senate Bill S7103

2013-2014 Legislative Session

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

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Archive: Last Bill Status - In Committee


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

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Senate Actions - UPPERCASE
Apr 28, 2014 referred to insurance

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S7103 - Bill Details

Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L

S7103 - Bill Texts

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

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BILL NUMBER:S7103

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 OR GENERAL IDEA OF BILL: To expand the time frame in which
insurance companies will provide coverage for rehabilitation of opioid
users.

SUMMARY OF SPECIFIC PROVISIONS: Section 1 amends subdivision B of para-
graph 30 of subsection (i) of section 3216 of the insurance law to
require every policy delivered or issued for delivery in New York State
increase the length of coverage for addiction rehabilitation to no less
than 60 days of treatment. It specifies that coverage can only be termi-
nated when the admitting or attending physician certifies that there is
no further treatment necessary and the patient should be discharged.
This allows for up to an additional 30 days of treatment, for a total of
90 days, if the admitting or attending physician deems it necessary.

It further provides that if the admitting or attending physician certi-
fies that treatment beyond 90 days is necessary, his or her certif-
ication shall be sufficient for eligibility for coverage through Medi-
caid as administered through county social services departments. Costs
associated with continued Medicaid coverage shall be borne by the state.

Section 2 amends subdivision B of paragraph 19 of subsection 1 of
section 3221 of the insurance law. This section's language mirrors that
of section 1, requiring that every group or blanket policy delivered or
issued for delivery in New York State be subject to the same provisions.

Section 3 amends subdivision 2 of subsection (oo) of Section 4303 of
insurance law. This section's language again mirrors that of section 1,
to require that every contract issued by a hospital service company or
health service corporation meet the same provisions.

Section 4 is the effective date.

JUSTIFICATION: As addiction to opioids, and particularly to heroin,
continues to rise in New York State, it is imperative that this public
health issue be addressed in a comprehensive way. Most of the treatment
programs provided by private sector insurance in New York only allow for
up to 30 days of treatment coverage - a duration that is grossly inade-
quate for effective treatment. The result is a tragic scenario that
plays out far too often in New York: parents who have health insurance
coverage for their children that will not meet the needs of treating
heroin addiction are forced to "emancipate" their loved ones so they
qualify for Medicaid.

While requiring private sector policies to cover of up to 90 days will
not bring comply with these federal Medicaid standards, it significantly
improves on existing coverage. In addition, the bill provides for a

smooth transition from private coverage to Medicaid after 90 days, and
ensures that any additional cost will be borne by the State, rather than
counties.

PRIOR LEGISLATIVE HISTORY: New Bill - 2014

FISCAL IMPLICATIONS: To be determined.

EFFECTIVE DATE: This act shall take effect on 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.

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

                                  7103

                            I N  S E N A T E

                             April 28, 2014
                               ___________

Introduced  by  Sens.  GIPSON, BRESLIN, DILAN, HOYLMAN, KRUEGER, PARKER,
  PERKINS, STAVISKY -- 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 THE
DURATION OF SUCH COVERAGE SHALL NOT BE LESS THAN SIXTY DAYS AND  MAY  BE
TERMINATED  ONLY  WHEN AND IF THE ADMITTING OR ATTENDING PHYSICIAN, OR A
PHYSICIAN ASSISTANT OR NURSE PRACTITIONER ACTING UNDER  THE  SUPERVISION
OF THE ADMITTING OR ATTENDING PHYSICIAN, PROVIDING DETOXIFICATION, REHA-
BILITATION  OR  OUTPATIENT  TREATMENT  CERTIFIES  THAT  ADMISSION OF THE
COVERED PERSON IS NOT NECESSARY AND EARLY DISCHARGE IS APPROPRIATE.  THE
DURATION  OF  SUCH COVERAGE SHALL BE EXTENDED BY AS MANY AS THIRTY ADDI-
TIONAL INPATIENT DAYS OR SESSIONS IF THE ADMITTING OR  ATTENDING  PHYSI-
CIAN,  OR  A  PHYSICIAN ASSISTANT OR NURSE PRACTITIONER ACTING UNDER THE
SUPERVISION OF THE ADMITTING OR ATTENDING PHYSICIAN,  DEEMS  SUCH  ADDI-
TIONAL DAYS OR SESSIONS ARE NECESSARY.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD14106-02-4

S. 7103                             2

  (C)  IF  THE ADMITTING OR ATTENDING PHYSICIAN CERTIFIES THAT TREATMENT
BEYOND NINETY DAYS IS NECESSARY, SUCH CERTIFICATION SHALL BE  SUFFICIENT
FOR  ELIGIBILITY  FOR  COVERAGE THROUGH MEDICAID AS ADMINISTERED THROUGH
COUNTY SOCIAL SERVICES DEPARTMENTS, AND NO FURTHER  CERTIFICATION  SHALL
BE REQUIRED BY SUCH DEPARTMENTS.
  (D) COSTS ASSOCIATED WITH CONTINUED MEDICAID COVERAGE SHALL NOT ACCRUE
TO THE COUNTY AND SHALL BE ASSUMED BY THE STATE.
  (E) 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 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  THE
DURATION  OF SUCH COVERAGE SHALL NOT BE LESS THAN SIXTY DAYS, AND MAY BE
TERMINATED ONLY WHEN AND IF THE ADMITTING OR ATTENDING PHYSICIAN,  OR  A
PHYSICIAN  ASSISTANT  OR NURSE PRACTITIONER ACTING UNDER THE SUPERVISION
OF THE ADMITTING OR ATTENDING PHYSICIAN, PROVIDING DETOXIFICATION, REHA-
BILITATION OR OUTPATIENT  TREATMENT  CERTIFIES  THAT  ADMISSION  OF  THE
COVERED  PERSON IS NOT NECESSARY AND EARLY DISCHARGE IS APPROPRIATE. THE
DURATION OF SUCH COVERAGE SHALL BE EXTENDED BY AS MANY AS  THIRTY  ADDI-
TIONAL  INPATIENT  DAYS OR SESSIONS IF THE ADMITTING OR ATTENDING PHYSI-
CIAN, OR A PHYSICIAN ASSISTANT OR NURSE PRACTITIONER  ACTING  UNDER  THE
SUPERVISION  OF  THE  ADMITTING OR ATTENDING PHYSICIAN, DEEMS SUCH ADDI-
TIONAL DAYS OR SESSIONS ARE NECESSARY.
  (C) IF THE ADMITTING OR ATTENDING PHYSICIAN CERTIFIES  THAT  TREATMENT
BEYOND  NINETY DAYS IS NECESSARY, SUCH CERTIFICATION SHALL BE SUFFICIENT
FOR ELIGIBILITY FOR COVERAGE THROUGH MEDICAID  AS  ADMINISTERED  THROUGH
COUNTY  SOCIAL  SERVICES DEPARTMENTS, AND NO FURTHER CERTIFICATION SHALL
BE REQUIRED BY SUCH DEPARTMENTS.
  (D) COSTS ASSOCIATED WITH CONTINUED MEDICAID COVERAGE SHALL NOT ACCRUE
TO THE COUNTY AND SHALL BE ASSUMED BY THE STATE.
  (E) 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.

S. 7103                             3

  (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  THE
DURATION OF SUCH COVERAGE NOT BE LESS THAN SIXTY DAYS, AND MAY BE TERMI-
NATED ONLY WHEN AND IF THE ADMITTING OR ATTENDING PHYSICIAN, OR A PHYSI-
CIAN ASSISTANT OR NURSE PRACTITIONER ACTING UNDER THE SUPERVISION OF THE
ADMITTING  OR  ATTENDING  PHYSICIAN, PROVIDING DETOXIFICATION, REHABILI-
TATION OR OUTPATIENT TREATMENT CERTIFIES THAT ADMISSION OF  THE  COVERED
PERSON IS NOT NECESSARY AND EARLY DISCHARGE IS APPROPRIATE. THE DURATION
OF SUCH COVERAGE SHALL BE EXTENDED BY AS MANY AS THIRTY ADDITIONAL INPA-
TIENT  DAYS  OR  SESSIONS  IF THE ADMITTING OR ATTENDING PHYSICIAN, OR A
PHYSICIAN ASSISTANT OR NURSE PRACTITIONER ACTING UNDER  THE  SUPERVISION
OF  THE  ADMITTING OR ATTENDING PHYSICIAN, DEEMS SUCH ADDITIONAL DAYS OR
SESSIONS ARE NECESSARY.
  (3) IF THE ADMITTING OR ATTENDING PHYSICIAN CERTIFIES  THAT  TREATMENT
BEYOND  NINETY DAYS IS NECESSARY, SUCH CERTIFICATION SHALL BE SUFFICIENT
FOR ELIGIBILITY FOR COVERAGE THROUGH MEDICAID  AS  ADMINISTERED  THROUGH
COUNTY  SOCIAL  SERVICES DEPARTMENTS, AND NO FURTHER CERTIFICATION SHALL
BE REQUIRED BY SUCH DEPARTMENTS.
  (4) COSTS ASSOCIATED WITH CONTINUED MEDICAID COVERAGE SHALL NOT ACCRUE
TO THE COUNTY AND SHALL BE ASSUMED BY THE STATE.
  (5) 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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