Requires blanket health insurance policies to provide coverage for outpatient treatment by mental health practitioners (mental health counsellors, marriage and family therapists, creative arts therapists and psychoanalysts) licensed pursuant to article 163 of the education law.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A978
SPONSOR: Kellner TITLE OF BILL: An act to amend the insurance law, in relation to
health insurance coverage of outpatient care provided by a mental health
practitioner
PURPOSE OR GENERAL IDEA OF BILL: The purpose of this bill is to
require blanket health insurance policies to provide coverage for outpa-
tient treatment by mental health practitioners.
SUMMARY OF SPECIFIC PROVISIONS:
Section (1) would amend item (ii) of subparagraph (A) of paragraph 5 of
subsection 1 of section 3221 of the insurance law to provide that a
group or accident and health insurance policy which provides coverage
for physician services must also provide coverage for outpatient care by
a mental health counselor, marriage and family therapist, creative arts
therapist or psychoanalyst licensed under article one hundred sixty
three of the education law.
Section 2 would amend paragraph 1 of subsection (h) of section 4303 of
the insurance law to require that a medical expense indemnity corpo-
ration or health service corporation must provide coverage for outpa-
tient care by a mental health counselor, marriage and family therapist,
creative arts therapist or psychoanalyst licensed under article one
hundred sixty-three of the education law.
Section 3 states the enactment date.
JUSTIFICATION: Current law does not explicitly include mental health
practitioners as allowable providers of outpatient mental health
services, thereby allowing insurers to deny coverage for the valuable
services these practitioners can provide.
Mental health practitioners licensed by the New York State Department of
Education face strict requirements for licensure, including the require-
ment that they obtain a Master's degree or higher in a mental health
course o f study, These requirements ensure that such practitioner is
fully capable of providing mental health therapy.
This bill would require insurers to reimburse mental health practition-
ers, in addition to psychiatrists, psychologists or licensed clinical
social workers. This change will continue to serve the intent of
Timothy's Law by making needed mental health services available to more
patients, It will benefit rural areas especially, where a patient may
have limited access to a psychiatrist, psychologist or a licensed clin-
ical social worker. This amendment will ensure that a patient is not
denied mental health services because the currently enumerated providers
are located too far from the patients home, or the patient is unable to
afford the out of pocket expense of a mental health practitioner. In
addition, this bill would amplify patient choice by increasing the vari-
ety and number of reimbursable providers available to treat mental
health disorders.
PRIOR LEGISLATIVE HISTORY: A.9196 of 2012
FISCAL IMPLICATIONS: None.
EFFECTIVE DATE: This act shall take effect on the first of January
next succeeding the date on which it shall have become law and shall
apply to policies and contracts issued, renewed, modified, altered or
amended on or after such effective date.
STATE OF NEW YORK
________________________________________________________________________
978
2013-2014 Regular Sessions
IN ASSEMBLY(Prefiled)
January 9, 2013
___________
Introduced by M. of A. KELLNER -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law, in relation to health insurance
coverage of outpatient care provided by a mental health practitioner
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Item (ii) of subparagraph (A) of paragraph 5 of subsection
2 (1) of section 3221 of the insurance law, as amended by chapter 502 of
3 the laws of 2007, is amended to read as follows:
4 (ii) where the policy provides coverage for physician services, it
5 shall include benefits for outpatient care provided by a psychiatrist or
6 psychologist licensed to practice in this state, or a mental health
7 counselor, marriage and family therapist, creative arts therapist or
8 psychoanalyst licensed pursuant to article one hundred sixty-three of
9 the education law, or a licensed clinical social worker who meets the
10 requirements of subparagraph (D) of paragraph four of this subsection,
11 or a professional corporation or university faculty practice corporation
12 thereof. Such benefits may be limited to not less than twenty visits in
13 any contract year, plan year, or calendar year.
14 § 2. Paragraph 1 of subsection (h) of section 4303 of the insurance
15 law, as amended by chapter 502 of the laws of 2007, is amended to read
16 as follows:
17 (1) A medical expense indemnity corporation or a health service corpo-
18 ration, which provides group, group remittance or school blanket cover-
19 age for physician services, shall provide as part of its contract broad-
20 based coverage for the diagnosis and treatment of mental, nervous or
21 emotional disorders or ailments, however defined in such contract, at
22 least equal to the coverage provided for other health conditions and
23 shall include: benefits for outpatient care provided by a psychiatrist
24 or psychologist licensed to practice in this state, or a mental health
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02162-01-3
A. 978 2
1 counselor, marriage and family therapist, creative arts therapist or
2 psychoanalyst licensed pursuant to article one hundred sixty-three of
3 the education law, or a licensed clinical social worker who meets the
4 requirements of subsection (n) of this section, or a professional corpo-
5 ration or university faculty practice corporation thereof, which bene-
6 fits may be limited to not less than twenty visits in any contract year,
7 plan year or calendar year. Such coverage may be provided on a contract
8 year, plan year or calendar year basis and shall be consistent with the
9 provision of other benefits under the contract. Such coverage may be
10 subject to annual deductibles, co-pays and coinsurance as may be deemed
11 appropriate by the superintendent and shall be consistent with those
12 imposed on other benefits under the contract. In the event the group
13 remittance group or contract holder is provided coverage provided under
14 this paragraph and under subparagraph (B) of paragraph one of subsection
15 (g) of this section from the same health service corporation, or under a
16 contract which is jointly underwritten by two health service corpo-
17 rations or by a health service corporation and a medical expense indem-
18 nity corporation, the aggregate of the benefits for out-patient care
19 obtained under subparagraph (B) of paragraph one of subsection (g) of
20 this section and this paragraph may be limited to not less than twenty
21 visits in any contract year, plan year or calendar year.
22 § 3. This act shall take effect on the first of January next succeed-
23 ing the date on which it shall have become a law and shall apply to
24 policies and contracts issued, renewed, modified, altered or amended on
25 or after such effective date.
