A04938 Summary:

BILL NOA04938
 
SAME ASNo Same As
 
SPONSORCurran
 
COSPNSRDuprey, Finch, Raia
 
MLTSPNSR
 
Amd SS3216, 3221, 4235 & 4303, Ins L
 
Allows health insurance reimbursements for certain mental health services provided by licensed mental health counselors.
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A04938 Actions:

BILL NOA04938
 
02/09/2015referred to insurance
01/06/2016referred to insurance
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A04938 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A4938
 
SPONSOR: Curran (MS)
  TITLE OF BILL: An act to amend the insurance law, in relation to allowing reimbursements for certain services provided by licensed mental health counselors   PURPOSE OR GENERAL IDEA OF BILL: Allows reimbursements for services provided by licensed mental health counselors.   SUMMARY OF SPECIFIC PROVISIONS: Section 1 amends paragraph 4 of subsection (i) of section 3216 of the insurance law adding a licensed mental health counselor to the list of physician, psychiatrist {or}, a certified and registered psychologist when a policy provides for reimbursement for psychiatric or psycholog- ical services or for diagnosis and treatment of mental, nervous or emotional disorders or ailments, however defined in the policy, the insured shall be entitled to reimbursement for such services. Section 2 paragraph 4-a adds a licensed mental health counselor, within the lawful scope of his or her practice, who is licensed pursuant to article one hundred sixty-three of the education law. Section 2 paragraph 4-b adds the state board of mental health practi- tioners shall maintain a list of all licensed mental health counselors qualified for reimbursement under this paragraph. Section 2 paragraph 4-d adds or a licensed mental health counselor.   JUSTIFICATION: Amends the Insurance Law to allow for reimbursements for services provided by licensed mental health counselors.   PRIOR LEGISLATIVE HISTORY: 2013-2014: Referred and held for consideration in insurance.   FISCAL IMPLICATIONS: None   EFFECTIVE DATE: The ninetieth day after it shall have become a law.
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A04938 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          4938
 
                               2015-2016 Regular Sessions
 
                   IN ASSEMBLY
 
                                    February 9, 2015
                                       ___________
 
        Introduced  by  M.  of  A.  CURRAN, DUPREY, FINCH, RAIA -- read once and
          referred to the Committee on Insurance
 
        AN ACT to amend the insurance law, in relation  to  allowing  reimburse-
          ments  for certain services provided by licensed mental health counse-
          lors
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section 1. Paragraph 4 of subsection (i) of section 3216 of the insur-
     2  ance law is amended to read as follows:
     3    (4)  If a policy provides for reimbursement for psychiatric or psycho-
     4  logical services or for diagnosis and treatment of mental,  nervous,  or
     5  emotional  disorders  or  ailments,  however  defined in the policy, the
     6  insured shall be entitled to reimbursement for such services,  diagnosis
     7  or  treatment  whether  performed  by  a physician, psychiatrist [or], a
     8  certified and registered psychologist, or a licensed mental health coun-
     9  selor when the services rendered are within the lawful  scope  of  their
    10  practice.
    11    §  2.  Paragraph  4 of subsection (l) of section 3221 of the insurance
    12  law, subparagraph (A) as amended by chapter 230 of  the  laws  of  2004,
    13  subparagraph  (B)  as  amended  by  chapter 420 of the laws of 2002, and
    14  subparagraphs (D) and (E) as amended by section 50 of part D of  chapter
    15  56 of the laws of 2013, is amended to read as follows:
    16    (4)  (A)  Every  insurer  delivering a group policy or issuing a group
    17  policy for delivery, in this state,  which  provides  reimbursement  for
    18  psychiatric or psychological services or for the diagnosis and treatment
    19  of  mental, nervous or emotional disorders and ailments, however defined
    20  in such policy, by physicians, psychiatrists or psychologists, must make
    21  available and if requested by the policyholder provide the same coverage
    22  to insureds for such services when  performed  by  a  licensed  clinical
    23  social  worker,  within  the lawful scope of his or her practice, who is
    24  licensed pursuant to article one hundred fifty-four of the education law
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD08188-01-5

        A. 4938                             2
 
     1  or a licensed mental health counselor, within the lawful scope of his or
     2  her practice, who is licensed pursuant to  article  one  hundred  sixty-
     3  three  of the education law.  Written notice of the availability of such
     4  coverage  shall  be  delivered to the policyholder prior to inception of
     5  such group policy and annually thereafter, except that this notice shall
     6  not be required where a policy covers two hundred or more  employees  or
     7  where  the  benefit  structure  was the subject of collective bargaining
     8  affecting persons who are employed in more than one state.
     9    (B) The state board for social work  shall  maintain  a  list  of  all
    10  licensed  clinical social workers qualified for reimbursement under this
    11  paragraph. The state board of mental health practitioners shall maintain
    12  a list of all licensed mental health counselors qualified for reimburse-
    13  ment under this paragraph.
    14    (C) Such coverage shall be made available at the inception of all  new
    15  policies and, with respect to all other policies at any subsequent annu-
    16  al anniversary date of the policy subject to evidence of insurability.
    17    (D)  In addition to the requirements of subparagraph (A) of this para-
    18  graph, every insurer issuing a group policy for delivery in  this  state
    19  where  the  policy provides reimbursement to insureds for psychiatric or
    20  psychological services or for the diagnosis  and  treatment  of  mental,
    21  nervous  or  emotional  disorders  and ailments, however defined in such
    22  policy, by physicians, psychiatrists or psychologists, shall provide the
    23  same coverage to insureds for such services when performed by a licensed
    24  clinical social worker, within the lawful scope of his or her  practice,
    25  who  is  licensed  pursuant to subdivision two of section seven thousand
    26  seven hundred four of the education law  or  a  licensed  mental  health
    27  counselor,  within  the  lawful  scope  of  his  or her practice, who is
    28  licensed pursuant to subdivision three of section  eight  thousand  four
    29  hundred  two of the education law and in addition shall have either: (i)
    30  three or more additional years experience in  psychotherapy,  which  for
    31  the  purposes  of this subparagraph shall mean the use of verbal methods
    32  in interpersonal relationships with the intent of assisting a person  or
    33  persons  to  modify  attitudes  and  behavior  that  are intellectually,
    34  socially or emotionally maladaptive, under supervision, satisfactory  to
    35  the  state  board  for  social work, or the state board of mental health
    36  practitioners, in a facility, licensed or incorporated by an appropriate
    37  governmental department, providing services for diagnosis  or  treatment
    38  of  mental,  nervous  or  emotional disorders or ailments; (ii) three or
    39  more additional years experience in psychotherapy under the supervision,
    40  satisfactory to the state board for social work, or the state  board  of
    41  mental  health  practitioners,  of a psychiatrist, a licensed and regis-
    42  tered psychologist [or], a licensed clinical social worker or a licensed
    43  mental  health  counselor  qualified  for  reimbursement   pursuant   to
    44  subsection (e) of this section, or (iii) a combination of the experience
    45  specified  in  items  (i)  and  (ii) of this subparagraph totaling three
    46  years, satisfactory to the state board for social work.  The state board
    47  of mental health practitioners shall maintain a  list  of  all  licensed
    48  mental health counselors qualified for reimbursement under this subpara-
    49  graph.
    50    (E)  The  state  board  for  social  work shall maintain a list of all
    51  licensed clinical  social  workers  qualified  for  reimbursement  under
    52  subparagraph (D) of this paragraph.
    53    § 3. Item (ii) of subparagraph (A) of paragraph 5 of subsection (l) of
    54  section 3221 of the insurance law, as amended by chapter 502 of the laws
    55  of 2007, is amended to read as follows:

        A. 4938                             3
 
     1    (ii)  where  the  policy  provides coverage for physician services, it
     2  shall include benefits for outpatient care provided by a psychiatrist or
     3  psychologist licensed to practice in this  state,  a  licensed  clinical
     4  social  worker  or  a  licensed  mental  health  counselor who meets the
     5  requirements  of  subparagraph (D) of paragraph four of this subsection,
     6  or a professional corporation or university faculty practice corporation
     7  thereof. Such benefits may be limited to not less than twenty visits  in
     8  any contract year, plan year, or calendar year.
     9    § 4. Subparagraph (G) of paragraph 4 of subsection (f) of section 4235
    10  of  the insurance law, as relettered by chapter 456 of the laws of 1993,
    11  is amended to read as follows:
    12    (G) psychiatric or psychological services or  for  the  diagnosis  and
    13  treatment of mental, nervous, or emotional disorders or ailments, howev-
    14  er defined in such policy, a subscriber to such policy shall be entitled
    15  to reimbursement for such psychiatric or psychological services or diag-
    16  nosis  or treatment whether performed by a physician, psychiatrist [or],
    17  a certified and registered psychologist  or  a  licensed  mental  health
    18  counselor  when  the  services  rendered  are within the lawful scope of
    19  their practice, and when such policy or any  certificate  issued  there-
    20  under  is  delivered  or  issued  for  delivery without this state by an
    21  authorized insurer, covered persons residing  in  this  state  shall  be
    22  entitled  to  reimbursement for such diagnosis and treatment by a physi-
    23  cian, psychiatrist or a certified and registered psychologist as herein-
    24  above provided; and
    25    § 5. Paragraph 1 of subsection (h) and  subsections  (i)  and  (n)  of
    26  section  4303  of  the  insurance  law, paragraph 1 of subsection (h) as
    27  amended by chapter 502 of the laws of 2007 and subsections (i)  and  (n)
    28  as  amended  by  chapter 230 of the laws of 2004, are amended to read as
    29  follows:
    30    (1) A medical expense indemnity corporation or a health service corpo-
    31  ration, which provides group, group remittance or school blanket  cover-
    32  age for physician services, shall provide as part of its contract broad-
    33  based  coverage  for  the  diagnosis and treatment of mental, nervous or
    34  emotional disorders or ailments, however defined in  such  contract,  at
    35  least  equal  to  the  coverage provided for other health conditions and
    36  shall include: benefits for outpatient care provided by  a  psychiatrist
    37  or  psychologist licensed to practice in this state, a licensed clinical
    38  social worker or a  licensed  mental  health  counselor  who  meets  the
    39  requirements of subsection (n) of this section, or a professional corpo-
    40  ration  or  university faculty practice corporation thereof, which bene-
    41  fits may be limited to not less than twenty visits in any contract year,
    42  plan year or calendar year. Such coverage may be provided on a  contract
    43  year,  plan year or calendar year basis and shall be consistent with the
    44  provision of other benefits under the contract.  Such  coverage  may  be
    45  subject  to annual deductibles, co-pays and coinsurance as may be deemed
    46  appropriate by the superintendent and shall  be  consistent  with  those
    47  imposed  on  other  benefits  under the contract. In the event the group
    48  remittance group or contract holder is provided coverage provided  under
    49  this paragraph and under subparagraph (B) of paragraph one of subsection
    50  (g) of this section from the same health service corporation, or under a
    51  contract  which  is  jointly  underwritten  by two health service corpo-
    52  rations or by a health service corporation and a medical expense  indem-
    53  nity  corporation,  the  aggregate  of the benefits for out-patient care
    54  obtained under subparagraph (B) of paragraph one of  subsection  (g)  of
    55  this  section  and this paragraph may be limited to not less than twenty
    56  visits in any contract year, plan year or calendar year.

        A. 4938                             4
 
     1    (i) A medical expense indemnity corporation or health  service  corpo-
     2  ration which provides coverage for physicians, psychiatrists or psychol-
     3  ogists  for  psychiatric  or psychological services or for the diagnosis
     4  and treatment of mental, nervous or emotional  disorders  and  ailments,
     5  however  defined  in such contract, must make available and if requested
     6  by all persons holding individual contracts in a  group  whose  premiums
     7  are paid by a remitting agent or by the contract holder in the case of a
     8  group  contract  issued  pursuant to section four thousand three hundred
     9  five of this article, provide the same coverage for such  services  when
    10  performed  by a licensed clinical social worker, within the lawful scope
    11  of his or her practice, who is licensed pursuant to article one  hundred
    12  fifty-four  of  the education law or a licensed mental health counselor,
    13  within the lawful scope of his or her practice, who is licensed pursuant
    14  to article one hundred sixty-three of the education law. The state board
    15  for social work shall maintain a list of all  licensed  clinical  social
    16  workers  qualified  for  reimbursement  under this subsection. The state
    17  board of mental health  practitioners  shall  maintain  a  list  of  all
    18  licensed  clinical social workers qualified for reimbursement under this
    19  subsection. Such coverage shall be made available at  the  inception  of
    20  all new contracts and, with respect to all other contracts, at any anni-
    21  versary  date subject to evidence of insurability. Written notice of the
    22  availability of such coverage shall be delivered to the group  remitting
    23  agent  or  group contract holder prior to inception of such contract and
    24  annually thereafter, except that this notice shall not be required where
    25  a policy covers two hundred or  more  employees  or  where  the  benefit
    26  structure was the subject of collective bargaining affecting persons who
    27  are employed in more than one state.
    28    (n) In addition to the requirements of subsection (i) of this section,
    29  every  health service or medical expense indemnity corporation issuing a
    30  group contract pursuant to this section or a group  remittance  contract
    31  for  delivery  in  this  state  which contract provides reimbursement to
    32  subscribers or physicians, psychiatrists or psychologists for  psychiat-
    33  ric  or  psychological  services  or  for the diagnosis and treatment of
    34  mental, nervous or emotional disorders and ailments, however defined  in
    35  such  contract,  must provide the same coverage to persons covered under
    36  the group contract for such services when performed by a licensed  clin-
    37  ical  social worker, within the lawful scope of his or her practice, who
    38  is licensed pursuant to subdivision two of section seven thousand  seven
    39  hundred four of the education law or a licensed mental health counselor,
    40  within the lawful scope of his or her practice, who is licensed pursuant
    41  to  subdivision  three of section eight thousand four hundred two of the
    42  education law and in addition shall have either (i) three or more  addi-
    43  tional years experience in psychotherapy, which for the purposes of this
    44  subsection  shall  mean  the  use  of  verbal  methods  in interpersonal
    45  relationships with the intent of assisting a person or persons to modify
    46  attitudes and behavior which are intellectually, socially or emotionally
    47  maladaptive, under supervision, satisfactory  to  the  state  board  for
    48  social  work  or  the  state  board of mental health practitioners, in a
    49  facility,  licensed  or  incorporated  by  an  appropriate  governmental
    50  department,  providing  services  for  diagnosis or treatment of mental,
    51  nervous or emotional disorders or ailments, or (ii) three or more  addi-
    52  tional  years  experience in psychotherapy under the supervision, satis-
    53  factory to the state board for social work or the state board of  mental
    54  health  practitioners,  of  a  psychiatrist,  a  licensed and registered
    55  psychologist or a licensed clinical social  worker  or  licensed  mental
    56  health  practitioner  qualified for reimbursement pursuant to subsection

        A. 4938                             5
 
     1  (i) of this section, or (iii) a combination of the experience  specified
     2  in  [paragraphs]  items (i) and (ii) of this subparagraph totaling three
     3  years, satisfactory to the state board for  social  work  or  the  state
     4  board  of  mental health practitioners.  The state board for social work
     5  shall maintain a list of all licensed clinical social workers  qualified
     6  for  reimbursement  under  this  subsection.  The  state board of mental
     7  health practitioners shall maintain a list of all licensed mental health
     8  counselors qualified for reimbursement under this subsection.
     9    § 6. This act shall take effect on the ninetieth day  after  it  shall
    10  have become a law.
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