STATE OF NEW YORK
________________________________________________________________________
5834
2019-2020 Regular Sessions
IN ASSEMBLY
February 19, 2019
___________
Introduced by M. of A. GIGLIO, DeSTEFANO, KOLB, LAWRENCE, McDONOUGH,
MIKULIN, B. MILLER, MORINELLO, RA, REILLY, SMITH, WALSH -- Multi-Spon-
sored by -- M. of A. SAYEGH, TAGUE -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring health
insurance coverage for substance use disorder treatment services
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 30 of subsection (i) of section 3216 of the
2 insurance law, as amended by section 1 of part B of chapter 71 of the
3 laws of 2016, is amended by adding a new subparagraph (E) to read as
4 follows:
5 (E) Coverage provided under this paragraph for detoxification, shall
6 be at a minimum, seven days. Rehabilitation services shall be, at a
7 minimum, thirty days.
8 § 2. Subparagraphs (D) and (E) of paragraph 31 of subsection (i) of
9 section 3216 of the insurance law are relettered subparagraphs (E) and
10 (F) and a new subparagraph (D) is added to read as follows:
11 (D) Coverage provided under this paragraph for detoxification, shall
12 be at a minimum, seven days. Rehabilitation services shall be, at a
13 minimum, thirty days.
14 § 3. Paragraph 6 of subsection (l) of section 3221 of the insurance
15 law is amended by adding a new subparagraph (E) to read as follows:
16 (E) Coverage provided under this paragraph for detoxification, shall
17 be at a minimum, seven days. Rehabilitation services shall be, at a
18 minimum, thirty days.
19 § 4. Subparagraphs (D) and (E) of paragraph 7 of subsection (l) of
20 section 3221 of the insurance law are relettered subparagraphs (E) and
21 (F) and a new subparagraph (D) is added to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD06860-01-9
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1 (D) Coverage provided under this paragraph for detoxification, shall
2 be at a minimum, seven days. Rehabilitation services shall be, at a
3 minimum, thirty days.
4 § 5. Paragraph 3 of subsection (k) of section 4303 of the insurance
5 law is renumbered paragraph 5 and a new paragraph 3 is added to read as
6 follows:
7 (3) Coverage provided under this paragraph for detoxification, shall
8 be at a minimum, seven days. Rehabilitation services shall be, at a
9 minimum, thirty days.
10 § 6. Paragraphs 3, 4 and 5 of subsection (l) of section 4303 of the
11 insurance law, paragraphs 3 and 4 as amended by chapter 41 of the laws
12 of 2014 and paragraph 5 as added by section 5 of part MM of chapter 57
13 of the laws of 2018, are amended to read as follows:
14 (3) Coverage provided under this paragraph for detoxification, shall
15 be at a minimum, seven days. Rehabilitation services shall be, at a
16 minimum, thirty days.
17 (4) Coverage provided under this subsection may be subject to annual
18 deductibles and co-insurance as deemed appropriate by the superintendent
19 and that are consistent with those imposed on other benefits within a
20 given contract.
21 [(4)] (5) A contract providing coverage for substance use disorder
22 services pursuant to this subsection shall provide up to twenty outpa-
23 tient visits per contract or calendar year to an individual who identi-
24 fies him or herself as a family member of a person suffering from
25 substance use disorder and who seeks treatment as a family member who is
26 otherwise covered by the applicable contract pursuant to this
27 subsection. The coverage required by this subsection shall include
28 treatment as a family member pursuant to such family member's own
29 contract provided such family member:
30 (A) does not exceed the allowable number of family visits provided by
31 the applicable contract pursuant to this subsection; and
32 (B) is otherwise entitled to coverage pursuant to this subsection and
33 such family member's applicable contract.
34 [(5)] (6) This paragraph shall apply to facilities in this state
35 certified by the office of alcoholism and substance abuse services for
36 the provision of outpatient, intensive outpatient, outpatient rehabili-
37 tation and opioid treatment that are participating in the corporation's
38 provider network. Coverage provided under this subsection shall not be
39 subject to preauthorization. Coverage provided under this subsection
40 shall not be subject to concurrent review for the first two weeks of
41 continuous treatment, not to exceed fourteen visits, provided the facil-
42 ity notifies the corporation of both the start of treatment and the
43 initial treatment plan within forty-eight hours. The facility shall
44 perform clinical assessment of the patient at each visit, including the
45 periodic consultation with the corporation to ensure that the facility
46 is using the evidence-based and peer reviewed clinical review tool
47 utilized by the corporation which is designated by the office of alco-
48 holism and substance abuse services and appropriate to the age of the
49 patient, to ensure that the outpatient treatment is medically necessary
50 for the patient. Any utilization review of the treatment provided under
51 this paragraph may include a review of all services provided during such
52 outpatient treatment, including all services provided during the first
53 two weeks of continuous treatment, not to exceed fourteen visits, of
54 such outpatient treatment. Provided, however, the corporation shall only
55 deny coverage for any portion of the initial two weeks of continuous
56 treatment, not to exceed fourteen visits, for outpatient treatment on
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1 the basis that such treatment was not medically necessary if such outpa-
2 tient treatment was contrary to the evidence-based and peer reviewed
3 clinical review tool utilized by the corporation which is designated by
4 the office of alcoholism and substance abuse services. A subscriber
5 shall not have any financial obligation to the facility for any treat-
6 ment under this paragraph other than any copayment, coinsurance, or
7 deductible otherwise required under the contract.
8 § 7. This act shall take effect on the thirtieth day after it shall
9 have become a law.
