What's happening
This bill requires commercial insurance policies to cover peer support services by certified recovery peer advocates for substance use disorder treatment.
Why it matters
Expands access to peer support. By requiring insurance coverage for services from certified recovery peer advocates, the bill could help more people with substance use disorder (SUD) access peer-based support, which is shown to increase engagement and retention in treatment.
Supports recovery-oriented care. Recognizing peer advocates in law helps legitimize their role and integrates lived experience into the healthcare system, potentially leading to improved outcomes and a more holistic approach to SUD recovery.
Addresses parity and equity. The bill explicitly prohibits insurers from imposing greater restrictions (like higher copays or more stringent treatment limits) on peer support services than on other medical or surgical benefits, helping ensure SUD treatment is not subject to discriminatory practices.
Could reduce stigma and barriers. Mandating coverage for peer support services may normalize their use, reduce stigma around seeking help, and lower barriers for individuals who may distrust traditional medical providers or need additional encouragement to enter or stay in treatment.
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Who cares
Commercial health insurers
The bill would require comprehensive medical policies and contracts to cover outpatient substance use disorder peer support services provided by certified recovery peer advocates.
People with substance use disorder covered by commercial insurance
They would gain coverage for certified peer support services under existing limits on financial requirements and treatment restrictions for outpatient substance use disorder benefits.
Certified recovery peer advocates
Their services would become a required covered component of outpatient substance use disorder treatment when they meet the Office of Alcoholism and Substance Abuse Services definition.
Headline styles
Require Insurance for Peer Support
Plain English, a few words. Used as the page title.
Sponsors
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.
Insurers Cover Peer Addiction Support
In Assembly Committee · Insurance · Sponsor Linda Rosenthal
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
5426
2019-2020 Regular Sessions
IN SENATE
April 30, 2019
Introduced by Sen. HARCKHAM -- 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 mandating commercial insurance coverage of peer support services as part of treatment for substance use disorder
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 and also including peer support services provided by a certified recovery peer advocate as defined by the office of alcoholism and substance abuse services. 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).
§ 2. Subparagraph (A) of paragraph 31 of subsection (i) of section 3216 of the insurance law, as amended by section 6 of subpart A of part BB of chapter 57 of the laws of 2019, is amended to read as follows:
(A) Every policy that provides medical, major medical or similar comprehensive-type coverage shall provide outpatient coverage for the diagnosis and treatment of substance use disorder, including detoxification and rehabilitation services and also including peer support services provided by a certified recovery peer advocate as defined by
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11397-01-9
S. 5426 2
the office of alcoholism and substance abuse services. 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.
§ 3. 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 and also including peer support services provided by a certified recovery peer advocate as defined by the office of alcoholism and substance abuse services. 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).
§ 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221 of the insurance law, as amended by section 16 of subpart A of part BB of chapter 57 of the laws of 2019, is amended to read as follows:
(A) Every policy that provides medical, major medical or similar comprehensive-type coverage shall provide outpatient coverage for the diagnosis and treatment of substance use disorder, including detoxification and rehabilitation services and also including peer support services provided by a certified recovery peer advocate as defined by the office of alcoholism and substance abuse services. 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.
§ 5. 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 and also including peer support services provided by a certified recovery peer advocate as defined by the office of alcoholism and substance abuse services. 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).
§ 6. Paragraph 1 of subsection (l) of section 4303 of the insurance law, as amended by section 27 of subpart A of part BB of chapter 57 of the laws of 2019, is amended to read as follows:
S. 5426 3
(1) Every contract that provides medical, major medical or similar comprehensive-type coverage shall provide outpatient coverage for the diagnosis and treatment of substance use disorder, including detoxification and rehabilitation services and also including peer support services provided by a certified recovery peer advocate as defined by the office of alcoholism and substance abuse services. 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.
§ 7. This act shall take effect on the thirtieth day after it shall have become a law; provided that the amendments to subparagraph (A) of paragraph (31) of subsection (i) of section 3216 of the insurance law made by section two of this act, the amendments to subparagraph (A) of paragraph (7) of subsection (l) of section 3221 of the insurance law made by section four of this act and the amendments to paragraph (1) of subsection (l) of section 4303 of the insurance law made by section six of this act shall take effect on the same date and in the same manner as subpart A of part BB of chapter 57 of the laws of 2019, takes effect.
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 mandating commercial insurance coverage of peer support services as part of treatment for substance use disorder
Purpose
This bill will mandate that commercial insurance coverage include peer support services as part of substance use disorder.
Summary of provisions
Section 1 amends paragraph 31 of subsection (i) of section 3216 of the insurance law, as added by chapter 41 of the laws of 2014.
Section 2 amends paragraph 31 of subsection (i) of section 3216 of the insurance law, as amended by section 6 of subpart A of part BB of chap- ter 57 of the laws of 2019.
Section 3 amends subparagraph 7 of subsection (1) of section 3221 of the insurance law, as amended by chapter 41 of the laws of 2014.
Section 4 amends subparagraph (A) of paragraph 7 of subsection (1) of section 3221 of the insurance law, as amended by section 16 of subpart A of part BB of chapter 57 of the laws of 2019.
Section 5 amends subsection (1) of section 4303 of the insurance law, as amended by chapter 41 of the laws of 2014.
Section 6 amends paragraph 1 of subsection (1) of section 4303 of the insurance law, as amended by section 27 of subpart A of part BB of chap- ter 57 of the laws of 2019.
Section 7 sets the effective date.
Justification
Peer support services has proven effective in the treatment of substance use disorder and insurance companies need to recognize the pivotal role that these services can play in treatment programs. Peer to peer coun- seling allows those dealing with substance use disorder to connect and speak to individuals who have lived through similar experiences.
This legislation would mandate that insurance companies include peer support services for the treatment of substance use disorder, therefore providing a resource that could help countless people in their battle with substance use.
Legislative history
This is a new bill.
Fiscal implications
None to the State.
Effective date
This act shall take effect on the thirtieth day after it shall have become law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.