STATE OF NEW YORK
________________________________________________________________________
5263
2025-2026 Regular Sessions
IN SENATE
February 20, 2025
___________
Introduced by Sen. ASHBY -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to providing that cover-
age for outpatient diagnosis and treatment of substance use disorder
shall not be subject to preauthorization
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 31 of subsection (i) of
2 section 3216 of the insurance law, as amended by section 6 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 medical, major medical or similar
6 comprehensive-type coverage shall provide outpatient coverage for the
7 diagnosis and treatment of substance use disorder, including detoxifica-
8 tion and rehabilitation services. Such coverage shall not be subject to
9 preauthorization and shall not apply financial requirements or treatment
10 limitations to outpatient substance use disorder benefits that are more
11 restrictive than the predominant financial requirements and treatment
12 limitations applied to substantially all medical and surgical benefits
13 covered by the policy.
14 § 2. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221
15 of the insurance law, as amended by section 16 of subpart A of part BB
16 of chapter 57 of the laws of 2019, is amended to read as follows:
17 (A) Every policy that provides medical, major medical or similar
18 comprehensive-type coverage shall provide outpatient coverage for the
19 diagnosis and treatment of substance use disorder, including detoxifica-
20 tion and rehabilitation services. Such coverage shall not be subject to
21 preauthorization and shall not apply financial requirements or treatment
22 limitations to outpatient substance use disorder benefits that are more
23 restrictive than the predominant financial requirements and treatment
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD08834-02-5
S. 5263 2
1 limitations applied to substantially all medical and surgical benefits
2 covered by the policy.
3 § 3. Paragraph 1 of subsection (l) of section 4303 of the insurance
4 law, as amended by section 27 of subpart A of part BB of chapter 57 of
5 the laws of 2019, is amended to read as follows:
6 (1) Every contract that provides medical, major medical or similar
7 comprehensive-type coverage shall provide outpatient coverage for the
8 diagnosis and treatment of substance use disorder, including detoxifica-
9 tion and rehabilitation services. Such coverage shall not be subject to
10 preauthorization and shall not apply financial requirements or treatment
11 limitations to outpatient substance use disorder benefits that are more
12 restrictive than the predominant financial requirements and treatment
13 limitations applied to substantially all medical and surgical benefits
14 covered by the contract.
15 § 4. This act shall take effect immediately, and shall apply to poli-
16 cies and contracts issued, renewed, modified, altered or amended on or
17 after such date.
