Senate Bill S7103

                            
                    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.