Senate Bill S6478A

                                 BILL NUMBER:  S6478A

 TITLE OF BILL :

An act to amend the insurance law, in relation to insurance coverage
for substance abuse disorder services

 PURPOSE :

To require insurance companies provide at least ninety days of
inpatient rehabilitation services to an insured upon a doctor's
prescription.

 SUMMARY OF PROVISIONS :

Section 1 amends § 3216(i)(30) of the Insurance Law to provide that an
individual accident policy providing medical coverage for the
diagnosis and treatment of substance use disorder shall include
coverage for at least ninety days at an inpatient rehabilitation
facility when prescribed by a doctor.

Section 2 amends § 3221(1)(6) of the Insurance Law to provide that
group or blanket accident and health insurance policies providing
medical coverage for the diagnosis and treatment of substance use
disorder shall include coverage for at least ninety days at an
inpatient rehabilitation facility when prescribed by a doctor.
              

Section 3 amends § 4303(k) of the Insurance Law to provide that every
contract issued by a hospital service corporation or health service
corporation which provides coverage for in-patient hospital care shall
also provide coverage for the diagnosis and treatment of substance use
disorder shall include coverage for at least ninety days at a
rehabilitation facility when prescribed by a doctor.

Section 4 provides the effective date.

 EXISTING LAW :

Section 3216 of the Insurance Law relates to individual accident and
health insurance policy provisions. Paragraph 30 of subsection (i) of
this section provides, every policy that provides medical, major
medical, or similar comprehensive-type coverage must provide inpatient
coverage for the diagnosis and treatment of substance abuse disorder,
including detoxification and rehabilitation services.

Section 3221 of the Insurance Law relates to group or blanket accident
and health insurance policies. Paragraph (6) of subsection (1) of this
section provides, every policy that provides medical, major medical,
or similar comprehensive-type coverage must provide inpatient coverage
for the diagnosis and treatment of substance abuse disorder, including
detoxification and rehabilitation services.

Section 4303 of the Insurance Law relates to contracts issued by a
hospital service corporation or health service corporation.
Subsection (k) of this section provides, every policy that provides
medical, major medical, or similar comprehensive-type coverage must
provide inpatient coverage for the diagnosis and treatment of
substance abuse disorder, including detoxification and rehabilitation
services.

 JUSTIFICATION :

Heroin use has increased significantly across the United States and in
New York among all demographics, including gender, age, and income
level. All communities are susceptible to heroin or prescription
opioid addiction and the use or misuse of these drugs is a problem in
rural, suburban and urban communities across our state. Public
awareness and community involvement are key factors in addressing this
problem. But the expansion of access to effective treatments for those
who are addicted is paramount in preventing the continued development
of heroin and opioid addiction. By legislatively requiring insurance
coverage for at least ninety days of inpatient rehabilitation services
for substance abuse disorders upon a doctor's prescription, New York
promotes public health in every community and makes a serious effort
in reversing the national trend toward increased heroin and opioid
use.

The Centers for Disease Control reports that the greatest increases in
heroin and opioid use have occurred in groups with historically lower
rates of heroin use, including women and people with private insurance
and higher incomes. In its most recent report the CDC found that
nearly all individuals using heroin also use or misuse other
substances, but the strongest risk factor for heroin use disorder is a
prescription opioid use disorder. Increased use has also lead to
increased deaths associated to heroin overdose. Heroin-related deaths
increased a dramatic 39% between 2012 and 2013, while the rate of
heroin-related overdose deaths nearly quadrupled over the past decade.

Increased use of naloxone, or Narcan, the antidote used to reverse
overdoses, has had an acute effect on saving lives from heroin
overdose. But reversing overdoses is insufficient in combating and
overcoming the heroin problem in New York State. Connecting overdose
victims and those individuals struggling with prescription drug and
heroin use disorders to treatment facilities is vital to the success
of correcting heroin addiction in our state. Ensuring that insurance
providers actually provide a minimum of 90 days of substance abuse
inpatient rehabilitation services pursuant to a doctor's order is an
integral component to making the connection between victims and users
and treatment facilities effective and successful. For all of the
aforementioned reasons it is imperative that this legislation is
enacted.

 LEGISLATIVE HISTORY :

New bill.

 FISCAL IMPLICATIONS :

To be determined.

 EFFECTIVE DATE :
This act shall take effect ninety days after is shall become law.