STATE OF NEW YORK
________________________________________________________________________
6586
2025-2026 Regular Sessions
IN ASSEMBLY
March 6, 2025
___________
Introduced by M. of A. WEPRIN -- 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 health insurance policies and Medicaid to cover
patient navigation services
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subsection (i) of section 3216 of insurance law is amended
2 by adding a new paragraph 40 to read as follows:
3 (40) (A) Every policy which provides medical, major medical, or simi-
4 lar comprehensive-type coverage shall provide coverage for patient navi-
5 gation services to improve access to care for individuals who are eligi-
6 ble for screening, follow-up or treatment services. Eligibility for
7 patient navigation services coverage includes individuals with a serious
8 condition that is expected to last at least three months and places the
9 individual at high risk for one or more of the following:
10 (i) Hospitalization;
11 (ii) Nursing home placement;
12 (iii) A sudden worsening of preexisting symptoms;
13 (iv) Physical or mental decline; or
14 (v) Death.
15 (B) Patient navigation services shall include, but not be limited to:
16 (i) Screening for nonclinical and social needs that do not require a
17 licensed healthcare provider to complete;
18 (ii) Referrals and follow-up to connect individuals to services
19 including, but not limited to transportation, employment, job training,
20 food insecurity, childcare, housing, language or health literacy
21 support;
22 (iii) Help with enrollment or maintaining enrollment in government
23 programs or other assistance programs;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD08151-01-5
A. 6586 2
1 (iv) Arranging for and accompaniment to in-person and virtual health-
2 care visits; or
3 (v) Other prevention, screening and treatment health education, health
4 navigation, health advocacy, or individual supports including transition
5 of care supports.
6 (C) Reimbursement shall be provided to individuals who are trained and
7 have completed a national patient navigation certification or creden-
8 tialing program, or other certification or training program approved by
9 the department of health. Approved individuals shall be employed by or
10 in consultation with facilities certified under article twenty-eight of
11 the public health law, diagnostic and treatment centers, federally qual-
12 ified health centers, clinics, physicians or other licensed healthcare
13 providers, to provide patient navigation services. Individuals author-
14 ized to provide patient navigation services shall do so under the gener-
15 al supervision of a licensed physician or other licensed healthcare
16 provider.
17 § 2. Subsection (l) of section 3221 of insurance law is amended by
18 adding a new paragraph 23 to read as follows:
19 (23) (A) Every insurer delivering a group or blanket policy or issuing
20 a group or blanket policy for delivery in this state that provides
21 coverage for medical, major medical or similar comprehensive-type cover-
22 age shall provide coverage for patient navigation services to improve
23 access to care for individuals who are eligible for screening, follow-up
24 or treatment services. Eligibility for patient navigation services
25 coverage includes individuals with a serious condition that is expected
26 to last at least three months and places the individual at high risk for
27 one or more of the following:
28 (i) Hospitalization;
29 (ii) Nursing home placement;
30 (iii) A sudden worsening of preexisting symptoms;
31 (iv) Physical or mental decline; or
32 (v) Death.
33 (B) Patient navigation services shall include but not be limited to:
34 (i) Screening for nonclinical and social needs that do not require a
35 licensed healthcare provider to complete;
36 (ii) Referrals and follow-up to connect individuals to services
37 including, but not limited to transportation, employment, job training,
38 food insecurity, childcare, housing, language or health literacy
39 support;
40 (iii) Help with enrollment or maintaining enrollment in government
41 programs or other assistance programs;
42 (iv) Arranging for and accompaniment to in-person and virtual health-
43 care visits; or
44 (v) Other prevention, screening and treatment health education, health
45 navigation, health advocacy, or individual supports including transition
46 of care supports.
47 (C) Reimbursement shall be provided to individuals who are trained and
48 have completed a national patient navigation certification or creden-
49 tialing program, or other certification or training program approved by
50 the department of health. Approved individuals shall be employed by or
51 in consultation with facilities certified under article twenty-eight of
52 the public health law, diagnostic and treatment centers, federally qual-
53 ified health centers, clinics, physicians or other licensed healthcare
54 providers, to provide patient navigation services. Individuals author-
55 ized to provide patient navigation services shall do so under the gener-
A. 6586 3
1 al supervision of a licensed physician or other licensed healthcare
2 provider.
3 § 3. Section 4303 of the insurance law is amended by adding a new
4 subsection (ww) to read as follows:
5 (ww) (1) Every policy which provides medical, major medical, or simi-
6 lar comprehensive-type coverage shall provide coverage for patient navi-
7 gation services to improve access to care for individuals who are eligi-
8 ble for screening, follow-up or treatment services. Eligibility for
9 patient navigation services coverage includes individuals with a serious
10 condition that is expected to last at least three months and places the
11 individual at high risk for one or more of the following:
12 (A) Hospitalization;
13 (B) Nursing home placement;
14 (C) A sudden worsening of preexisting symptoms;
15 (D) Physical or mental decline; or
16 (E) Death.
17 (2) Patient navigation services shall include but not be limited to:
18 (A) Screening for nonclinical and social needs that do not require a
19 licensed healthcare provider to complete;
20 (B) Referrals and follow-up to connect individuals to services includ-
21 ing, but not limited to transportation, employment, job training, food
22 insecurity, childcare, housing, language or health literacy support;
23 (C) Help with enrollment or maintaining enrollment in government
24 programs or other assistance programs;
25 (D) Arranging for and accompaniment to in-person and virtual health-
26 care visits; or
27 (E) Other prevention, screening and treatment health education, health
28 navigation, health advocacy, or individual supports including transition
29 of care supports.
30 (3) Reimbursement shall be provided to individuals who are trained and
31 have completed a national patient navigation certification or creden-
32 tialing program, or other certification or training program approved by
33 the department of health. Approved individuals shall be employed by or
34 in consultation with facilities certified under article twenty-eight of
35 the public health law, diagnostic and treatment centers, federally qual-
36 ified health centers, clinics, physicians or other licensed healthcare
37 providers, to provide patient navigation services. Individuals author-
38 ized to provide patient navigation services shall do so under the gener-
39 al supervision of a licensed physician or other licensed healthcare
40 provider.
41 § 4. Subdivision 2 of section 365-a of the social services law is
42 amended by adding a new paragraph (nn) to read as follows:
43 (nn) (i) patient navigation services to improve access to care for
44 individuals who are eligible for screening, follow-up or treatment
45 services. Eligibility for patient navigation services coverage includes
46 individuals with a serious condition that is expected to last at least
47 three months and places the individual at high risk for one or more of
48 the following:
49 (A) hospitalization;
50 (B) nursing home placement;
51 (C) a sudden worsening of preexisting symptoms;
52 (D) physical or mental decline; or
53 (E) death.
54 (ii) Patient navigation services shall include but not be limited to:
55 (A) screening for nonclinical and social needs that do not require a
56 licensed healthcare provider to complete;
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1 (B) referrals and follow-up to connect individuals to services includ-
2 ing, but not limited to transportation, employment, job training, food
3 insecurity, childcare, housing, language or health literacy support;
4 (C) help with enrollment or maintaining enrollment in government
5 programs or other assistance programs;
6 (D) arranging for and accompaniment to in-person and virtual health-
7 care visits; or
8 (E) other prevention, screening and treatment health education, health
9 navigation, health advocacy, or individual supports including transition
10 of care supports.
11 (iii) Reimbursement shall be provided to individuals who are trained
12 and have completed a national patient navigation certification or
13 credentialing program, or other certification or training program
14 approved by the department of health. Approved individuals shall be
15 employed by or in consultation with facilities certified under article
16 twenty-eight of the public health law, diagnostic and treatment centers,
17 federally qualified health centers, clinics, physicians or other
18 licensed healthcare providers, to provide patient navigation services.
19 Individuals authorized to provide patient navigation services shall do
20 so under the general supervision of a licensed physician or other
21 licensed healthcare provider.
22 § 5. This act shall take effect on the first of January next succeed-
23 ing the date on which it shall have become a law and shall apply to all
24 policies and contracts issued, renewed, modified, altered or amended on
25 or after such date. Effective immediately, the addition, amendment
26 and/or repeal of any rule or regulation necessary for the implementation
27 of this act on its effective date are authorized to be made and
28 completed on or before such effective date.
