NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A2412
SPONSOR: Jones TITLE OF BILL:
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
PURPOSE::
This bill would allow patients who need detoxification and rehabili-
tation services to be covered for said services for up to a forty-five
day period.
SUMMARY OF PROVISIONS::
Sections 1 through 8 of this legislation provides inpatient and outpa-
tient coverage for the diagnosis and treatment of substance use disor-
der, including detoxification and rehabilitation services, for a period
of not less than forty-five days.
Section 9 contains the effective date.
JUSTIFICATION::
Drug overdoses continue to increase across New York State. A rise in
drug use is also a contributing factor to crime rates across the state.
Additionally, the Family Court system and the foster care system has
experienced a rise in cases because of the increased drug use. The state
needs to offer more solutions for those who are seeking treatment and
that includes updating current Medicaid coverage.
Currently, Medicaid coverage for rehabilitative services does not have a
set minimum day requirement causing treatment to become unaffordable and
out of reach for many seeking help. This causes many patients who need
diagnosis and treatment of substance use disorder to not get the proper
treatment. During the short amount of time in which patients are covered
now, they are not properly rehabilitated, thus making them fall back
into the same cycle. This legislation would guarantee longer coverage to
keep patients in rehabilitation services longer and to receive the
treatment they need to recover. Updating Medicaid policy so it properly
covers substance use treatment will lead to more people seeking treat-
ment and getting the resources they need, which will help the state in
its fight against addiction.
LEGISLATIVE HISTORY::
01/28/2019 referred to insurance
01/08/2020 referred to insurance
01/06/2021 referred to insurance
01/05/2022 referred to insurance
FISCAL IMPLICATIONS::
To be determined.
EFFECTIVE DATE::
This act shall take effect immediately and shall apply to all policies
and contracts issued, renewed, modified, altered or amended on or after
such date.
STATE OF NEW YORK
________________________________________________________________________
2412
2023-2024 Regular Sessions
IN ASSEMBLY
January 26, 2023
___________
Introduced by M. of A. JONES, GUNTHER, WALSH, DICKENS -- Multi-Sponsored
by -- M. of A. COOK, THIELE -- read once and referred to the Committee
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-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02918-01-3
A. 2412 2
1 tion and rehabilitation services, for a period of not less than forty-
2 five days. Such coverage shall not apply financial requirements or
3 treatment limitations to outpatient substance use disorder benefits that
4 are more restrictive than the predominant financial requirements and
5 treatment limitations applied to substantially all medical and surgical
6 benefits covered by the policy.
7 § 3. Subparagraph (A) of paragraph 6 of subsection (l) of section 3221
8 of the insurance law, as amended by section 15 of subpart A of part BB
9 of chapter 57 of the laws of 2019, is amended to read as follows:
10 (A) Every policy that provides hospital, major medical or similar
11 comprehensive coverage shall provide inpatient coverage for the diagno-
12 sis and treatment of substance use disorder, including detoxification
13 and rehabilitation services, for a period of not less than forty-five
14 days. Such inpatient coverage shall include unlimited medically neces-
15 sary treatment for substance use disorder treatment services provided in
16 residential settings. Further, such inpatient coverage shall not apply
17 financial requirements or treatment limitations, including utilization
18 review requirements, to inpatient substance use disorder benefits that
19 are more restrictive than the predominant financial requirements and
20 treatment limitations applied to substantially all medical and surgical
21 benefits covered by the policy.
22 § 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221
23 of the insurance law, as amended by section 16 of subpart A of part BB
24 of chapter 57 of the laws of 2019, is amended to read as follows:
25 (A) Every policy that provides medical, major medical or similar
26 comprehensive-type coverage shall provide outpatient coverage for the
27 diagnosis and treatment of substance use disorder, including detoxifica-
28 tion and rehabilitation services, for a period of not less than forty-
29 five days. Such coverage shall not apply financial requirements or
30 treatment limitations to outpatient substance use disorder benefits that
31 are more restrictive than the predominant financial requirements and
32 treatment limitations applied to substantially all medical and surgical
33 benefits covered by the policy.
34 § 5. Paragraph 1 of subsection (k) of section 4303 of the insurance
35 law, as amended by section 26 of subpart A of part BB of chapter 57 of
36 the laws of 2019, is amended to read as follows:
37 (1) Every contract that provides hospital, major medical or similar
38 comprehensive coverage shall provide inpatient coverage for the diagno-
39 sis and treatment of substance use disorder, including detoxification
40 and rehabilitation services, for a period of not less than forty-five
41 days. Such inpatient coverage shall include unlimited medically neces-
42 sary treatment for substance use disorder treatment services provided in
43 residential settings. Further, such inpatient coverage shall not apply
44 financial requirements or treatment limitations, including utilization
45 review requirements, to inpatient substance use disorder benefits that
46 are more restrictive than the predominant financial requirements and
47 treatment limitations applied to substantially all medical and surgical
48 benefits covered by the contract.
49 § 6. Paragraph 1 of subsection (l) of section 4303 of the insurance
50 law, as amended by section 27 of subpart A of part BB of chapter 57 of
51 the laws of 2019, is amended to read as follows:
52 (1) Every contract that provides medical, major medical or similar
53 comprehensive-type coverage shall provide outpatient coverage for the
54 diagnosis and treatment of substance use disorder, including detoxifica-
55 tion and rehabilitation services, for a period of not less than forty-
56 five days. Such coverage shall not apply financial requirements or
A. 2412 3
1 treatment limitations to outpatient substance use disorder benefits that
2 are more restrictive than the predominant financial requirements and
3 treatment limitations applied to substantially all medical and surgical
4 benefits covered by the contract.
5 § 7. Paragraph (c) of subdivision 2 of section 365-a of the social
6 services law, as amended by section 12-a of part C of chapter 60 of the
7 laws of 2014, is amended to read as follows:
8 (c) out-patient hospital or clinic services in facilities operated in
9 compliance with applicable provisions of this chapter, the public health
10 law, the mental hygiene law and other laws, including any provisions
11 thereof requiring an operating certificate or license, including facili-
12 ties authorized by the appropriate licensing authority to provide inte-
13 grated mental health services, and/or alcoholism and substance abuse
14 services, and/or physical health services, and/or services to persons
15 with developmental disabilities, when such services are provided at a
16 single location or service site, or where such facilities are not
17 conveniently accessible, in any hospital located within the state and
18 care and services in a day treatment program operated by the department
19 of mental hygiene or by a voluntary agency under an agreement with such
20 department in that part of a public institution operated and approved
21 pursuant to law as an intermediate care facility for persons with devel-
22 opmental disabilities; and provided, that alcoholism and substance abuse
23 services shall be covered for a period of not less than forty-five days;
24 and provided further, that the commissioners of health, mental health,
25 alcoholism and substance abuse services and the office for people with
26 developmental disabilities may issue regulations, including emergency
27 regulations promulgated prior to October first, two thousand fifteen
28 that are required to facilitate the establishment of integrated services
29 clinics. Any such regulations promulgated under this paragraph shall be
30 described in the annual report required pursuant to section forty-five-c
31 of part A of chapter fifty-six of the laws of two thousand thirteen;
32 § 8. Paragraph (n) of subdivision 2 of section 365-a of the social
33 services law, as amended by chapter 558 of the laws of 1999, is amended
34 to read as follows:
35 (n) care, treatment, maintenance and rehabilitation services that
36 would otherwise qualify for reimbursement pursuant to this chapter to
37 persons suffering from alcoholism in alcoholism facilities or chemical
38 dependence, as such term is defined in section 1.03 of the mental
39 hygiene law, in inpatient chemical dependence facilities, services, or
40 programs operated in compliance with applicable provisions of this chap-
41 ter and the mental hygiene law, and certified by the office of alcohol-
42 ism and substance abuse services, provided however that such services
43 shall be limited to such periods of time as may be determined necessary
44 in accordance with a utilization review procedure established by the
45 commissioner of the office of alcoholism and substance abuse services
46 and that such services shall be covered for a period of not less than
47 forty-five days, and provided further, that this paragraph shall not
48 apply to any hospital or part of a hospital as defined in section two
49 thousand eight hundred one of the public health law.
50 § 9. This act shall take effect immediately and shall apply to all
51 policies and contracts issued, renewed, modified, altered or amended on
52 or after such date.
