senate Bill S4623

Amended

Requires health insurance to cover drug and alcohol abuse and dependency treatment services

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 16 / Apr / 2013
    • REFERRED TO INSURANCE
  • 08 / Jan / 2014
    • REFERRED TO INSURANCE
  • 25 / Apr / 2014
    • AMEND AND RECOMMIT TO INSURANCE
  • 25 / Apr / 2014
    • PRINT NUMBER 4623A

Summary

Requires health insurance to cover drug and alcohol abuse and dependency treatment services.

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Bill Details

Versions:
S4623
S4623A
Legislative Cycle:
2013-2014
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3216, 3221 & 4303, Ins L
Versions Introduced in 2013-2014 Legislative Cycle:
A7003A

Sponsor Memo

BILL NUMBER:S4623

TITLE OF BILL: An act to amend the insurance law, in relation to
requiring health insurance coverage for drug and alcohol abuse and
dependency treatment services

PURPOSE: To ensure that patients suffering from drug and alcohol
dependency receive appropriate care, by directing insurers to provide
authorization and payment to appropriately licensed healthcare
providers for detoxification, rehabilitation and intensive residential
rehabilitation based on the examining physician's recommendation.

SUMMARY OF PROVISIONS:

Section 1 adds a new paragraph (30) to subsection (i) of section 3216
of the Insurance Law to require every policy delivered or issued for
delivery in New York State which provides medical, major medical, or
similar comprehensive-type coverage to include specific coverage for
drug and alcohol abuse and dependency treatment services that are
certified as necessary by a qualified health professional. The only
prerequisite for the coverage of hospital-based detoxification is the
certification and referral by a qualified health professional which
will control both the nature and the duration of covered treatment,
excepting when the attending physician providing the drug and alcohol
treatment certifies that admission of the covered person is not
necessary, early discharge is appropriate, or additional days or
sessions are necessary. The location of covered treatment is dependent
on the insurer's requirements relating to the use of participating
providers.

Section 2 adds a new paragraph (19) to subsection (1) of section 3221
of the Insurance Law. This section's language mirrors that of section
1, pertaining to every group or blanket policy delivered or issued for
delivery in New York State.

Section 3 adds a new subsection (oo) to section 4303 of the Insurance
law. This section's language again mirrors that of section 1,
pertaining to every contract issued by a hospital service company or
health service corporation.

Section 4 provides an effective date.

JUSTIFICATION: Prescription Drug Abuse is a public health crisis.
During the 2011-12 Legislative Session the Senate Health Committee
held two Roundtables on the subject and issued a report entitled "The
Prescription Drug Crisis in New York State: A Comprehensive Approach."
In 2012 New York State took a bold step and adopted I-STOP (The
Internet System for Tracking Over-Prescribing) which includes a number
of provisions aimed at gaining better control over prescribing of
controlled substances. At the same time, Nassau and Suffolk County
each convened Task Forces on Prescription Drug Abuse. This legislation
addresses concerns raised and recommendation that have been made to
make sure patients whose health care provider feels that they need
drug or alcohol addiction treatment are able to access those services
from their insurer.


This legislation recognizes the important balance between insurers and
providers in providing appropriate health care services. Many
insurance companies rate healthcare providers based on the provider's
ability to place patients into the appropriate level of care and
contract with providers on this ability, as well as the provider's
ability to deliver quality healthcare outcomes. Providers are not
going to automatically start admitting everyone unnecessarily for
several reasons: 1) there will be no capacity increase in this bill,
limiting the number of available beds to what they are at the present
time; and 2) insurers can decide not to contract with providers who
admit patients too readily, frequently or unnecessarily. In addition,
with payment reform a part of the health care system overhaul and
Affordable Care Act, providers have begun to take on the payment risk.
By having arrangements with insurers to manage a population of
beneficiaries and being paid a set amount for these managed lives, as
opposed to on a fee-for-service basis, providers will make decisions
based on what a patient needs, rather than on what they might get paid
for a particular procedure. If a health care facility admits patients
unnecessarily, the dollars will soon be coming out of their pocket,
NOT the insurance company.

A similar provision was adopted in the State of Pennsylvania in 1989
and has proven effective in ensuring appropriate treatment for those
suffering from alcohol and drug addiction. This legislation will
provide a focus for New York to consider similar provisions. As New
York's I-STOP law goes into effect, those currently addicted to
prescription pain medication may find their sources dry up and seek
treatment. This bill is an important next step to ensure those seeking
treatment can access it.

PRIOR LEGISLATIVE HISTORY: New Bill

FISCAL IMPLICATIONS: To be determined

EFFECTIVE DATE: The first of January next succeeding 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.

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

                                  4623

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                             April 16, 2013
                               ___________

Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

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 ACTING UNDER  THE  SUPER-
VISION  OF  A  PHYSICIAN,  PROVIDING  DETOXIFICATION,  REHABILITATION OR
OUTPATIENT TREATMENT CERTIFIES THAT ADMISSION OF THE COVERED  PERSON  IS
NOT  NECESSARY,  EARLY  DISCHARGE IS APPROPRIATE OR ADDITIONAL 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.
                                                           LBD05370-02-3

S. 4623                             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 ACTING UNDER  THE  SUPER-
VISION  OF  A  PHYSICIAN,  PROVIDING  DETOXIFICATION,  REHABILITATION OR
OUTPATIENT TREATMENT CERTIFIES THAT ADMISSION OF THE COVERED  PERSON  IS
NOT  NECESSARY,  EARLY  DISCHARGE IS APPROPRIATE OR ADDITIONAL 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 ACTING UNDER  THE  SUPER-
VISION  OF  A  PHYSICIAN,  PROVIDING  DETOXIFICATION,  REHABILITATION OR
OUTPATIENT TREATMENT CERTIFIES THAT ADMISSION OF THE COVERED  PERSON  IS
NOT  NECESSARY,  EARLY  DISCHARGE IS APPROPRIATE OR ADDITIONAL 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.

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