senate Bill S7662

Amended

Relates to insurance coverage for substance abuse disorder

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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

  • 23 / May / 2014
    • REFERRED TO INSURANCE
  • 02 / Jun / 2014
    • REPORTED AND COMMITTED TO RULES
  • 03 / Jun / 2014
    • AMEND (T) AND RECOMMIT TO RULES
  • 03 / Jun / 2014
    • PRINT NUMBER 7662A
  • 03 / Jun / 2014
    • ORDERED TO THIRD READING CAL.1151
  • 09 / Jun / 2014
    • PASSED SENATE
  • 09 / Jun / 2014
    • DELIVERED TO ASSEMBLY
  • 09 / Jun / 2014
    • REFERRED TO INSURANCE

Summary

Relates to insurance coverage for substance abuse disorder; requires health plans to use a health care provider who specializes in behavioral health or substance use disorder treatment to supervise and oversee the medical management decisions relating to substance abuse treatment.

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Bill Details

Versions:
S7662
S7662A
Legislative Cycle:
2013-2014
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Add ยง3242, Ins L

Sponsor Memo

BILL NUMBER:S7662

TITLE OF BILL: An act to amend the insurance law, in relation to
requiring health insurance coverage for substance abuse disorder
treatment services and creating a workgroup to study and make
recommendations

PURPOSE: This legislation clarifies that health insurance coverage
must provide for substance abuse disorder treatment services improves
the utilization review process for determining such insurance coverage
and requires insurers to continue to provide coverage throughout the
entire appeals process.

SUMMARY OF PROVISIONS: Section one amends the insurance law by adding
a new section 3242 entitled coverage for substance abuse disorder. It
clarifies that health plans shall include specific coverage for drug
and alcohol abuse and dependency treatment services pursuant to the
federal Mental Health and Parity Act of 2008 and applicable state
statutes, It also requires a health plan to use a health care provider
who specializes in substance abuse disorder treatment when conducting
medical management or utilization review and utilizes only clinical
review criteria contained in the American Society of Addiction
Medicine's Patient Placement Criteria or a similar criteria deemed
appropriate and approved by OASAS in consultation with DFS and DOH.
This section also requires all internal and external appeals to be
conducted on an expedited basis and health plans to provide coverage
for substance abuse services until all appeals, both internal and
external, have been exhausted

Section 2 creates a workgroup to study and make recommendations on
improving access to and availability of substance abuse and dependency
treatment services. The workgroup shall submit a report by December
31, 2014

JUSTIFICATION: The New York State Senate Heroin and Opioid Task Force
has held hearings throughout the state to discuss the rise in the use
of heroin and other opioids in New York State and to develop
recommendations for treating and preventing addiction. At each of
these hearings, the issue of health insurance coverage has been at the
forefront This legislation will improve access to care by ensuring
that decisions regarding treatment are strengthened and standardized
and that they are made by medical doctors who specialize in substance
abuse, Further, the legislation also ensures that individuals
requiring treatment have access to an expedited appeals process and
that they are not denied care while the appeals process is underway
The legislation also establishes a workgroup to be convened jointly
with OASAS, DFS and DOH in order to study and develop recommendations
on improving access to and availability of substance abuse and
dependency treatment services.

LEGISLATIVE HISTORY: New bill.

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: Immediately.


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

                                  7662

                            I N  S E N A T E

                              May 23, 2014
                               ___________

Introduced by Sens. SEWARD, HANNON, MARTINS, RITCHIE, BOYLE, BALL, BONA-
  CIC,  CARLUCCI,  FELDER,  GALLIVAN,  GOLDEN,  GRIFFO,  LANZA,  LARKIN,
  LITTLE, MARCELLINO, MARCHIONE, MAZIARZ, NOZZOLIO, O'MARA, RANZENHOFER,
  ROBACH, SAVINO, VALESKY, YOUNG -- 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 substance abuse disorder treatment services and
  creating a workgroup to study and make recommendations

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

  Section  1.  The insurance law is amended by adding a new section 3242
to read as follows:
  S 3242. COVERAGE FOR SUBSTANCE ABUSE DISORDER. (A)  (1)  EVERY  POLICY
DELIVERED  OR  ISSUED  FOR DELIVERY BY A HEALTH PLAN IN THIS STATE WHICH
PROVIDES MEDICAL, MAJOR MEDICAL OR SIMILAR  COMPREHENSIVE-TYPE  COVERAGE
SHALL INCLUDE SPECIFIC COVERAGE FOR DRUG AND ALCOHOL ABUSE AND DEPENDEN-
CY  TREATMENT  SERVICES  PURSUANT TO THE FEDERAL PAUL WELLSTONE AND PETE
DOMENICI MENTAL HEALTH PARITY AND ADDICTION  EQUITY  ACT  OF  2008,  AND
APPLICABLE STATE STATUTES WHICH REQUIRES PARITY BETWEEN MENTAL HEALTH OR
SUBSTANCE  USE  DISORDER  BENEFITS  AND  MEDICAL/SURGICAL  BENEFITS WITH
RESPECT TO FINANCIAL REQUIREMENTS AND TREATMENT.
  (2) DETERMINATION OF COVERAGE FOR SUBSTANCE ABUSE OR DEPENDENCY TREAT-
MENT SERVICES BY A HEALTH PLAN SHALL BE MADE THROUGH A  MEDICAL  MANAGE-
MENT REVIEW PROCESS WHICH:
  (A)  UTILIZES  A HEALTH CARE PROVIDER WHO SPECIALIZES IN SUBSTANCE USE
DISORDER; AND
  (B) UTILIZES ONLY CLINICAL REVIEW CRITERIA CONTAINED IN  THE  AMERICAN
SOCIETY  OF  ADDICTION  MEDICINE'S PATIENT PLACEMENT CRITERIA OR ANOTHER
CARE CRITERIA OR COMPENDIA DEEMED APPROPRIATE AND APPROVED FOR SUCH  USE
BY THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES IN CONSULTATION
WITH THE COMMISSIONER OF HEALTH AND THE SUPERINTENDENT OF THE DEPARTMENT
OF FINANCIAL SERVICES.
  (3)  THE  LOCATION OF COVERED TREATMENT PURSUANT TO THIS SECTION 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.
S                                                          LBD15361-02-4

S. 7662                             2

IPATING  PROVIDERS,  INCLUDING  THOSE  PROVIDERS  LOCATED OUTSIDE OF THE
STATE.
  (B)  WHERE AN INSURED'S TREATING HEALTHCARE PROVIDER DETERMINES THAT A
DELAY IN PROVIDING CARE OR  TREATMENT  RELATING  TO  A  SUBSTANCE  ABUSE
DISORDER  WOULD  POSE  A  SERIOUS  THREAT TO THE HEALTH OR SAFETY OF THE
INSURED, ALL INTERNAL AND EXTERNAL APPEALS OF UTILIZATION REVIEW  DETER-
MINATIONS  SHALL  BE  CONDUCTED  ON  AN EXPEDITED BASIS, AS SET FORTH IN
SUBSECTION (B) OF SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THIS  CHAP-
TER  AND  IN  PARAGRAPH THREE OF SUBSECTION (B) OF SECTION FOUR THOUSAND
NINE HUNDRED FOURTEEN OF THIS CHAPTER.
  (C) IN THE EVENT OF AN ADVERSE DETERMINATION FOR  SUBSTANCE  ABUSE  OR
DEPENDENCY TREATMENT SERVICES, THE HEALTH PLAN SHALL CONTINUE TO PROVIDE
COVERAGE  FOR  ALL  SUCH  SERVICES  UNTIL  THE INSURED HAS EXHAUSTED ALL
APPEALS, BOTH INTERNAL AND EXTERNAL, OR OTHERWISE  NOTIFIES  THE  HEALTH
PLAN  THAT  HE  OR  SHE HAS DECIDED TO NOT MOVE FORWARD WITH THE APPEALS
PROCESS.
  (D) FOR PURPOSES OF THIS SECTION: (1) "SUBSTANCE ABUSE  OR  DEPENDENCY
TREATMENT  SERVICES"  SHALL INCLUDE, BUT NOT BE LIMITED TO, HOSPITAL AND
NON-HOSPITAL  BASED   DETOXIFICATION,   INCLUDING   MEDICALLY   MANAGED,
MEDICALLY  SUPERVISED  AND MEDICALLY MONITORED WITHDRAWAL, INPATIENT AND
INTENSIVE RESIDENTIAL REHABILITATION, AND INTENSIVE AND  ROUTINE  OUTPA-
TIENT TREATMENT; AND
  (2) "HEALTH PLAN" SHALL MEAN AN INSURER LICENSED TO WRITE ACCIDENT AND
HEALTH  INSURANCE SUBJECT TO ARTICLE FORTY-TWO OF THIS CHAPTER; A CORPO-
RATION ORGANIZED PURSUANT TO ARTICLE  FORTY-THREE  OF  THIS  CHAPTER;  A
MUNICIPAL  COOPERATIVE HEALTH BENEFIT PLAN CERTIFIED PURSUANT TO ARTICLE
FORTY-SEVEN OF THIS CHAPTER; A HEALTH MAINTENANCE ORGANIZATION CERTIFIED
PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW;  OR  A  STUDENT
HEALTH  PLAN  ESTABLISHED OR MAINTAINED PURSUANT TO SECTION ONE THOUSAND
ONE HUNDRED TWENTY-FOUR OF THIS CHAPTER.
  S 2. 1. Within thirty days of the effective  date  of  this  act,  the
commissioner  of  the office of alcoholism and substance abuse services,
superintendent of the department of financial services, and the  commis-
sioner  of  health,  shall jointly convene a workgroup to study and make
recommendations on improving access to  and  availability  of  substance
abuse  and  dependency  treatment  services  in the state. The workgroup
shall be co-chaired by such commissioners and superintendent, and  shall
include, but not be limited to, a review of the following:
  a.  Identifying barriers to obtaining necessary substance abuse treat-
ment services for across the state;
  b. Recommendations  for  increasing  access  to  and  availability  of
substance  abuse  treatment services in the state, including underserved
areas of the state;
  c. Identifying best clinical practices for substance  abuse  treatment
services;
  d. A review of current insurance coverage requirements and recommenda-
tions for improving insurance coverage for substance abuse and dependen-
cy treatment;
  e.  Recommendations  for  improving  state  agency  communication  and
collaboration relating to substance  abuse  treatment  services  in  the
state; and
  f.  Resources  for  affected  individuals  and families who are having
difficulties obtaining necessary substance abuse treatment services.
  2. The workgroup shall submit a report of its findings and recommenda-
tions to the governor, the temporary president of the senate, the speak-
er of the assembly, the chairs of  the  senate  and  assembly  insurance

S. 7662                             3

committees,  and the chairs of the senate and assembly health committees
no later than December 31, 2014.
  S 3. This act shall take effect immediately.

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