STATE OF NEW YORK
________________________________________________________________________
2529
2019-2020 Regular Sessions
IN SENATE
January 28, 2019
___________
Introduced by Sen. LITTLE -- read twice and ordered printed, and when
printed to be committed 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 1 of part B of
3 chapter 71 of the laws of 2016, is amended to read as follows:
4 (A) Every policy that provides hospital, major medical or similar
5 comprehensive coverage must provide inpatient coverage for the diagnosis
6 and treatment of substance use disorder, including detoxification and
7 rehabilitation services, for a period of not less than forty-five days.
8 Such inpatient coverage shall include unlimited medically necessary
9 treatment for substance use disorder treatment services provided in
10 residential settings as required by the Mental Health Parity and
11 Addiction Equity Act of 2008 (29 U.S.C. § 1185a). Further, such inpa-
12 tient coverage shall not apply financial requirements or treatment limi-
13 tations, including utilization review requirements, to inpatient
14 substance use disorder benefits that are more restrictive than the
15 predominant financial requirements and treatment limitations applied to
16 substantially all medical and surgical benefits covered by the policy.
17 Further, such coverage shall be provided consistent with the federal
18 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction
19 Equity Act of 2008 (29 U.S.C. § 1185a).
20 § 2. Subparagraph (A) of paragraph 31 of subsection (i) of section
21 3216 of the insurance law, as added by chapter 41 of the laws of 2014,
22 is amended to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02798-01-9
S. 2529 2
1 (A) Every policy that provides medical, major medical or similar
2 comprehensive-type coverage must provide outpatient coverage for the
3 diagnosis and treatment of substance use disorder, including detoxifica-
4 tion and rehabilitation services, for a period of not less than forty-
5 five days. Such coverage shall not apply financial requirements or
6 treatment limitations to outpatient substance use disorder benefits that
7 are more restrictive than the predominant financial requirements and
8 treatment limitations applied to substantially all medical and surgical
9 benefits covered by the policy. Further, such coverage shall be
10 provided consistent with the federal Paul Wellstone and Pete Domenici
11 Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. §
12 1185a).
13 § 3. Subparagraph (A) of paragraph 6 of subsection (l) of section 3221
14 of the insurance law, as amended by section 2 of part B of chapter 71 of
15 the laws of 2016, is amended to read as follows:
16 (A) Every policy that provides hospital, major medical or similar
17 comprehensive coverage must provide inpatient coverage for the diagnosis
18 and treatment of substance use disorder, including detoxification and
19 rehabilitation services, for a period of not less than forty-five days.
20 Such inpatient coverage shall include unlimited medically necessary
21 treatment for substance use disorder treatment services provided in
22 residential settings as required by the Mental Health Parity and
23 Addiction Equity Act of 2008 (29 U.S.C. § 1185a). Further, such inpa-
24 tient coverage shall not apply financial requirements or treatment limi-
25 tations, including utilization review requirements, to inpatient
26 substance use disorder benefits that are more restrictive than the
27 predominant financial requirements and treatment limitations applied to
28 substantially all medical and surgical benefits covered by the policy.
29 Further, such coverage shall be provided consistent with the federal
30 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction
31 Equity Act of 2008 (29 U.S.C. § 1185a).
32 § 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221
33 of the insurance law, as amended by chapter 41 of the laws of 2014, is
34 amended to read as follows:
35 (A) Every policy that provides medical, major medical or similar
36 comprehensive-type coverage must provide outpatient coverage for the
37 diagnosis and treatment of substance use disorder, including detoxifica-
38 tion and rehabilitation services, for a period of not less than forty-
39 five days. Such coverage shall not apply financial requirements or
40 treatment limitations to outpatient substance use disorder benefits that
41 are more restrictive than the predominant financial requirements and
42 treatment limitations applied to substantially all medical and surgical
43 benefits covered by the policy. Further, such coverage shall be
44 provided consistent with the federal Paul Wellstone and Pete Domenici
45 Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. §
46 1185a).
47 § 5. Paragraph 1 of subsection (k) of section 4303 of the insurance
48 law, as amended by section 3 of part B of chapter 71 of the laws of
49 2016, is amended to read as follows:
50 (1) Every contract that provides hospital, major medical or similar
51 comprehensive coverage must provide inpatient coverage for the diagnosis
52 and treatment of substance use disorder, including detoxification and
53 rehabilitation services, for a period of not less than forty-five days.
54 Such inpatient coverage shall include unlimited medically necessary
55 treatment for substance use disorder treatment services provided in
56 residential settings as required by the Mental Health Parity and
S. 2529 3
1 Addiction Equity Act of 2008 (29 U.S.C. § 1185a). Further, such inpa-
2 tient coverage shall not apply financial requirements or treatment limi-
3 tations, including utilization review requirements, to inpatient
4 substance use disorder benefits that are more restrictive than the
5 predominant financial requirements and treatment limitations applied to
6 substantially all medical and surgical benefits covered by the contract.
7 Further, such coverage shall be provided consistent with the federal
8 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction
9 Equity Act of 2008 (29 U.S.C. § 1185a).
10 § 6. Paragraph 1 of subsection (l) of section 4303 of the insurance
11 law, as amended by chapter 41 of the laws of 2014, is amended to read as
12 follows:
13 (1) Every contract that provides medical, major medical or similar
14 comprehensive-type coverage must provide outpatient coverage for the
15 diagnosis and treatment of substance use disorder, including detoxifica-
16 tion and rehabilitation services, for a period not less than forty-five
17 days. Such coverage shall not apply financial requirements or treatment
18 limitations to outpatient substance use disorder benefits that are more
19 restrictive than the predominant financial requirements and treatment
20 limitations applied to substantially all medical and surgical benefits
21 covered by the contract. Further, such coverage shall be provided
22 consistent with the federal Paul Wellstone and Pete Domenici Mental
23 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
24 § 7. Paragraph (c) of subdivision 2 of section 365-a of the social
25 services law, as amended by section 12-a of part C of chapter 60 of the
26 laws of 2014, is amended to read as follows:
27 (c) out-patient hospital or clinic services in facilities operated in
28 compliance with applicable provisions of this chapter, the public health
29 law, the mental hygiene law and other laws, including any provisions
30 thereof requiring an operating certificate or license, including facili-
31 ties authorized by the appropriate licensing authority to provide inte-
32 grated mental health services, and/or alcoholism and substance abuse
33 services, and/or physical health services, and/or services to persons
34 with developmental disabilities, when such services are provided at a
35 single location or service site, or where such facilities are not
36 conveniently accessible, in any hospital located within the state and
37 care and services in a day treatment program operated by the department
38 of mental hygiene or by a voluntary agency under an agreement with such
39 department in that part of a public institution operated and approved
40 pursuant to law as an intermediate care facility for persons with devel-
41 opmental disabilities; and provided, that alcoholism and substance abuse
42 services shall be covered for a period of not less than forty-five days;
43 and provided further, that the commissioners of health, mental health,
44 alcoholism and substance abuse services and the office for people with
45 developmental disabilities may issue regulations, including emergency
46 regulations promulgated prior to October first, two thousand fifteen
47 that are required to facilitate the establishment of integrated services
48 clinics. Any such regulations promulgated under this paragraph shall be
49 described in the annual report required pursuant to section forty-five-c
50 of part A of chapter fifty-six of the laws of two thousand thirteen;
51 § 8. Paragraph (n) of subdivision 2 of section 365-a of the social
52 services law, as amended by chapter 558 of the laws of 1999, is amended
53 to read as follows:
54 (n) care, treatment, maintenance and rehabilitation services that
55 would otherwise qualify for reimbursement pursuant to this chapter to
56 persons suffering from alcoholism in alcoholism facilities or chemical
S. 2529 4
1 dependence, as such term is defined in section 1.03 of the mental
2 hygiene law, in inpatient chemical dependence facilities, services, or
3 programs operated in compliance with applicable provisions of this chap-
4 ter and the mental hygiene law, and certified by the office of alcohol-
5 ism and substance abuse services, provided however that such services
6 shall be limited to such periods of time as may be determined necessary
7 in accordance with a utilization review procedure established by the
8 commissioner of the office of alcoholism and substance abuse services
9 and that such services shall be covered for a period of not less than
10 forty-five days, and provided further, that this paragraph shall not
11 apply to any hospital or part of a hospital as defined in section two
12 thousand eight hundred one of the public health law.
13 § 9. This act shall take effect immediately and shall apply to all
14 policies and contracts issued, renewed, modified, altered or amended on
15 or after such date.
