NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A4440
SPONSOR: Hyer-Spencer (MS) TITLE OF BILL: An act to amend the insurance law and the executive
law, in relation to enacting the "fair insurance treatment act of 2009"
PURPOSE:
To enact the "Fair Insurance Treatment Act of 2008" to require health
Insurers to provide coverage for mental illness and chemical dependence.
SUMMARY OF PROVISIONS:
Section 1 is the short title, "Fair Insurance Treatment Act of 2008".
Section 2 is the legislative findings and intent.
Section 3 ensures that all policies delivered or issued for delivery
which provide coverage for medical or hospital care must provide cover-
age for mental, nervous or emotional disorders or ailments of alcohol-
ism, alcohol abuse, substance abuse, substance dependence or chemical
dependence and shall not impose greater limitations on such coverage
than for physical health benefits.
Section 4 amends the intent of §3217 of the Insurance Law which sets
minimum standards for accident and health insurance policies and this
would require the Commissioner of Mental Health and the Commissioner of
the Office of Alcohol and substance Abuse Services to certify provisions
contrary to the mental health, and substance abuse and chemical depend-
ency needs of the public, respectively.
Section 5 mandates all group policies or group policies for delivery
must provide coverage for the diagnosis and treatment of mental, nervous
or emotional disorders or ailments on a basis that is at least equal to
the coverage provided for other health conditions and shall include
in-patient or outpatient services. Annual deductibles and coinsurance
for such coverage must also be consistent with those imposed on other
benefits. It also mandates all group or school blanket policy or insur-
ers issuing a group or school blanket policy for delivery must provide
coverage for diagnosis and treatment of chemical abuse and chemical
dependence detoxification and rehabilitation and shall include inpatient
hospital or detoxification facility,detoxification or rehabilitation
services. Annual deductibles and coinsurance for such coverage must be
consistent with those imposed on other benefits. In addition, this
requires insurers delivering a group or school blanket policy or issuing
a group or school blanket policy for delivery which provides in-patient
care must provide unlimited outpatient care for the diagnosis and treat-
ment of chemical dependence.
Section 6 makes equal provisions with regard to hospital service corpo-
rations, health service corporations and medical expense indemnity
corporations.
Section 7 prevents stop-loss coverage to any insurer which imposes cost-
sharing obligations relating to a specific disease or condition incon-
sistent with the provisions of this bill.
Section 8 eliminates the maximum coverage to be provided for the inpa-
tient or outpatient treatment of mental, nervous or emotional disorders
or ailments of alcoholism and alcohol abuse and substance abuse and
chemical dependence.
Section 9 classifies the limitation of health care coverage for. specif-
ic diseases or conditions to a specific number of days, dollar amount,
lifetime dollar amount, or the imposition of cost-sharing obligations
for such coverage .as discriminatory practice, unless it is consistent
with other health care services provided.
JUSTIFICATION:
Under present law, health insurance contracts may deny coverage for the
diagnosis and treatment of mental, nervous or emotional disorders, may
place a limit on the number of days or visits permitted or may require
different deductibles, coinsurance or copayrnents for treatment Health
insurance contracts are currently required to partially cover substance
abuse treatment while there is no mandated insurance coverage of
substance abuse rehabilitation. This bill mandates equal insurance
coverage for mental health and substance abuse services as provided for
other health services covered. Therefore, this creates equal coverage
for mental health and substance abuse services under all health policies
and HMOs and also for self-insurance plans by classifying the limitation
of such coverage as discriminatory practice.
LEGISLATIVE HISTORY:
2008: A.8847A - Amend & Recommit to Insurance 2007: S.5615 -
Referred to Insurance
2005-2006: S.1944 - Referred to Insurance
2003-2004: S.3298 - Referred to Insurance
2001-2002: S.5381 - Referred to Insurance
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
This act shall take effect immediately.
STATE OF NEW YORK
________________________________________________________________________
4440
2009-2010 Regular Sessions
IN ASSEMBLY
February 4, 2009
___________
Introduced by M. of A. HYER-SPENCER, ALFANO, SPANO, WALKER, TITONE --
Multi-Sponsored by -- M. of A. BARRA, DIAZ, GABRYSZAK, MAISEL, McDO-
NOUGH, TOBACCO -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law and the executive law, in relation to
enacting the "fair insurance treatment act of 2009"
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Short title. This act shall be known and may be cited as
2 the "fair insurance treatment act of 2009".
3 § 2. Legislative findings and intent. The legislature hereby declares
4 that health insurance policies and health maintenance organization
5 contracts have traditionally discriminated against persons with mental
6 illness (including children with serious emotional disorders) and
7 persons with chemical dependency by either not including medically
8 necessary mental health and chemical dependency treatment and services
9 as covered benefits or subjecting these services to disparate benefit
10 limitations or cost sharing requirements. Although federal law has
11 prohibited the imposition of lower annual and lifetime dollars limits by
12 certain plans on mental health coverage, it is the intent of this legis-
13 lation to strengthen and enhance those protections, and to ensure that
14 mental health and chemical dependency coverage is provided by insurers
15 and health maintenance organizations, and is provided on terms compara-
16 ble to other health care and medical services. Nothing in this act is
17 intended to limit or restrict the right of health maintenance organiza-
18 tions and health insurers to require that all services covered by them
19 satisfy reasonable and appropriate utilization review requirements, in
20 accordance with their contracts, and applicable laws and regulations,
21 provided that such utilization review requirements are applied in a
22 consistent fashion to all services covered by such contracts.
23 § 3. Subsection (i) of section 3216 of the insurance law is amended by
24 adding a new paragraph 26 to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD07523-01-9
A. 4440 2
1 (26) Every policy delivered or issued for delivery in this state which
2 provides coverage for medical or hospital care shall provide coverage
3 for the treatment and diagnosis of mental, nervous or emotional disor-
4 ders or ailments of alcoholism, alcohol abuse, substance abuse,
5 substance dependence or chemical dependence, however defined in such
6 contract. Such policy shall not impose any greater limitations on such
7 coverage than it does for physical health benefits.
8 § 4. Paragraph 4 of subsection (b) of section 3217 of the insurance
9 law is amended to read as follows:
10 (4) elimination of provisions which may be contrary to the health care
11 needs of the public, as certified to the superintendent by the commis-
12 sioner of health, elimination of provisions which may be contrary to the
13 mental health care needs of the public, as certified to the superinten-
14 dent by the commissioner of mental health, and elimination of provisions
15 which may be contrary to the substance abuse and chemical dependency
16 care needs of the public, as certified to the superintendent by the
17 commissioner of alcohol and substance abuse services; and
18 § 5. Paragraphs 6 and 7 of subsection (1) of section 3221 of the
19 insurance law, paragraph 6 as amended by chapter 558 of the laws of 1999
20 and paragraph 7 as amended by chapter 565 of the laws of 2000, are
21 amended to read as follows:
22 (6) (A) Every insurer delivering a group or school blanket policy or
23 issuing a group or school blanket policy for delivery, in this state,
24 which provides coverage for inpatient hospital care [must make available
25 and, if requested by the policyholder,] shall provide, as part of such
26 policy, coverage for the diagnosis and treatment of chemical abuse and
27 chemical dependence, however defined in such policy, provided, however,
28 that the term chemical abuse shall mean and include alcohol and
29 substance abuse and chemical dependence shall mean and include alcohol-
30 ism and substance dependence, however defined in such policy. Written
31 notice of the availability of such coverage shall be delivered to the
32 policyholder prior to inception of such group policy and annually there-
33 after, except that this notice shall not be required where a policy
34 covers two hundred or more employees or where the benefit structure was
35 the subject of collective bargaining affecting persons who are employed
36 in more than one state.
37 (B) Such coverage shall [be at least equal to] include the following:
38 (i) [with respect to] benefits for detoxification as a consequence of
39 chemical dependence, inpatient benefits in a hospital or a detoxifica-
40 tion facility [may not be limited to less than seven days of active
41 treatment in any calendar year]; and
42 (ii) [with respect to] benefits for rehabilitation services, [such
43 benefits may not be limited to less than thirty days of] and inpatient
44 care in [any calendar year] a hospital or rehabilitation facility.
45 (C) Such coverage may be limited to facilities in New York state which
46 are certified by the office of alcoholism and substance abuse services
47 and, in other states, to those which are accredited by the joint commis-
48 sion on accreditation of hospitals as alcoholism, substance abuse or
49 chemical dependence treatment programs.
50 (D) Such coverage shall be made available at the inception of all new
51 policies and with respect to all other policies at any anniversary date
52 of the policy subject to evidence of insurability.
53 (E) Such coverage may be subject to annual deductibles and co-insu-
54 rance as may be deemed appropriate by the superintendent and are
55 consistent with those imposed on other benefits within a given policy.
56 [Further, each insurer shall report to the superintendent each year the
A. 4440 3
1 number of contract holders to whom it has issued policies for the inpa-
2 tient treatment of chemical dependence, and the approximate number of
3 persons covered by such policies.]
4 (F) Such coverage shall not replace, restrict or eliminate existing
5 coverage provided by the policy.
6 (7) Every insurer delivering a group or school blanket policy or issu-
7 ing a group or school blanket policy for delivery in this state which
8 provides coverage for inpatient hospital care [must] shall provide
9 coverage, as part of such policy, for [at least sixty] outpatient
10 [visits in any calendar year] care for the diagnosis and treatment of
11 chemical dependence of which up to twenty visits may be for family
12 members, except that this provision shall not apply to a policy which
13 covers persons employed in more than one state or the benefit structure
14 of which was the subject of collective bargaining affecting persons who
15 are employed in more than one state. Such coverage may be limited to
16 facilities in New York state certified by the office of alcoholism and
17 substance abuse services or licensed by such office as outpatient clin-
18 ics or medically supervised ambulatory substance abuse programs and, in
19 other states, to those which are accredited by the joint commission on
20 accreditation of hospitals as alcoholism or chemical dependence treat-
21 ment programs. Such coverage may be subject to annual deductibles and
22 co-insurance as may be deemed appropriate by the superintendent and are
23 consistent with those imposed on other benefits within a given policy.
24 Such coverage shall not replace, restrict, or eliminate existing cover-
25 age provided by the policy. Except as otherwise provided in the applica-
26 ble policy or contract, no insurer delivering a group or school blanket
27 policy or issuing a group or school blanket policy providing coverage
28 for alcoholism or substance abuse services pursuant to this section
29 shall deny coverage to a family member who identifies themself as a
30 family member of a person suffering from the disease of alcoholism,
31 substance abuse or chemical dependency and who seeks treatment as a
32 family member who is otherwise covered by the applicable policy or
33 contract pursuant to this section. The coverage required by this para-
34 graph shall include treatment as a family member pursuant to such family
35 members' own policy or contract provided such family member (i) does not
36 exceed the allowable number of family visits provided by the applicable
37 policy or contract pursuant to this section, and (ii) is otherwise enti-
38 tled to coverage pursuant to this section and such family members'
39 applicable policy or contract.
40 § 6. Subsections (k) and (l) of section 4303 of the insurance law,
41 subsection (k) as amended by chapter 558 of the laws of 1999 and
42 subsection (l) as amended by chapter 565 of the laws of 2000, are
43 amended to read as follows:
44 (k) A hospital service corporation or a health service corporation
45 which provides group, group remittance or school blanket coverage for
46 inpatient hospital care [must make available and if requested by the
47 contract holder] shall provide, as part of any contract issued pursuant
48 to this section, coverage for the diagnosis and treatment of chemical
49 abuse and chemical dependence, however defined in such policy, provided,
50 however, that the term chemical abuse shall mean and include alcohol and
51 substance abuse and chemical dependence shall mean and include alcohol-
52 ism and substance dependence, however defined in such policy, except
53 that this provision shall not apply to a policy which covers persons
54 employed in more than one state or the benefit structure of which was
55 the subject of collective bargaining affecting persons who are employed
56 in more than one state. Such coverage shall [be at least equal to]
A. 4440 4
1 include the following: (1) [with respect to] benefits for detoxification
2 as a consequence of chemical dependence, inpatient benefits for care in
3 a hospital or detoxification facility [may not be limited to less than
4 seven days of active treatment in any calendar year]; and (2) [with
5 respect to] benefits for inpatient rehabilitation services[, such bene-
6 fits may not be limited to less than thirty days of] and inpatient reha-
7 bilitation in a hospital based or free standing chemical dependence
8 facility [in any calendar year]. Such coverage may be limited to facili-
9 ties in New York state which are certified by the office of alcoholism
10 and substance abuse services and, in other states, to those which are
11 accredited by the joint commission on accreditation of hospitals as
12 alcoholism, substance abuse, or chemical dependence treatment programs.
13 Such coverage shall be [made available] provided at the inception of all
14 new policies and with respect to policies issued before the effective
15 date of this subsection at the first annual anniversary date thereaft-
16 er[, without evidence of insurability and at any subsequent annual anni-
17 versary date subject to evidence of insurability]. Such coverage may be
18 subject to annual deductibles and co-insurance as may be deemed appro-
19 priate by the superintendent and are consistent with those imposed on
20 other benefits within a given policy. Further, each hospital service
21 corporation or health service corporation shall report to the super-
22 intendent each year the number of contract holders to whom it has issued
23 policies for the inpatient treatment of chemical dependence, and the
24 approximate number of persons covered by such policies. Such coverage
25 shall not replace, restrict or eliminate existing coverage provided by
26 the policy. Written notice of the availability of such coverage shall be
27 delivered to the group remitting agent or group contract holder prior to
28 inception of such contract and annually thereafter, except that this
29 notice shall not be required where a policy covers two hundred or more
30 employees or where the benefit structure was the subject of collective
31 bargaining affecting persons who are employed in more than one state.
32 (l) A hospital service corporation or a health service corporation
33 which provides group, group remittance or school blanket coverage for
34 inpatient hospital care must provide coverage, as part of any contract
35 issued pursuant to this section, for [at least sixty] outpatient [visits
36 in any calendar year] care for the diagnosis and treatment of chemical
37 dependence of which up to twenty outpatient visits may be for family
38 members, except that this provision shall not apply to a contract issued
39 pursuant to section four thousand three hundred five of this article
40 which covers persons employed in more than one state or the benefit
41 structure of which was the subject of collective bargaining affecting
42 persons who are employed in more than one state. Such coverage may be
43 limited to facilities in New York state certified by the office of alco-
44 holism and substance abuse services or licensed by such office as outpa-
45 tient clinics or medically supervised ambulatory substance abuse
46 programs and, in other states, to those which are accredited by the
47 joint commission on accreditation of hospitals as alcoholism or chemical
48 dependence substance abuse treatment programs. Such coverage may be
49 subject to annual deductibles and co-insurance as may be deemed appro-
50 priate by the superintendent and are consistent with those imposed on
51 other benefits within a given policy. Such coverage shall not replace,
52 restrict or eliminate existing coverage provided by the policy. Except
53 as otherwise provided in the applicable policy or contract, no hospital
54 service corporation or health service corporation providing coverage for
55 alcoholism or substance abuse services pursuant to this section shall
56 deny coverage to a family member who identifies themself as a family
A. 4440 5
1 member of a person suffering from the disease of alcoholism, substance
2 abuse or chemical dependency and who seeks treatment as a family member
3 who is otherwise covered by the applicable policy or contract pursuant
4 to this section. The coverage required by this subsection shall include
5 treatment as a family member pursuant to such family members' own policy
6 or contract provided such family member (i) does not exceed the allow-
7 able number of family visits provided by the applicable policy or
8 contract pursuant to this section, and (ii) is otherwise entitled to
9 coverage pursuant to this section and such family members' applicable
10 policy or contract.
11 § 7. Section 4320 of the insurance law, as added by chapter 695 of the
12 laws of 1993, is amended to read as follows:
13 § 4320. Limitations on administrative services and stop-loss coverage.
14 No insurer, subsidiary of an insurer, or controlled person of a holding
15 company system may act as an administrator or claims paying agent, as
16 opposed to an insurer, on behalf of a group which denies or limits bene-
17 fits for or imposes cost sharing obligations relating to a specific
18 disease or condition or for a procedure or treatment unique to a specif-
19 ic disease or condition in a manner which would be inconsistent with
20 this chapter or regulations promulgated by the superintendent had the
21 group purchased insurance or which are inconsistent with limits or obli-
22 gations imposed with respect to other diseases or conditions in the
23 health plan. No insurer, subsidiary of an insurer, or controlled person
24 of a holding company may provide stop loss, catastrophic or reinsurance
25 coverage to groups which deny or limit benefits for or imposes cost
26 sharing obligations relating to a specific disease or condition or for a
27 procedure or treatment unique to a specific disease or condition in a
28 manner which would be inconsistent with this chapter or regulations
29 promulgated by the superintendent had the group purchased insurance or
30 which are inconsistent with limits or obligations imposed with respect
31 to other diseases or conditions in the health plan. A limit, maximum,
32 cost sharing obligation or other mechanism that controls total coverage
33 without regard to a specific disease or condition shall not be deemed
34 one that denies or limits benefits for a specific disease or condition,
35 or for a procedure or treatment unique to a specific disease or condi-
36 tion. Nothing herein shall be construed to mandate the inclusion of
37 specified benefits in an employer group plan, if such plan is not
38 subject to the provisions of this chapter.
39 § 8. Paragraphs 17, 18 and 19 of subsection (b) of section 4322 of the
40 insurance law, as added by chapter 504 of the laws of 1995, are amended
41 to read as follows:
42 (17) Inpatient diagnosis and treatment of mental, nervous or emotional
43 disorders or ailments [up to thirty days per calendar year combined with
44 inpatient treatment of alcoholism and substance abuse].
45 (18) Inpatient diagnosis and treatment of alcoholism and alcohol abuse
46 and substance abuse and [substance] chemical dependence [up to thirty
47 days per calendar year], and for detoxification [combined with] and
48 inpatient treatment of mental, nervous or emotional disorders or
49 ailments.
50 (19) Outpatient diagnosis and treatment of mental, nervous or
51 emotional disorders or ailments [up to thirty non-emergency and three
52 emergency visits per calendar year] or alcoholism and alcohol abuse and
53 chemical dependence.
54 § 9. Subdivision 20 of section 296 of the executive law, as renumbered
55 by chapter 204 of the laws of 1996, is renumbered 21 and a new subdivi-
56 sion 20 is added to read as follows:
A. 4440 6
1 20. It shall be an unlawful discriminatory practice for any employer,
2 labor organization, insurer, health maintenance organization or other
3 entity to limit health care coverage for specific diseases or condi-
4 tions, including mental, nervous or emotional disorders or ailments or
5 alcoholism, alcohol abuse, substance abuse, substance dependence or
6 chemical dependence, to a specific number of days or to a specific annu-
7 al dollar amount or to a specific lifetime dollar amount or to impose
8 specific cost-sharing obligations for the receipt of such coverage,
9 unless such limits or obligations apply, in a consistent and comparable
10 fashion, to all health care services provided by such coverage.
11 § 10. This act shall take effect on the first of January next succeed-
12 ing the date on which it shall have become a law, and shall apply to all
13 policies and contracts issued, renewed, modified, altered or amended on
14 or after such effective date; provided that any rules and regulations
15 necessary for the implementation of the provisions of this act on its
16 effective date are authorized and directed to be promulgated on or
17 before such date.
