What's happening
This bill prohibits health insurance companies from requiring behavioral health providers to participate in all their insurance products, allowing providers to choose specific plans.
Why it matters
Expands provider autonomy. The bill empowers behavioral health providers by letting them choose which specific insurance products (plans) they participate in, rather than forcing them to accept all plans from an insurer or managed care provider. This could help providers tailor their patient mix and administrative load.
May improve provider network stability. By eliminating “all-or-nothing” participation requirements, the law could encourage more behavioral health providers to join insurance networks, potentially increasing patient access to in-network behavioral health care.
Targets mental health parity and specialization. The bill specifically defines “behavioral health services” to include both inpatient and outpatient care by providers licensed under mental hygiene and public health laws, emphasizing mental health and substance use treatment. This recognition may help address ongoing gaps in mental health coverage.
Could influence insurance plan design and negotiations. Insurers might need to negotiate individual contracts for each of their products with behavioral health providers, potentially increasing administrative complexity for insurers but granting providers more negotiating leverage and flexibility.
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Who cares
Headline styles
Let Therapists Pick Plans
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Referred to health
- Referred to health
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.
Let Therapists Pick Insurance Plans
In Assembly Committee · Ways And Means · Sponsor Kevin Cahill
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3963
2019-2020 Regular Sessions
IN SENATE
February 22, 2019
Introduced by Sens. RIVERA, ORTT -- read twice and ordered printed, and when printed to be committed to the Committee on Health
AN ACT to amend the social services law, the public health law and the insurance law, in relation to prohibiting a provider of health care coverage from requiring providers of behavioral health services to offer all products offered by the provider of health care coverage
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 365-m of the social services law is amended by adding a new subdivision 6 to read as follows:
6. (a) No managed care provider under section three hundred sixtyfour-j of this title shall by contract or written policy or procedure, require a behavioral health services provider to participate in the in-network portion of any product offered by such managed care provider, other than products under such section. Behavioral health services providers shall have the right to select by execution of a separate agreement the products of such managed care provider in which the provider agrees to participate in the in-network portion.
(b) As used in this subdivision, "behavioral health services" means inpatient and outpatient behavioral health services provided by those licensed or certified pursuant to article thirty-one or thirty-two of the mental hygiene law, or programs that are licensed pursuant to both article thirty-one of the mental hygiene law and article twenty-eight of the public health law, or certified under both article thirty-two of the mental hygiene law and article twenty-eight of the public health law.
§ 2. Section 2511 of the public health law is amended by adding a new subdivision 22 to read as follows:
22. (a) No approved organization shall by contract or written policy or procedure, require a behavioral health services provider to participate in the in-network portion of any product offered by such organization, other than products under this title. Behavioral health services providers shall have the right to select by execution of a separate agreement the products of such approved organization in which the provider agrees to participate in the in-network portion.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00070-01-9
S. 3963 2
(b) As used in this subdivision, "behavioral health services" means inpatient and outpatient behavioral health services provided by those licensed or certified pursuant to article thirty-one or thirty-two of the mental hygiene law, or programs that are licensed pursuant to both article thirty-one of the mental hygiene law and article twenty-eight of this chapter, or certified under both article thirty-two of the mental hygiene law and article twenty-eight of this chapter.
§ 3. Section 4406-c of the public health law is amended by adding a new subdivision 10 to read as follows:
10. (a) No health care plan licensed pursuant to this article shall by contract or written policy or procedure, require a behavioral health services provider to participate in the in-network portion of any product offered by such plan. Behavioral health services providers shall have the right to select by execution of a separate agreement the products of such plan in which the provider agrees to participate in the in-network portion.
(b) As used in this subdivision, "behavioral health services" means inpatient and outpatient behavioral health services provided by those licensed or certified pursuant to article thirty-one or thirty-two of the mental hygiene law, or programs that are licensed pursuant to both article thirty-one of the mental hygiene law and article twenty-eight of this chapter, or certified under both article thirty-two of the mental hygiene law and article twenty-eight of this chapter.
§ 4. Section 3217-b of the insurance law is amended by adding a new subsection (l) to read as follows:
(l) (1) No insurer subject to the provisions of this article shall by contract, written policy or procedure, require a behavioral health services provider to participate in the in-network portion of any product offered by such insurer. Behavioral health services providers shall have the right to select by execution of a separate agreement the products of such insurers in which the provider agrees to participate in the in-network portion.
(2) As used in this subsection, "behavioral health services" means inpatient and outpatient behavioral health services provided by those licensed or certified pursuant to article thirty-one or thirty-two of the mental hygiene law, or programs that are licensed pursuant to both article thirty-one of the mental hygiene law and article twenty-eight of the public health law, or certified under both article thirty-two of the mental hygiene law and article twenty-eight of the public health law.
§ 5. Section 4325 of the insurance law is amended by adding a new subsection (m) to read as follows:
(m) (1) No corporation organized pursuant to this article shall by contract, written policy or procedure, require a behavioral health services provider to participate in the in-network portion of any product offered by such corporation. Behavioral health services providers shall have the right to select by execution of a separate agreement the products of such corporation in which the provider agrees to participate in the in-network portion.
(2) As used in this subsection, "behavioral health services" means inpatient and outpatient behavioral health services provided by those licensed or certified pursuant to article thirty-one or thirty-two of the mental hygiene law, or programs that are licensed pursuant to both article thirty-one of the mental hygiene law and article twenty-eight of the public health law, or certified under both article thirty-two of the mental hygiene law and article twenty-eight of the public health law.
§ 6. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the social services law, the public health law and the insurance law, in relation to prohibiting a provider of health care coverage from requiring providers of behavioral health services to offer all products offered by the provider of health care coverage
Purpose
To assure that behavioral health providers are permitted to select by execution of separate agreements the products that the provider will participate in with health care plans and health insurers.
Summary of provisions
Section one of the bill would amend Social Services law § 365-m to require Medicaid managed care plans to execute separate contracts with behavioral healthcare providers to provide coverage to Medicaid enrol- lees rather than rely upon previously-executed contracts.
Read the full memo (687 words)
Sections two through five make corresponding changes to Public Health Law § 2511 for child health plus plans and Public Health Law § 4406-c and Insurance Law §§ 3217-b and 4325, respectively for other health care plans and health insurers.
Section six provides that this act shall take effect immediately.
Justification
Beginning in the summer of 2015, mental health and substance abuse clients and the providers who serve them will be moving out of Medicaid fee-for-service and into a managed care environment. Providers will be paid by managed care organizations (MCOs) for Medicaid clients pursuant to rates and terms defined in contracts with MCOs.
Health insurance plans often include an All Products clause (APC) in their contracts with providers. The APC requires the provider to take all current and future product lines brought to them by the plans. If the provider does not agree to take all products - including those that do not include fair terms or adequately reimburse for their cost of services, then the provider cannot participate in the network for any of the insurance product lines. This would apply to products that serve Medicaid beneficiaries as well as patients enrolled in commercial, the Health Insurance Exchange and employer plans. The result could be a very serious access to care crisis in the public mental health and substance abuse services system - the front line providers for people with serious mental illness and those struggling with very serious substance abuse, opioid, heroin and other addictions.
A State Office of Mental Health study conducted in 2012 revealed that approximately 40% of these providers are in significant financial distress. This is due in part to the fact that in the behavioral health system, commercial rates are paid at between 1/4 and 1/3 the rate currently paid for Medicaid fee for service. When this population is moved in managed care and all rates are able to be set by the plans at these disparately low levels through the use of APCs, providers would be in the untenable position of either discontinuing existing relationships with clients or accepting rates that are well below their costs for providing services.
The All Products clause disrupts existing relationships between clini- cians and clients, and threatens continued access to care in a service system already overloaded with long waiting lists, workforce shortages and abysmal commercial rates. Seven states across the country have already banned the use of the APC in contracts between MCOs and certain providers. Attorneys General across the country as well as court deci- sions have prohibited plans from using the APC in contracts in instances where doing so has been deemed an unfair business practice to gain market share and deny competition that would otherwise occur.
This legislation would take a similar action by prohibiting the use of the All Products clause in contracts between behavioral health providers and MCOs and other health insurance plans This is essential to assure continued access to care and continuity of care for our most vulnerable citizens who utilize the public mental health and substance abuse system. Doing so is also critical to ensuring a smooth transition of behavioral health clients into Medicaid managed care by giving the providers an opportunity to negotiate reasonable contracts with the plans for the clients they serve.
Legislative history
New Bill
Fiscal implications
None.
Effective date
This act shall take immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.