STATE OF NEW YORK
________________________________________________________________________
9686
IN ASSEMBLY
January 21, 2026
___________
Introduced by M. of A. CASHMAN -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law and the social services law, in
relation to requiring insurance and Medicaid coverage for inpatient
and outpatient substance abuse treatment for a period of not less than
forty-five days
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subparagraph (A) of paragraph 30 of subsection (i) of
2 section 3216 of the insurance law, as amended by section 5 of subpart A
3 of part BB of chapter 57 of the laws of 2019, is amended to read as
4 follows:
5 (A) Every policy that provides hospital, major medical or similar
6 comprehensive coverage shall provide inpatient coverage for the diagno-
7 sis and treatment of substance use disorder, including detoxification
8 and rehabilitation services, for a period of not less than forty-five
9 days. Such inpatient coverage shall include unlimited medically neces-
10 sary treatment for substance use disorder treatment services provided in
11 residential settings. Further, such inpatient coverage shall not apply
12 financial requirements or treatment limitations, including utilization
13 review requirements, to inpatient substance use disorder benefits that
14 are more restrictive than the predominant financial requirements and
15 treatment limitations applied to substantially all medical and surgical
16 benefits covered by the policy.
17 § 2. Subparagraph (A) of paragraph 31 of subsection (i) of section
18 3216 of the insurance law, as amended by section 6 of subpart A of part
19 BB of chapter 57 of the laws of 2019, is amended to read as follows:
20 (A) Every policy that provides medical, major medical or similar
21 comprehensive-type coverage shall provide outpatient coverage for the
22 diagnosis and treatment of substance use disorder, including detoxifica-
23 tion and rehabilitation services, for a period of not less than forty-
24 five days. Such coverage shall not apply financial requirements or
25 treatment limitations to outpatient substance use disorder benefits that
26 are more restrictive than the predominant financial requirements and
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD04493-01-5
A. 9686 2
1 treatment limitations applied to substantially all medical and surgical
2 benefits covered by the policy.
3 § 3. Subparagraph (A) of paragraph 6 of subsection (l) of section 3221
4 of the insurance law, as amended by section 15 of subpart A of part BB
5 of chapter 57 of the laws of 2019, is amended to read as follows:
6 (A) Every policy that provides hospital, major medical or similar
7 comprehensive coverage shall provide inpatient coverage for the diagno-
8 sis and treatment of substance use disorder, including detoxification
9 and rehabilitation services, for a period of not less than forty-five
10 days. Such inpatient coverage shall include unlimited medically neces-
11 sary treatment for substance use disorder treatment services provided in
12 residential settings. Further, such inpatient coverage shall not apply
13 financial requirements or treatment limitations, including utilization
14 review requirements, to inpatient substance use disorder benefits that
15 are more restrictive than the predominant financial requirements and
16 treatment limitations applied to substantially all medical and surgical
17 benefits covered by the policy.
18 § 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221
19 of the insurance law, as amended by section 16 of subpart A of part BB
20 of chapter 57 of the laws of 2019, is amended to read as follows:
21 (A) Every policy that provides medical, major medical or similar
22 comprehensive-type coverage shall provide outpatient coverage for the
23 diagnosis and treatment of substance use disorder, including detoxifica-
24 tion and rehabilitation services, for a period of not less than forty-
25 five days. Such coverage shall not apply financial requirements or
26 treatment limitations to outpatient substance use disorder benefits that
27 are more restrictive than the predominant financial requirements and
28 treatment limitations applied to substantially all medical and surgical
29 benefits covered by the policy.
30 § 5. Paragraph 1 of subsection (k) of section 4303 of the insurance
31 law, as amended by section 26 of subpart A of part BB of chapter 57 of
32 the laws of 2019, is amended to read as follows:
33 (1) Every contract that provides hospital, major medical or similar
34 comprehensive coverage shall provide inpatient coverage for the diagno-
35 sis and treatment of substance use disorder, including detoxification
36 and rehabilitation services, for a period of not less than forty-five
37 days. Such inpatient coverage shall include unlimited medically neces-
38 sary treatment for substance use disorder treatment services provided in
39 residential settings. Further, such inpatient coverage shall not apply
40 financial requirements or treatment limitations, including utilization
41 review requirements, to inpatient substance use disorder benefits that
42 are more restrictive than the predominant financial requirements and
43 treatment limitations applied to substantially all medical and surgical
44 benefits covered by the contract.
45 § 6. Paragraph 1 of subsection (l) of section 4303 of the insurance
46 law, as amended by section 27 of subpart A of part BB of chapter 57 of
47 the laws of 2019, is amended to read as follows:
48 (1) Every contract that provides medical, major medical or similar
49 comprehensive-type coverage shall provide outpatient coverage for the
50 diagnosis and treatment of substance use disorder, including detoxifica-
51 tion and rehabilitation services, for a period of not less than forty-
52 five days. Such coverage shall not apply financial requirements or
53 treatment limitations to outpatient substance use disorder benefits that
54 are more restrictive than the predominant financial requirements and
55 treatment limitations applied to substantially all medical and surgical
56 benefits covered by the contract.
A. 9686 3
1 § 7. Paragraph (c) of subdivision 2 of section 365-a of the social
2 services law, as amended by section 12-a of part C of chapter 60 of the
3 laws of 2014, is amended to read as follows:
4 (c) out-patient hospital or clinic services in facilities operated in
5 compliance with applicable provisions of this chapter, the public health
6 law, the mental hygiene law and other laws, including any provisions
7 thereof requiring an operating certificate or license, including facili-
8 ties authorized by the appropriate licensing authority to provide inte-
9 grated mental health services, and/or alcoholism and substance abuse
10 services, and/or physical health services, and/or services to persons
11 with developmental disabilities, when such services are provided at a
12 single location or service site, or where such facilities are not
13 conveniently accessible, in any hospital located within the state and
14 care and services in a day treatment program operated by the department
15 of mental hygiene or by a voluntary agency under an agreement with such
16 department in that part of a public institution operated and approved
17 pursuant to law as an intermediate care facility for persons with devel-
18 opmental disabilities; and provided, that alcoholism and substance abuse
19 services shall be covered for a period of not less than forty-five days;
20 and provided further, that the commissioners of health, mental health,
21 alcoholism and substance abuse services and the office for people with
22 developmental disabilities may issue regulations, including emergency
23 regulations promulgated prior to October first, two thousand fifteen
24 that are required to facilitate the establishment of integrated services
25 clinics. Any such regulations promulgated under this paragraph shall be
26 described in the annual report required pursuant to section forty-five-c
27 of part A of chapter fifty-six of the laws of two thousand thirteen;
28 § 8. Paragraph (n) of subdivision 2 of section 365-a of the social
29 services law, as amended by chapter 558 of the laws of 1999, is amended
30 to read as follows:
31 (n) care, treatment, maintenance and rehabilitation services that
32 would otherwise qualify for reimbursement pursuant to this chapter to
33 persons suffering from alcoholism in alcoholism facilities or chemical
34 dependence, as such term is defined in section 1.03 of the mental
35 hygiene law, in inpatient chemical dependence facilities, services, or
36 programs operated in compliance with applicable provisions of this chap-
37 ter and the mental hygiene law, and certified by the office of alcohol-
38 ism and substance abuse services, provided however that such services
39 shall be limited to such periods of time as may be determined necessary
40 in accordance with a utilization review procedure established by the
41 commissioner of the office of alcoholism and substance abuse services
42 and that such services shall be covered for a period of not less than
43 forty-five days, and provided further, that this paragraph shall not
44 apply to any hospital or part of a hospital as defined in section two
45 thousand eight hundred one of the public health law.
46 § 9. This act shall take effect immediately and shall apply to all
47 policies and contracts issued, renewed, modified, altered or amended on
48 or after such date.
