Senate Bill S7319

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

                                  7319

                            I N  S E N A T E

                             April 15, 2016
                               ___________

Introduced  by Sens. VENDITTO, MURPHY -- 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 33 to read as follows:
  (33)  (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.  AT A MINIMUM SUCH
COVERAGE SHALL INCLUDE:
  (I) UP TO SEVEN DAYS OF DETOXIFICATION PER ADMISSION, SUCH DETOXIFICA-
TION MAY OCCUR IN A HOSPITAL OR NON-HOSPITAL RESIDENTIAL FACILITY;
  (II) THIRTY DAYS OF  REHABILITATION  PER  EPISODE  IN  A  HOSPITAL  OR
NON-HOSPITAL RESIDENTIAL FACILITY;
  (III)  THIRTY  SESSIONS  OF  OUTPATIENT OR PARTIAL HOSPITALIZATION PER
EPISODE OF CARE; AND
  (IV) FAMILY COUNSELING AND INTERVENTION 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 SUCH
COVERAGE SHALL BE TERMINATED WHEN THE ADMITTING OR ATTENDING  PHYSICIAN,
OR A PHYSICIAN ASSISTANT OR NURSE PRACTITIONER PROVIDING DETOXIFICATION,
REHABILITATION  OR  OUTPATIENT TREATMENT CERTIFIES THAT ADMISSION OF THE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11985-03-6
              

S. 7319                             2

COVERED PERSON IS NOT NECESSARY, EARLY DISCHARGE IS APPROPRIATE OR ADDI-
TIONAL INPATIENT DAYS OR SESSIONS ARE NECESSARY.
  (C) 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 DELIV-
ERY 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 QUALIFIED HEALTH PROFESSIONAL, AS DEFINED  IN  THE  REGU-
LATIONS  OF THE COMMISSIONER OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES.
AT A MINIMUM SUCH COVERAGE SHALL INCLUDE:
  (I) UP TO SEVEN DAYS OF DETOXIFICATION PER ADMISSION, SUCH DETOXIFICA-
TION MAY OCCUR IN A HOSPITAL OR NON-HOSPITAL RESIDENTIAL FACILITY;
  (II) THIRTY DAYS OF  REHABILITATION  PER  EPISODE  IN  A  HOSPITAL  OR
NON-HOSPITAL RESIDENTIAL FACILITY;
  (III)  THIRTY  SESSIONS  OF  OUTPATIENT OR PARTIAL HOSPITALIZATION PER
EPISODE; AND
  (IV) FAMILY COUNSELING AND INTERVENTION 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 SUCH
COVERAGE SHALL BE TERMINATED WHEN THE ADMITTING OR ATTENDING  PHYSICIAN,
OR A PHYSICIAN ASSISTANT OR NURSE PRACTITIONER PROVIDING DETOXIFICATION,
REHABILITATION  OR  OUTPATIENT TREATMENT CERTIFIES THAT ADMISSION OF THE
COVERED PERSON IS NOT NECESSARY, EARLY DISCHARGE IS APPROPRIATE OR ADDI-
TIONAL INPATIENT DAYS OR SESSIONS ARE NECESSARY.
  (C) 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 (qq) to read as follows:
  (QQ) (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.
AT A MINIMUM SUCH COVERAGE SHALL INCLUDE:
  (A) UP TO SEVEN DAYS OF DETOXIFICATION PER ADMISSION, SUCH DETOXIFICA-
TION MAY OCCUR IN A HOSPITAL OR NON-HOSPITAL RESIDENTIAL FACILITY;
  (B)  THIRTY  DAYS  OF  REHABILITATION  PER  EPISODE  IN  A HOSPITAL OR
NON-HOSPITAL RESIDENTIAL FACILITY;
  (C) THIRTY SESSIONS  OF  OUTPATIENT  OR  PARTIAL  HOSPITALIZATION  PER
EPISODE; AND
  (D) FAMILY COUNSELING AND INTERVENTION SERVICES.
  (2) THE ONLY PREREQUISITE FOR THE COVERAGE OF HOSPITAL OR NON-HOSPITAL
BASED  DETOXIFICATION, INCLUDING MEDICALLY MANAGED, MEDICALLY SUPERVISED

S. 7319                             3

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  SUCH
COVERAGE  SHALL BE TERMINATED WHEN THE ADMITTING OR ATTENDING PHYSICIAN,
OR A PHYSICIAN ASSISTANT OR NURSE PRACTITIONER PROVIDING DETOXIFICATION,
REHABILITATION OR OUTPATIENT TREATMENT CERTIFIES THAT ADMISSION  OF  THE
COVERED PERSON IS NOT NECESSARY, EARLY DISCHARGE IS APPROPRIATE OR ADDI-
TIONAL INPATIENT DAYS OR SESSIONS ARE NECESSARY.
  (3)  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.