Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|
---|---|
Jun 16, 2014 |
print number 9943b |
Jun 16, 2014 |
amend (t) and recommit to insurance |
Jun 04, 2014 |
print number 9943a |
Jun 04, 2014 |
amend (t) and recommit to insurance |
Jun 02, 2014 |
referred to insurance |
Assembly Bill A9943B
2013-2014 Legislative Session
Sponsored By
CUSICK
Archive: Last Bill Status - In Assembly Committee
- Introduced
-
- In Committee Assembly
- In Committee Senate
-
- On Floor Calendar Assembly
- On Floor Calendar Senate
-
- Passed Assembly
- Passed Senate
- Delivered to Governor
- Signed By Governor
Actions
Bill Amendments
2013-A9943 - Details
- See Senate Version of this Bill:
- S7882
- Current Committee:
- Assembly Insurance
- Law Section:
- Insurance Law
- Laws Affected:
- Amd §§3216, 3221, 4303, 4902, 4903 & 4904, Ins L; amd §§4902, 4903 & 4904, Pub Health L
2013-A9943 - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 9943 I N A S S E M B L Y June 2, 2014 ___________ Introduced by COMMITTEE ON RULES -- (at request of M. of A. Cusick) -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to insurance coverage for substance abuse disorder 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) WHEN CONDUCTING MEDICAL MANAGEMENT OR UTILIZATION REVIEW FOR PURPOSES OF DETERMINING HEALTH CARE COVERAGE FOR SUBSTANCE ABUSE DISORDER, A HEALTH PLAN SHALL USE A HEALTH CARE PROVIDER WHO SPECIALIZES IN BEHAVIORAL HEALTH OR SUBSTANCE ABUSE DISORDER TREATMENT TO SUPERVISE AND OVERSEE THE MEDICAL MANAGEMENT DECISIONS RELATING TO SUBSTANCE ABUSE TREATMENT. (2) A HEALTH PLAN SHALL ONLY UTILIZE CLINICAL REVIEW CRITERIA WHICH ARE BASED ON THE AMERICAN SOCIETY OF ADDICTION MEDICINE'S PATIENT PLACE- MENT CRITERIA, OR ANY OTHER NATIONALLY DEVELOPED, PEER REVIEWED AND WIDELY ACCEPTED CARE CRITERIA OR COMPENDIA WHICH ARE DEEMED APPROPRIATE BY THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, IN CONSULTA- TION WITH THE COMMISSIONER OF HEALTH AND THE SUPERINTENDENT. (3) THE TREATING HEALTHCARE PROVIDER, WHO SHALL BE A QUALIFIED HEALTH PROFESSIONAL AS DEFINED IN REGULATIONS ESTABLISHED BY THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, SHALL, TO THE EXTENT POSSIBLE, ALSO UTILIZE CLINICAL REVIEW CRITERIA WHICH ARE BASED ON THE AMERICAN SOCIETY OF ADDICTION MEDICINE'S PATIENT PLACEMENT CRITERIA, OR ANY OTHER NATIONALLY DEVELOPED, PEER REVIEWED AND WIDELY ACCEPTED CARE CRITERIA OR COMPENDIA WHICH ARE DEEMED APPROPRIATE BY THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, IN CONSULTATION WITH THE COMMISSIONER OF HEALTH AND THE SUPERINTENDENT, WHEN MAKING RECOMMENDATIONS RELATING TO SUBSTANCE ABUSE TREATMENT ON BEHALF OF AN INSURED. (4) THE TREATING HEALTHCARE PROVIDER SHALL SUBMIT ALL REQUESTS FOR PRIOR AUTHORIZATIONS AND ALL APPEALS TO AN INSURED'S HEALTH PLAN IN A TIMELY FASHION. (5) 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-
co-Sponsors
Harvey Weisenberg
Felix Ortiz
Aileen Gunther
James Skoufis
2013-A9943A - Details
- See Senate Version of this Bill:
- S7882
- Current Committee:
- Assembly Insurance
- Law Section:
- Insurance Law
- Laws Affected:
- Amd §§3216, 3221, 4303, 4902, 4903 & 4904, Ins L; amd §§4902, 4903 & 4904, Pub Health L
2013-A9943A - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 9943--A I N A S S E M B L Y June 2, 2014 ___________ Introduced by COMMITTEE ON RULES -- (at request of M. of A. Cusick) -- read once and referred to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law and the public health law, in relation to requiring health insurance coverage for substance abuse disorder treatment services and creating a workgroup to study and make recom- mendations 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 THAT PROVIDES MEDICAL, MAJOR-MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE SPECIFIC COVERAGE FOR DRUG AND ALCOHOL ABUSE AND DEPENDENCY 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. (B) 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: (I) UTILIZES A HEALTH CARE PROVIDER WHO SPECIALIZES IN BEHAVIORAL HEALTH AND WHO HAS EXPERIENCE IN THE DELIVERY OF SUBSTANCE ABUSE COURSES OF TREATMENT TO SUPERVISE AND OVERSEE THE MEDICAL MANAGEMENT DECISIONS RELATING TO SUBSTANCE ABUSE TREATMENT; AND (II) UTILIZES ONLY CLINICAL REVIEW CRITERIA CONTAINED IN THE MOST RECENT EDITION OF THE AMERICAN SOCIETY OF ADDICTION MEDICINE'S PATIENT PLACEMENT CRITERIA OR OTHER RECOGNIZED AND PEER REVIEWED CRITERIA OR COMPENDIA DEEMED APPROPRIATE AND APPROVED FOR SUCH USE BY THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES IN CONSULTATION WITH THE COMMIS- SIONER OF HEALTH AND THE SUPERINTENDENT. ANY ADDITIONAL CRITERIA SHALL BE SUBJECT TO THE APPROVAL OF THE COMMISSIONER OF THE OFFICE OF ALCOHOL- EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.
co-Sponsors
Harvey Weisenberg
Felix Ortiz
Aileen Gunther
James Skoufis
2013-A9943B (ACTIVE) - Details
- See Senate Version of this Bill:
- S7882
- Current Committee:
- Assembly Insurance
- Law Section:
- Insurance Law
- Laws Affected:
- Amd §§3216, 3221, 4303, 4902, 4903 & 4904, Ins L; amd §§4902, 4903 & 4904, Pub Health L
2013-A9943B (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 9943--B I N A S S E M B L Y June 2, 2014 ___________ Introduced by COMMITTEE ON RULES -- (at request of M. of A. Cusick, Weisenberg, Ortiz, Gunther, Skoufis, Rosenthal, Titone, Mosley, Peoples-Stokes, Galef, Barrett, Gottfried, Fahy, Braunstein, Camara, Cook, Hooper, Magee, O'Donnell, Rivera, Saladino, Sweeney, Thiele) -- read once and referred to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- again reported from said committee with amend- ments, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law and the public health law, in relation to requiring health insurance coverage for diagnosis and treatment of substance use 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. 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 THAT PROVIDES MEDICAL, MAJOR-MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE COVERAGE FOR DIAGNOSIS AND TREATMENT OF SUBSTANCE USE DISORDER BENEFITS PURSUANT TO THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008, AS AMENDED, OR OTHER APPLICABLE FEDERAL AND STATE STATUTES AND RULES AND REGULATIONS PROMULGATED THERETO WHICH REQUIRE PARITY BETWEEN MENTAL HEALTH OR SUBSTANCE USE DISORDER BENEFITS AND MEDICAL/SURGICAL BENEFITS WITH RESPECT TO FINANCIAL REQUIREMENTS AND TREATMENT OR WHICH REQUIRE COVERAGE OF SUCH TREATMENT, WHICHEVER PROVIDES A BENEFIT THAT IS MORE ADVANTAGEOUS TO THE POLICYHOLDER AS DETERMINED BY THE SUPERINTENDENT. SUCH COVERAGE SHALL INCLUDE BOTH INPA- TIENT AND OUTPATIENT TREATMENT, INCLUDING DETOXIFICATION AND REHABILI- TATION SERVICES. (B) IN THE EVENT OF AN ADVERSE DETERMINATION FOR SUBSTANCE USE DISOR- DER TREATMENT SERVICES, THE HEALTH PLAN SHALL CONTINUE TO PROVIDE COVER- AGE AND REIMBURSE FOR ALL SUCH SERVICES UNTIL THE INSURED HAS EXHAUSTED ALL APPEALS, BOTH INTERNAL AND EXTERNAL, OR OTHERWISE NOTIFIES THE HEALTH PLAN IN WRITING THAT HE OR SHE HAS DECIDED TO NOT MOVE FORWARD EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.
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