What's happening
This bill requires insurance policies in New York to cover substance use disorder treatment equally to other health conditions.
Why it matters
Expanding coverage for substance use disorders. ensures that insurance policies must treat substance use disorder diagnoses and treatments as equally important as physical health issues, potentially reducing financial barriers for individuals seeking help.
Parity in mental health and substance use treatment. may reduce discrimination in insurance coverage, leading to more comprehensive care and addressing longstanding gaps in access for those with addiction-related needs.
Standardizing benefits across plans. means that all group, school blanket, and similar insurance contracts in New York will need to offer consistent coverage for mental, emotional, and substance use disorders, helping to prevent confusion or denial of claims based on plan differences.
Potential for increased early intervention and treatment. could result in long-term cost savings for both individuals and the healthcare system by making it easier for people to access appropriate care before conditions worsen.
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Who cares
Headline styles
Expand Addiction Treatment Coverage
Plain English, a few words. Used as the page title.
Sponsors
Senator · Senate District 7
1 Co-sponsor
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.
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
2901
2019-2020 Regular Sessions
IN SENATE
January 30, 2019
Introduced by Sens. KAPLAN, ORTT -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
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.
LBD01624-01-9
S. 2901 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
S. 6663 of 2018/2018; Passed Senate
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.