S T A T E   O F   N E W   Y O R K
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                                  4938

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                            February 9, 2015
                               ___________

Introduced  by  M.  of  A.  CURRAN, DUPREY, FINCH, RAIA -- 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, subparagraph (A) as amended by chapter 230 of  the  laws  of  2004,
subparagraph  (B)  as  amended  by  chapter 420 of the laws of 2002, and
subparagraphs (D) and (E) as amended by section 50 of part D of  chapter
56 of the laws of 2013, 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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD08188-01-5
              

A. 4938                             2

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.  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
where the 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, shall 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  that  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;  (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 (e) 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.  THE STATE BOARD
OF  MENTAL  HEALTH  PRACTITIONERS  SHALL MAINTAIN A LIST OF ALL LICENSED
MENTAL HEALTH COUNSELORS QUALIFIED FOR REIMBURSEMENT UNDER THIS SUBPARA-
GRAPH.
  (E) The state board for social work  shall  maintain  a  list  of  all
licensed  clinical  social  workers  qualified  for  reimbursement under
subparagraph (D) of this paragraph.
  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:

A. 4938                             3

  (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
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.

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  (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
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

A. 4938                             5

(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
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.