What's happening
This bill requires insurance and Medicaid to cover at least forty-five days of inpatient and outpatient substance abuse treatment.
Why it matters
Ensures longer access to treatment. By mandating a minimum of forty-five days of inpatient and outpatient substance abuse treatment, the bill addresses the gap where many insurance policies and Medicaid plans previously limited coverage to shorter periods, potentially leading to incomplete recovery and increased relapse rates.
Reduces financial barriers. The bill explicitly prohibits insurers from imposing more restrictive financial requirements or treatment limitations on substance use disorder treatment than on other medical/surgical benefits, making it less likely that cost or utilization reviews will prevent people from accessing the full course of care.
Aligns with federal parity laws. By referencing compliance with the federal Mental Health Parity and Addiction Equity Act, the legislation strengthens enforcement of equal coverage for substance use disorders, ensuring mental health and substance abuse treatment are not treated less favorably than other health conditions.
Expands Medicaid coverage. The bill applies the forty-five-day minimum both to private insurance and Medicaid, broadening access for low-income individuals who are often disproportionately affected by substance use disorders and may otherwise have limited treatment options.
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Who cares
People seeking substance use disorder treatment
The bill would require at least 45 days of inpatient and outpatient treatment coverage under the insurance and Medicaid provisions it amends.
Health insurers
Policies and contracts subject to the bill would have to provide the 45-day minimum for substance use disorder diagnosis and treatment, including detoxification and rehabilitation.
Substance use treatment providers
Inpatient facilities and outpatient providers would gain an explicit minimum coverage period for services covered by the amended provisions.
New York State Medicaid administrators
The bill would require at least 45 days of coverage for the outpatient alcoholism and substance abuse services and inpatient treatment services specified in the Medicaid amendments.
Headline styles
Guarantee 45 Days Addiction Coverage
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
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.
Guarantee 45 Days Addiction Care
In Assembly Committee · Insurance · Sponsor Billy Jones
Full text
4 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2529
2019-2020 Regular Sessions
IN SENATE
January 28, 2019
Introduced by Sen. LITTLE -- 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 social services law, in relation to requiring insurance and Medicaid coverage for inpatient and outpatient substance abuse treatment for a period of not less than forty-five days
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subparagraph (A) of paragraph 30 of subsection (i) of section 3216 of the insurance law, as amended by section 1 of part B of chapter 71 of the laws of 2016, is amended to read as follows:
(A) Every policy that provides hospital, major medical or similar comprehensive coverage must provide inpatient coverage for the diagnosis and treatment of substance use disorder, including detoxification and rehabilitation services, for a period of not less than forty-five days. Such inpatient coverage shall include unlimited medically necessary treatment for substance use disorder treatment services provided in residential settings as required by the Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a). Further, such inpatient coverage shall not apply financial requirements or treatment limitations, including utilization review requirements, to inpatient substance use disorder benefits that are more restrictive than the predominant financial requirements and treatment limitations applied to substantially all medical and surgical benefits covered by the policy. Further, such coverage shall be provided consistent with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
§ 2. Subparagraph (A) of paragraph 31 of subsection (i) of section 3216 of the insurance law, as added by chapter 41 of the laws of 2014, is amended to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02798-01-9
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(A) Every policy that provides medical, major medical or similar comprehensive-type coverage must provide outpatient coverage for the diagnosis and treatment of substance use disorder, including detoxification and rehabilitation services, for a period of not less than fortyfive days. Such coverage shall not apply financial requirements or treatment limitations to outpatient substance use disorder benefits that are more restrictive than the predominant financial requirements and treatment limitations applied to substantially all medical and surgical benefits covered by the policy. Further, such coverage shall be provided consistent with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
§ 3. Subparagraph (A) of paragraph 6 of subsection (l) of section 3221 of the insurance law, as amended by section 2 of part B of chapter 71 of the laws of 2016, is amended to read as follows:
(A) Every policy that provides hospital, major medical or similar comprehensive coverage must provide inpatient coverage for the diagnosis and treatment of substance use disorder, including detoxification and rehabilitation services, for a period of not less than forty-five days. Such inpatient coverage shall include unlimited medically necessary treatment for substance use disorder treatment services provided in residential settings as required by the Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a). Further, such inpatient coverage shall not apply financial requirements or treatment limitations, including utilization review requirements, to inpatient substance use disorder benefits that are more restrictive than the predominant financial requirements and treatment limitations applied to substantially all medical and surgical benefits covered by the policy. Further, such coverage shall be provided consistent with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
§ 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221 of the insurance law, as amended by chapter 41 of the laws of 2014, is amended to read as follows:
(A) Every policy that provides medical, major medical or similar comprehensive-type coverage must provide outpatient coverage for the diagnosis and treatment of substance use disorder, including detoxification and rehabilitation services, for a period of not less than fortyfive days. Such coverage shall not apply financial requirements or treatment limitations to outpatient substance use disorder benefits that are more restrictive than the predominant financial requirements and treatment limitations applied to substantially all medical and surgical benefits covered by the policy. Further, such coverage shall be provided consistent with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
§ 5. Paragraph 1 of subsection (k) of section 4303 of the insurance law, as amended by section 3 of part B of chapter 71 of the laws of 2016, is amended to read as follows:
(1) Every contract that provides hospital, major medical or similar comprehensive coverage must provide inpatient coverage for the diagnosis and treatment of substance use disorder, including detoxification and rehabilitation services, for a period of not less than forty-five days. Such inpatient coverage shall include unlimited medically necessary treatment for substance use disorder treatment services provided in residential settings as required by the Mental Health Parity and
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Addiction Equity Act of 2008 (29 U.S.C. § 1185a). Further, such inpatient coverage shall not apply financial requirements or treatment limitations, including utilization review requirements, to inpatient substance use disorder benefits that are more restrictive than the predominant financial requirements and treatment limitations applied to substantially all medical and surgical benefits covered by the contract. Further, such coverage shall be provided consistent with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
§ 6. Paragraph 1 of subsection (l) of section 4303 of the insurance law, as amended by chapter 41 of the laws of 2014, is amended to read as follows:
(1) Every contract that provides medical, major medical or similar comprehensive-type coverage must provide outpatient coverage for the diagnosis and treatment of substance use disorder, including detoxification and rehabilitation services, for a period not less than forty-five days. Such coverage shall not apply financial requirements or treatment limitations to outpatient substance use disorder benefits that are more restrictive than the predominant financial requirements and treatment limitations applied to substantially all medical and surgical benefits covered by the contract. Further, such coverage shall be provided consistent with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
§ 7. Paragraph (c) of subdivision 2 of section 365-a of the social services law, as amended by section 12-a of part C of chapter 60 of the laws of 2014, is amended to read as follows:
(c) out-patient hospital or clinic services in facilities operated in compliance with applicable provisions of this chapter, the public health law, the mental hygiene law and other laws, including any provisions thereof requiring an operating certificate or license, including facilities authorized by the appropriate licensing authority to provide integrated mental health services, and/or alcoholism and substance abuse services, and/or physical health services, and/or services to persons with developmental disabilities, when such services are provided at a single location or service site, or where such facilities are not conveniently accessible, in any hospital located within the state and care and services in a day treatment program operated by the department of mental hygiene or by a voluntary agency under an agreement with such department in that part of a public institution operated and approved pursuant to law as an intermediate care facility for persons with developmental disabilities; and provided, that alcoholism and substance abuse services shall be covered for a period of not less than forty-five days; and provided further, that the commissioners of health, mental health, alcoholism and substance abuse services and the office for people with developmental disabilities may issue regulations, including emergency regulations promulgated prior to October first, two thousand fifteen that are required to facilitate the establishment of integrated services clinics. Any such regulations promulgated under this paragraph shall be described in the annual report required pursuant to section forty-five-c of part A of chapter fifty-six of the laws of two thousand thirteen;
§ 8. Paragraph (n) of subdivision 2 of section 365-a of the social services law, as amended by chapter 558 of the laws of 1999, is amended to read as follows:
(n) care, treatment, maintenance and rehabilitation services that would otherwise qualify for reimbursement pursuant to this chapter to persons suffering from alcoholism in alcoholism facilities or chemical
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dependence, as such term is defined in section 1.03 of the mental hygiene law, in inpatient chemical dependence facilities, services, or programs operated in compliance with applicable provisions of this chapter and the mental hygiene law, and certified by the office of alcoholism and substance abuse services, provided however that such services shall be limited to such periods of time as may be determined necessary in accordance with a utilization review procedure established by the commissioner of the office of alcoholism and substance abuse services and that such services shall be covered for a period of not less than forty-five days, and provided further, that this paragraph shall not apply to any hospital or part of a hospital as defined in section two thousand eight hundred one of the public health law.
§ 9. This act shall take effect immediately 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 and the social services law, in relation to requiring insurance and Medicaid coverage for inpatient and outpatient substance abuse treatment for a period of not less than forty-five days
Purpose
This bill would allow patients who need detoxification and rehabili- tation services to be covered for said services for up to a forty-five day period.
Summary of provisions
Section 1 through 8 of this legislation provides inpatient and outpa- tient coverage for the diagnosis and treatment of substance use disor- der, including detoxification and rehabilitation services, for a period of not less than forty-five days.
Section 9 contains the effective date.
Justification
Patients who need diagnosis and treatment of substance use disorder often times do not get the proper treatment because they cannot afford to stay in treatment and are not covered. During the short amount of time in which patients are covered now, they are not properly rehabili- tated, thus making them fall back into the same cycle. This legislation would provide longer coverage in order to keep patients in rehabili- tation services longer and to receive the proper rehabilitation services that they need in order to recover.
Legislative history
New Bill.
Fiscal implications
To be determined.
Effective date
This act shall take effect immediately and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date.
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