S T A T E O F N E W Y O R K
________________________________________________________________________
4293
2013-2014 Regular Sessions
I N A S S E M B L Y
February 1, 2013
___________
Introduced by M. of A. CURRAN -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to allowing reimburse-
ments for certain services provided by licensed mental health counse-
lors
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 4 of subsection (i) of section 3216 of the insur-
ance law is amended to read as follows:
(4) If a policy provides for reimbursement for psychiatric or psycho-
logical services or for diagnosis and treatment of mental, nervous, or
emotional disorders or ailments, however defined in the policy, the
insured shall be entitled to reimbursement for such services, diagnosis
or treatment whether performed by a physician, psychiatrist [or], a
certified and registered psychologist, OR A LICENSED MENTAL HEALTH COUN-
SELOR when the services rendered are within the lawful scope of their
practice.
S 2. Paragraph 4 of subsection (l) of section 3221 of the insurance
law, subparagraphs (A) and (D) as amended by chapter 230 of the laws of
2004 and subparagraph (B) as amended by chapter 420 of the laws of 2002,
is amended to read as follows:
(4) (A) Every insurer delivering a group policy or issuing a group
policy for delivery, in this state, which provides reimbursement for
psychiatric or psychological services or for the diagnosis and treatment
of mental, nervous or emotional disorders and ailments, however defined
in such policy, by physicians, psychiatrists or psychologists, must make
available and if requested by the policyholder provide the same coverage
to insureds for such services when performed by a licensed clinical
social worker, within the lawful scope of his or her practice, who is
licensed pursuant to article one hundred fifty-four of the education law
OR A LICENSED MENTAL HEALTH COUNSELOR, WITHIN THE LAWFUL SCOPE OF HIS OR
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08431-01-3
A. 4293 2
HER PRACTICE, WHO IS LICENSED PURSUANT TO ARTICLE ONE HUNDRED
SIXTY-THREE OF THE EDUCATION LAW. Written notice of the availability of
such coverage shall be delivered to the policyholder prior to inception
of such group policy and annually thereafter, except that this notice
shall not be required where a policy covers two hundred or more employ-
ees or where the benefit structure was the subject of collective
bargaining affecting persons who are employed in more than one state.
(B) The state board for social work shall maintain a list of all
licensed clinical social workers qualified for reimbursement under this
paragraph. THE STATE BOARD OF MENTAL HEALTH PRACTITIONERS SHALL MAINTAIN
A LIST OF ALL LICENSED MENTAL HEALTH COUNSELORS QUALIFIED FOR REIMBURSE-
MENT UNDER THIS PARAGRAPH.
(C) Such coverage shall be made available at the inception of all new
policies and, with respect to all other policies at any subsequent annu-
al anniversary date of the policy subject to evidence of insurability.
(D) In addition to the requirements of subparagraph (A) of this para-
graph, every insurer issuing a group policy for delivery in this state
which policy provides reimbursement to insureds for psychiatric or
psychological services or for the diagnosis and treatment of mental,
nervous or emotional disorders and ailments, however defined in such
policy, by physicians, psychiatrists or psychologists, must provide the
same coverage to insureds for such services when performed by a licensed
clinical social worker, within the lawful scope of his or her practice,
who is licensed pursuant to subdivision two of section seven thousand
seven hundred four of the education law OR A LICENSED MENTAL HEALTH
COUNSELOR, WITHIN THE LAWFUL SCOPE OF HIS OR HER PRACTICE, WHO IS
LICENSED PURSUANT TO SUBDIVISION THREE OF SECTION EIGHT THOUSAND FOUR
HUNDRED TWO OF THE EDUCATION LAW and in addition shall have either (i)
three or more additional years experience in psychotherapy, which for
the purposes of this subparagraph shall mean the use of verbal methods
in interpersonal relationships with the intent of assisting a person or
persons to modify attitudes and behavior which are intellectually,
socially or emotionally maladaptive, under supervision, satisfactory to
the state board for social work OR THE STATE BOARD OF MENTAL HEALTH
PRACTITIONERS, in a facility, licensed or incorporated by an appropriate
governmental department, providing services for diagnosis or treatment
of mental, nervous or emotional disorders or ailments, or (ii) three or
more additional years experience in psychotherapy under the supervision,
satisfactory to the state board for social work OR THE STATE BOARD OF
MENTAL HEALTH PRACTITIONERS, of a psychiatrist, a licensed and regis-
tered psychologist [or], a licensed clinical social worker OR A LICENSED
MENTAL HEALTH COUNSELOR qualified for reimbursement pursuant to
subsection (h) of this section, or (iii) a combination of the experience
specified in items (i) and (ii) OF THIS SUBPARAGRAPH totaling three
years, satisfactory to the state board for social work OR THE STATE
BOARD OF MENTAL HEALTH PRACTITIONERS. The state board for social work
shall maintain a list of all licensed clinical social workers qualified
for reimbursement under this subparagraph. THE STATE BOARD OF MENTAL
HEALTH PRACTITIONERS SHALL MAINTAIN A LIST OF ALL LICENSED MENTAL HEALTH
COUNSELORS QUALIFIED FOR REIMBURSEMENT UNDER THIS SUBPARAGRAPH.
S 3. Item (ii) of subparagraph (A) of paragraph 5 of subsection (l) of
section 3221 of the insurance law, as amended by chapter 502 of the laws
of 2007, is amended to read as follows:
(ii) where the policy provides coverage for physician services, it
shall include benefits for outpatient care provided by a psychiatrist or
psychologist licensed to practice in this state, a licensed clinical
A. 4293 3
social worker OR A LICENSED MENTAL HEALTH COUNSELOR who meets the
requirements of subparagraph (D) of paragraph four of this subsection,
or a professional corporation or university faculty practice corporation
thereof. Such benefits may be limited to not less than twenty visits in
any contract year, plan year, or calendar year.
S 4. Subparagraph (G) of paragraph 4 of subsection (f) of section 4235
of the insurance law, as relettered by chapter 456 of the laws of 1993,
is amended to read as follows:
(G) psychiatric or psychological services or for the diagnosis and
treatment of mental, nervous, or emotional disorders or ailments, howev-
er defined in such policy, a subscriber to such policy shall be entitled
to reimbursement for such psychiatric or psychological services or diag-
nosis or treatment whether performed by a physician, psychiatrist [or],
a certified and registered psychologist OR A LICENSED MENTAL HEALTH
COUNSELOR when the services rendered are within the lawful scope of
their practice, and when such policy or any certificate issued there-
under is delivered or issued for delivery without this state by an
authorized insurer, covered persons residing in this state shall be
entitled to reimbursement for such diagnosis and treatment by a physi-
cian, psychiatrist or a certified and registered psychologist as herein-
above provided; and
S 5. Paragraph 1 of subsection (h) and subsections (i) and (n) of
section 4303 of the insurance law, paragraph 1 of subsection (h) as
amended by chapter 502 of the laws of 2007 and subsections (i) and (n)
as amended by chapter 230 of the laws of 2004, are amended to read as
follows:
(1) A medical expense indemnity corporation or a health service corpo-
ration, which provides group, group remittance or school blanket cover-
age for physician services, shall provide as part of its contract broad-
based coverage for the diagnosis and treatment of mental, nervous or
emotional disorders or ailments, however defined in such contract, at
least equal to the coverage provided for other health conditions and
shall include: benefits for outpatient care provided by a psychiatrist
or psychologist licensed to practice in this state, a licensed clinical
social worker OR A LICENSED MENTAL HEALTH COUNSELOR who meets the
requirements of subsection (n) of this section, or a professional corpo-
ration or university faculty practice corporation thereof, which bene-
fits may be limited to not less than twenty visits in any contract year,
plan year or calendar year. Such coverage may be provided on a contract
year, plan year or calendar year basis and shall be consistent with the
provision of other benefits under the contract. Such coverage may be
subject to annual deductibles, co-pays and coinsurance as may be deemed
appropriate by the superintendent and shall be consistent with those
imposed on other benefits under the contract. In the event the group
remittance group or contract holder is provided coverage provided under
this paragraph and under subparagraph (B) of paragraph one of subsection
(g) of this section from the same health service corporation, or under a
contract which is jointly underwritten by two health service corpo-
rations or by a health service corporation and a medical expense indem-
nity corporation, the aggregate of the benefits for out-patient care
obtained under subparagraph (B) of paragraph one of subsection (g) of
this section and this paragraph may be limited to not less than twenty
visits in any contract year, plan year or calendar year.
(i) A medical expense indemnity corporation or health service corpo-
ration which provides coverage for physicians, psychiatrists or psychol-
ogists for psychiatric or psychological services or for the diagnosis
A. 4293 4
and treatment of mental, nervous or emotional disorders and ailments,
however defined in such contract, must make available and if requested
by all persons holding individual contracts in a group whose premiums
are paid by a remitting agent or by the contract holder in the case of a
group contract issued pursuant to section four thousand three hundred
five of this article, provide the same coverage for such services when
performed by a licensed clinical social worker, within the lawful scope
of his or her practice, who is licensed pursuant to article one hundred
fifty-four of the education law OR A LICENSED MENTAL HEALTH COUNSELOR,
WITHIN THE LAWFUL SCOPE OF HIS OR HER PRACTICE, WHO IS LICENSED PURSUANT
TO ARTICLE ONE HUNDRED SIXTY-THREE OF THE EDUCATION LAW. The state board
for social work shall maintain a list of all licensed clinical social
workers qualified for reimbursement under this subsection. THE STATE
BOARD OF MENTAL HEALTH PRACTITIONERS SHALL MAINTAIN A LIST OF ALL
LICENSED CLINICAL SOCIAL WORKERS QUALIFIED FOR REIMBURSEMENT UNDER THIS
SUBSECTION. Such coverage shall be made available at the inception of
all new contracts and, with respect to all other contracts, at any anni-
versary date subject to evidence of insurability. Written notice of the
availability of such coverage shall be delivered to the group remitting
agent or group contract holder prior to inception of such contract and
annually thereafter, except that this notice shall not be required where
a policy covers two hundred or more employees or where the benefit
structure was the subject of collective bargaining affecting persons who
are employed in more than one state.
(n) In addition to the requirements of subsection (i) of this section,
every health service or medical expense indemnity corporation issuing a
group contract pursuant to this section or a group remittance contract
for delivery in this state which contract provides reimbursement to
subscribers or physicians, psychiatrists or psychologists for psychiat-
ric or psychological services or for the diagnosis and treatment of
mental, nervous or emotional disorders and ailments, however defined in
such contract, must provide the same coverage to persons covered under
the group contract for such services when performed by a licensed clin-
ical social worker, within the lawful scope of his or her practice, who
is licensed pursuant to subdivision two of section seven thousand seven
hundred four of the education law OR A LICENSED MENTAL HEALTH COUNSELOR,
WITHIN THE LAWFUL SCOPE OF HIS OR HER PRACTICE, WHO IS LICENSED PURSUANT
TO SUBDIVISION THREE OF SECTION EIGHT THOUSAND FOUR HUNDRED TWO OF THE
EDUCATION LAW and in addition shall have either (i) three or more addi-
tional years experience in psychotherapy, which for the purposes of this
subsection shall mean the use of verbal methods in interpersonal
relationships with the intent of assisting a person or persons to modify
attitudes and behavior which are intellectually, socially or emotionally
maladaptive, under supervision, satisfactory to the state board for
social work OR THE STATE BOARD OF MENTAL HEALTH PRACTITIONERS, in a
facility, licensed or incorporated by an appropriate governmental
department, providing services for diagnosis or treatment of mental,
nervous or emotional disorders or ailments, or (ii) three or more addi-
tional years experience in psychotherapy under the supervision, satis-
factory to the state board for social work OR THE STATE BOARD OF MENTAL
HEALTH PRACTITIONERS, of a psychiatrist, a licensed and registered
psychologist or a licensed clinical social worker OR LICENSED MENTAL
HEALTH PRACTITIONER qualified for reimbursement pursuant to subsection
(i) of this section, or (iii) a combination of the experience specified
in [paragraphs] ITEMS (i) and (ii) OF THIS SUBPARAGRAPH totaling three
years, satisfactory to the state board for social work OR THE STATE
A. 4293 5
BOARD OF MENTAL HEALTH PRACTITIONERS. The state board for social work
shall maintain a list of all licensed clinical social workers qualified
for reimbursement under this subsection. THE STATE BOARD OF MENTAL
HEALTH PRACTITIONERS SHALL MAINTAIN A LIST OF ALL LICENSED MENTAL HEALTH
COUNSELORS QUALIFIED FOR REIMBURSEMENT UNDER THIS SUBSECTION.
S 6. This act shall take effect on the ninetieth day after it shall
have become a law.