S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5676
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 14, 2017
                                ___________
 
 Introduced  by M. of A. CURRAN, 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.
   §  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.
              

                                                            LBD09854-01-7

 A. 5676                             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  employees  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.
   § 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. 5676                             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.
   § 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
   § 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.

 A. 5676                             4
 
   (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. 5676                             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.
   § 6. This act shall take effect on the ninetieth day  after  it  shall
 have become a law.