What's happening
This bill prohibits insurance policies from requiring preauthorization for outpatient diagnosis and treatment of substance use disorder.
Why it matters
Faster and easier access to care. By prohibiting preauthorization for outpatient substance use disorder treatment, the bill aims to remove delays and administrative barriers that can prevent or slow down access to essential services for individuals seeking help.
Reduced risk during critical moments. People with substance use disorders often need prompt intervention; eliminating preauthorization can help ensure that individuals get timely treatment during periods of crisis or high motivation, potentially reducing the risk of overdose or relapse.
Insurance parity and fairness. The bill reinforces the requirement that substance use disorder benefits cannot have more restrictive financial or treatment limitations than other medical/surgical benefits, further aligning insurance practices with federal mental health parity laws and promoting equitable treatment.
Impact on providers and system efficiency. Treatment providers may face fewer administrative burdens and can start care plans without waiting for insurer approval, streamlining service delivery and potentially improving outcomes for patients.
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Who cares
Headline styles
End Preapproval for Addiction Care
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
333
2019-2020 Regular Sessions
IN SENATE (Prefiled)
January 9, 2019
Introduced by Sen. AKSHAR -- 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 providing that coverage for outpatient diagnosis and treatment of substance use disorder shall not be subject to preauthorization
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. 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:
(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. Such coverage shall not be subject to preauthorization and 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).
§ 2. Subparagraph (A) of paragraph 7 of subsection (1) 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. Such coverage shall not be subject to preauthorization and shall not apply financial requirements or treatment limitations to outpatient substance use disorder benefits that are more
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05578-01-9
S. 333 2
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. 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. Such coverage shall not be subject to preauthorization and 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).
§ 4. This act shall take effect immediately, and shall apply to polices 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 providing that coverage for outpatient diagnosis and treatment of substance use disorder shall not be subject to preauthorization
Purpose
To amend the Insurance Law by prohibiting preauthorization for coverage of outpatient diagnosis and treatment of substance use disorder.
Summary of provisions
Sections one, two and three of this bill amends various sections of the insurance law, as amended by chapter 41 of the laws of 2014, by stating that coverage for outpatient diagnosis and treatment of substance use disorder provided by policies providing medical coverage shall not be subject to preauthorization.
Section four provides that the act shall take effect immediately after its enactment, and shall apply to policies and contracts issued, renewed, modified, altered or amended on or after such date.
Justification
The aim of this bill is to work towards removing one of the many exist- ent barriers to substance use treatment. In 2016, the Senate's Task Force on Heroin and Opioid Addiction released a report with recommenda- tions. Many of the recommendations were adopted that year, including provisions which made it easier of people to access treatment, by among other things, requiring health plan coverage, without preauthorization, of in-network inpatient treatment by OASAS certified providers. The state also adopted legislation to prohibit for the first 14 days of treatment concurrent utilization review.
This legislation builds upon those reforms, by prohibiting preauthori- zation for outpatient treatment of substance use disorder, making it easier to access treatment and maintain sobriety.
Legislative history
2018 - S.8046: Referred to Insurance
Fiscal implications
To be determined, provided savings should accrue as those ready for recovery can access outpatient care quickly and avoid the costly conse- quences of returning to abusing substances.
Effective date
This act shall take effect immediately, and shall apply to 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.