NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9640
SPONSOR: Lupardo TITLE OF BILL: An act to amend the insurance law, in relation to
health insurance coverage of outpatient care provided by licensed
marriage and family therapists
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 licensed marriage and family therapists.
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 marriage and family therapist 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 marriage and family therapist licensed under article one
hundred sixty-three of the education law.
Section 3 states the enactment date.
JUSTIFICATION: Current law does not explicitly include marriage and
family therapists as allowable providers of outpatient mental health
services, thereby allowing insurers to deny coverage for the valuable
services these practitioners can provide.
Marriage and family therapists licensed by the New York State Department
of Education face strict requirements for licensure, including the
requirement that they obtain a Master's degree or higher in a mental
health course of study. These requirements ensure that such practitioner
is fully capable of providing marriage and family therapy.
LEGISLATIVE HISTORY: This is a new bill.
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
________________________________________________________________________
9640
IN ASSEMBLY
March 22, 2012
___________
Introduced by M. of A. LUPARDO -- 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 licensed marriage and family
therapists
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, marriage and family
7 therapist licensed pursuant to article one hundred sixty-three of the
8 education law, or a licensed clinical social worker who meets the
9 requirements of subparagraph (D) of paragraph four of this subsection,
10 or a professional corporation or university faculty practice corporation
11 thereof. Such benefits may be limited to not less than twenty visits in
12 any contract year, plan year, or calendar year.
13 § 2. Paragraph 1 of subsection (h) of section 4303 of the insurance
14 law, as amended by chapter 502 of the laws of 2007, is amended to read
15 as follows:
16 (1) A medical expense indemnity corporation or a health service corpo-
17 ration, which provides group, group remittance or school blanket cover-
18 age for physician services, shall provide as part of its contract broad-
19 based coverage for the diagnosis and treatment of mental, nervous or
20 emotional disorders or ailments, however defined in such contract, at
21 least equal to the coverage provided for other health conditions and
22 shall include: benefits for outpatient care provided by a psychiatrist
23 or psychologist licensed to practice in this state, marriage and family
24 therapist licensed pursuant to article one hundred sixty-three of the
25 education law, or a licensed clinical social worker who meets the
26 requirements of subsection (n) of this section, or a professional corpo-
27 ration or university faculty practice corporation thereof, which bene-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13963-01-2
A. 9640 2
1 fits may be limited to not less than twenty visits in any contract year,
2 plan year or calendar year. Such coverage may be provided on a contract
3 year, plan year or calendar year basis and shall be consistent with the
4 provision of other benefits under the contract. Such coverage may be
5 subject to annual deductibles, co-pays and coinsurance as may be deemed
6 appropriate by the superintendent and shall be consistent with those
7 imposed on other benefits under the contract. In the event the group
8 remittance group or contract holder is provided coverage provided under
9 this paragraph and under subparagraph (B) of paragraph one of subsection
10 (g) of this section from the same health service corporation, or under a
11 contract which is jointly underwritten by two health service corpo-
12 rations or by a health service corporation and a medical expense indem-
13 nity corporation, the aggregate of the benefits for out-patient care
14 obtained under subparagraph (B) of paragraph one of subsection (g) of
15 this section and this paragraph may be limited to not less than twenty
16 visits in any contract year, plan year or calendar year.
17 § 3. This act shall take effect on the first of January next succeed-
18 ing the date on which it shall have become a law and shall apply to
19 policies and contracts issued, renewed, modified, altered or amended on
20 or after such effective date.
