S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 7003--A

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                             April 29, 2013
                               ___________

Introduced  by  M.  of  A.  CUSICK, SALADINO, RUSSELL, CYMBROWITZ, RAIA,
  JOHNS, DenDEKKER, PEOPLES-STOKES, OTIS, GOTTFRIED, RA  --  Multi-Spon-
  sored by -- M. of A.  ABBATE, HIKIND, JACOBS, McDONOUGH, MOSLEY, SWEE-
  NEY,  THIELE, WEISENBERG -- read once and referred to the Committee on
  Insurance -- recommitted to the Committee on Insurance  in  accordance
  with  Assembly  Rule  3, sec. 2 -- committee discharged, bill amended,
  ordered reprinted as amended and recommitted to said committee

AN ACT to amend the insurance  law,  in  relation  to  requiring  health
  insurance coverage for drug and alcohol abuse and dependency treatment
  services

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
amended by adding a new paragraph 30 to read as follows:
  (30)  (A)  EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
WHICH PROVIDES MEDICAL,  MAJOR  MEDICAL  OR  SIMILAR  COMPREHENSIVE-TYPE
COVERAGE  SHALL INCLUDE SPECIFIC COVERAGE FOR DRUG AND ALCOHOL ABUSE AND
DEPENDENCY TREATMENT SERVICES THAT ARE CERTIFIED AS NECESSARY BY A QUAL-
IFIED HEALTH PROFESSIONAL, AS DEFINED IN THE REGULATIONS OF THE  COMMIS-
SIONER OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES.
  (B) THE ONLY PREREQUISITE FOR THE COVERAGE OF HOSPITAL OR NON-HOSPITAL
BASED  DETOXIFICATION, INCLUDING MEDICALLY MANAGED, MEDICALLY SUPERVISED
AND MEDICALLY MONITORED WITHDRAWAL, OR INPATIENT OR  INTENSIVE  RESIDEN-
TIAL REHABILITATION, OR INTENSIVE OR ROUTINE OUTPATIENT TREATMENT, SHALL
BE THAT A COVERED PERSON BE CERTIFIED AND REFERRED BY A QUALIFIED HEALTH
PROFESSIONAL.  SUCH  CERTIFICATION  AND  REFERRAL SHALL CONTROL BOTH THE
NATURE AND DURATION OF COVERED TREATMENT; PROVIDED, HOWEVER,  THAT  SUCH
COVERAGE  SHALL BE TERMINATED WHEN THE ADMITTING OR ATTENDING PHYSICIAN,
OR A PHYSICIAN ASSISTANT OR NURSE PRACTITIONER PROVIDING DETOXIFICATION,
REHABILITATION OR OUTPATIENT TREATMENT CERTIFIES THAT ADMISSION  OF  THE
COVERED PERSON IS NOT NECESSARY, EARLY DISCHARGE IS APPROPRIATE OR ADDI-
TIONAL INPATIENT DAYS OR SESSIONS ARE NECESSARY.
  (C) THE LOCATION OF COVERED TREATMENT PURSUANT TO THIS PARAGRAPH SHALL
BE  SUBJECT TO THE INSURER'S REQUIREMENTS RELATING TO THE USE OF PARTIC-

              

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05370-03-4

A. 7003--A                          2

IPATING PROVIDERS, INCLUDING THOSE  PROVIDERS  LOCATED  OUTSIDE  OF  THE
STATE.
  S 2. Subsection (1) of section 3221 of the insurance law is amended by
adding a new paragraph 19 to read as follows:
  (19)(A) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY
IN  THIS  STATE WHICH PROVIDES MEDICAL, MAJOR MEDICAL OR SIMILAR COMPRE-
HENSIVE-TYPE COVERAGE SHALL INCLUDE SPECIFIC COVERAGE FOR DRUG AND ALCO-
HOL ABUSE AND DEPENDENCY TREATMENT SERVICES THAT ARE CERTIFIED AS NECES-
SARY BY A QUALIFIED HEALTH PROFESSIONAL, AS DEFINED IN  THE  REGULATIONS
OF THE COMMISSIONER OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES.
  (B) THE ONLY PREREQUISITE FOR THE COVERAGE OF HOSPITAL OR NON-HOSPITAL
BASED  DETOXIFICATION, INCLUDING MEDICALLY MANAGED, MEDICALLY SUPERVISED
AND MEDICALLY MONITORED WITHDRAWAL, OR INPATIENT OR  INTENSIVE  RESIDEN-
TIAL REHABILITATION, OR INTENSIVE OR ROUTINE OUTPATIENT TREATMENT, SHALL
BE THAT A COVERED PERSON BE CERTIFIED AND REFERRED BY A QUALIFIED HEALTH
PROFESSIONAL.  SUCH  CERTIFICATION  AND  REFERRAL SHALL CONTROL BOTH THE
NATURE AND DURATION OF COVERED TREATMENT; PROVIDED, HOWEVER,  THAT  SUCH
COVERAGE  SHALL BE TERMINATED WHEN THE ADMITTING OR ATTENDING PHYSICIAN,
OR A PHYSICIAN ASSISTANT OR NURSE PRACTITIONER PROVIDING DETOXIFICATION,
REHABILITATION OR OUTPATIENT TREATMENT CERTIFIES THAT ADMISSION  OF  THE
COVERED PERSON IS NOT NECESSARY, EARLY DISCHARGE IS APPROPRIATE OR ADDI-
TIONAL INPATIENT DAYS OR SESSIONS ARE NECESSARY.
  (C) THE LOCATION OF COVERED TREATMENT PURSUANT TO THIS PARAGRAPH SHALL
BE  SUBJECT TO THE INSURER'S REQUIREMENTS RELATING TO THE USE OF PARTIC-
IPATING PROVIDERS, INCLUDING THOSE  PROVIDERS  LOCATED  OUTSIDE  OF  THE
STATE.
  S  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (oo) to read as follows:
  (OO)(1) EVERY CONTRACT ISSUED BY A HOSPITAL SERVICE COMPANY OR  HEALTH
SERVICE  CORPORATION  WHICH  PROVIDES  MEDICAL, MAJOR MEDICAL OR SIMILAR
COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE SPECIFIC COVERAGE FOR DRUG AND
ALCOHOL ABUSE AND DEPENDENCY TREATMENT SERVICES THAT  ARE  CERTIFIED  AS
NECESSARY  BY  A  QUALIFIED HEALTH PROFESSIONAL, AS DEFINED IN THE REGU-
LATIONS OF THE COMMISSIONER OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES.
  (2) THE ONLY PREREQUISITE FOR THE COVERAGE OF HOSPITAL OR NON-HOSPITAL
BASED DETOXIFICATION, INCLUDING MEDICALLY MANAGED, MEDICALLY  SUPERVISED
AND  MEDICALLY  MONITORED WITHDRAWAL, OR INPATIENT OR INTENSIVE RESIDEN-
TIAL REHABILITATION, OR INTENSIVE OR ROUTINE OUTPATIENT TREATMENT, SHALL
BE THAT A COVERED PERSON BE CERTIFIED AND REFERRED BY A QUALIFIED HEALTH
PROFESSIONAL. SUCH CERTIFICATION AND REFERRAL  SHALL  CONTROL  BOTH  THE
NATURE  AND  DURATION OF COVERED TREATMENT, PROVIDED, HOWEVER, THAT SUCH
COVERAGE SHALL BE TERMINATED WHEN THE ADMITTING OR ATTENDING  PHYSICIAN,
OR A PHYSICIAN ASSISTANT OR NURSE PRACTITIONER PROVIDING DETOXIFICATION,
REHABILITATION  OR  OUTPATIENT TREATMENT CERTIFIES THAT ADMISSION OF THE
COVERED PERSON IS NOT NECESSARY, EARLY DISCHARGE IS APPROPRIATE OR ADDI-
TIONAL INPATIENT DAYS OR SESSIONS ARE NECESSARY.
  (3) THE LOCATION OF COVERED  TREATMENT  PURSUANT  TO  THIS  SUBSECTION
SHALL  BE  SUBJECT  TO THE INSURER'S REQUIREMENTS RELATING TO THE USE OF
PARTICIPATING PROVIDERS, INCLUDING THOSE PROVIDERS  LOCATED  OUTSIDE  OF
THE STATE.
  S  4. This act shall take effect on the first of January next succeed-
ing the date on which it shall have become a  law  and  shall  apply  to
policies  and contracts issued, renewed, modified, altered or amended on
or after such date.