The ombudsman for substance use disorder insurance coverage shall:
(i) identify, accept, investigate, refer and resolve complaints that are made by or on behalf of consumers relative to health insurance coverage of and access to initial and continuing substance use disorder care, including medication assisted treatment, both inpatient and outpatient;
(ii) accept, investigate, refer and resolve complaints that are made by treatment providers relative to health insurance coverage of and reimbursement for initial or continuing substance use disorder care, including medication assisted treatment, both inpatient and outpatient;
(iii) accept, investigate, refer and resolve complaints that are made by or on behalf of consumers or by providers relative to network adequacy for access to and continuing substance use disorder care, including medication assisted treatment, both inpatient and outpatient; and
(iv) make recommendations to the commissioner and the superintendent of financial services biennially beginning October first, two thousand nineteen, on regulatory and/or statutory changes necessary to ensure access to appropriate care, and such recommendations shall be shared
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD14734-02-8
S. 8002 2
with the legislature upon issuance. Such recommendations may also include whether the ombudsman role should be extended to include broader behavioral health insurance complaints and concerns.
§ 2. This act shall take effect on the ninetieth day after it shall have become a law.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the mental hygiene law, in relation to directing the office of alcoholism and substance abuse services to provide an ombudsman for substance use disorder insurance coverage
Purpose
To create a state Ombudsman for substance use disorder insurance cover- age within the Office of Alcoholism and Substance Abuse Services (OASAS) to investigate and resolve consumer and provider complaints regarding insurance coverage and reimbursement for initial or continuing substance use disorder care and network adequacy and access to care.
Summary of provisions
Section 1 of the bill amends section 19.07 of the mental hygiene law to provide that OASAS shall establish an ombudsman for substance use disor- der insurance coverage to identify, accept, investigate, refer and resolve consumer complains relative to health insurance coverage and access to substance use disorder care, including medication assisted treatment, both inpatient and outpatient. The ombudsman shall also accept, investigate refer and resolve complaints of treatment providers relative to insurance coverage, and both providers and consumers rela- tive to network adequacy for access to and continuing substance use disorder care. The legislation also directs the ombudsman to make recom- mendations to the Commissioner and Superintendent of Financial Services biennially beginning October 1, 2019 on regulatory and/or statuary changes necessary to ensure access to appropriate care, whether the roll of the ombudsman should be expanded to include broader behavioral health insurance complaints and concerns, and to share those recommendations with the legislature upon issuance.
Section 2 provides an effective date.
Justification
New York continues to be in the midst of an opioid epidemic despite added funding for prevention and treatment and many policy initiatives implemented to provide access to care and limit over prescribing of opioids. New York State took the lead in 2007 by requiring insurers to provide mental health parity and the federal government followed suit in 2008 and added the requirement that substance abuse services also be covered in parity with other health care coverage. Between 20014 and 2016 the legislature adopted and the Governor signed into law many insurance law provisions to remove additional barriers to substance abuse treatment including Chapter 41 of 2014, Chapter 371 of 2015, and Chapters 69 and 71 of 2016. These more recent changes to the law have all been in effect for more than a year, yet consumers and providers continue to come forward with complaints about accessing care.
This legislation creates an Ombudsman for Substance Use Disorder Insur- ance Coverage, within OASAS, charged with assisting consumers and providers in addressing insurance problems around substance use disor- der, including network adequacy. The legislation also directs the Ombudsman to make recommendations on regulatory and/or statutory changes necessary to ensure access to appropriate care and whether the role of
the Ombudsman should be expanded to include broader behavioral health insurance complaints and concerns.
Establishing an Ombudsman focused specifically on making sure those in need can access substance use disorder care is vitally important as we continue to fight the opioid epidemic.
Legislative history
New Bill
Fiscal implications
To be determined
Effective date
120 days after enactment
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.