S T A T E O F N E W Y O R K
________________________________________________________________________
7585
2017-2018 Regular Sessions
I N A S S E M B L Y
May 3, 2017
___________
Introduced by M. of A. JONES -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law and the social services law, in
relation to requiring insurance and Medicaid coverage for inpatient
and outpatient substance abuse treatment for a period of not less than
forty-five days
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subparagraph (A) of paragraph 30 of subsection (i) of
section 3216 of the insurance law, as amended by section 1 of part B of
chapter 71 of the laws of 2016, is amended to read as follows:
(A) Every policy that provides hospital, major medical or similar
comprehensive coverage must provide inpatient coverage for the diagnosis
and treatment of substance use disorder, including detoxification and
rehabilitation services, FOR A PERIOD OF NOT LESS THAN FORTY-FIVE DAYS.
Such inpatient coverage shall include unlimited medically necessary
treatment for substance use disorder treatment services provided in
residential settings as required by the Mental Health Parity and
Addiction Equity Act of 2008 (29 U.S.C. § 1185a). Further, such inpa-
tient coverage shall not apply financial requirements or treatment limi-
tations, including utilization review requirements, to inpatient
substance use disorder benefits that are more restrictive than the
predominant financial requirements and treatment limitations applied to
substantially all medical and surgical benefits covered by the policy.
Further, such coverage shall be provided consistent with the federal
Paul Wellstone and Pete Domenici Mental Health Parity and Addiction
Equity Act of 2008 (29 U.S.C. § 1185a).
§ 2. Subparagraph (A) of paragraph 31 of subsection (i) of section
3216 of the insurance law, as added by chapter 41 of the laws of 2014,
is amended to read as follows:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10981-01-7
A. 7585 2
(A) Every policy that provides medical, major medical or similar
comprehensive-type coverage must provide outpatient coverage for the
diagnosis and treatment of substance use disorder, including detoxifica-
tion and rehabilitation services, FOR A PERIOD OF NOT LESS THAN FORTY-
FIVE DAYS. Such coverage shall not apply financial requirements or
treatment limitations to outpatient substance use disorder benefits that
are more restrictive than the predominant financial requirements and
treatment limitations applied to substantially all medical and surgical
benefits covered by the policy. Further, such coverage shall be
provided consistent with the federal Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. §
1185a).
§ 3. Subparagraph (A) of paragraph 6 of subsection (l) of section 3221
of the insurance law, as amended by section 2 of part B of chapter 71 of
the laws of 2016, is amended to read as follows:
(A) Every policy that provides hospital, major medical or similar
comprehensive coverage must provide inpatient coverage for the diagnosis
and treatment of substance use disorder, including detoxification and
rehabilitation services, FOR A PERIOD OF NOT LESS THAN FORTY-FIVE DAYS.
Such inpatient coverage shall include unlimited medically necessary
treatment for substance use disorder treatment services provided in
residential settings as required by the Mental Health Parity and
Addiction Equity Act of 2008 (29 U.S.C. § 1185a). Further, such inpa-
tient coverage shall not apply financial requirements or treatment limi-
tations, including utilization review requirements, to inpatient
substance use disorder benefits that are more restrictive than the
predominant financial requirements and treatment limitations applied to
substantially all medical and surgical benefits covered by the policy.
Further, such coverage shall be provided consistent with the federal
Paul Wellstone and Pete Domenici Mental Health Parity and Addiction
Equity Act of 2008 (29 U.S.C. § 1185a).
§ 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221
of the insurance law, as amended by chapter 41 of the laws of 2014, is
amended to read as follows:
(A) Every policy that provides medical, major medical or similar
comprehensive-type coverage must provide outpatient coverage for the
diagnosis and treatment of substance use disorder, including detoxifica-
tion and rehabilitation services, FOR A PERIOD OF NOT LESS THAN FORTY-
FIVE DAYS. Such coverage shall not apply financial requirements or
treatment limitations to outpatient substance use disorder benefits that
are more restrictive than the predominant financial requirements and
treatment limitations applied to substantially all medical and surgical
benefits covered by the policy. Further, such coverage shall be
provided consistent with the federal Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. §
1185a).
§ 5. Paragraph 1 of subsection (k) of section 4303 of the insurance
law, as amended by section 3 of part B of chapter 71 of the laws of
2016, is amended to read as follows:
(1) Every contract that provides hospital, major medical or similar
comprehensive coverage must provide inpatient coverage for the diagnosis
and treatment of substance use disorder, including detoxification and
rehabilitation services, FOR A PERIOD OF NOT LESS THAN FORTY-FIVE DAYS.
Such inpatient coverage shall include unlimited medically necessary
treatment for substance use disorder treatment services provided in
residential settings as required by the Mental Health Parity and
A. 7585 3
Addiction Equity Act of 2008 (29 U.S.C. § 1185a). Further, such inpa-
tient coverage shall not apply financial requirements or treatment limi-
tations, including utilization review requirements, to inpatient
substance use disorder benefits that are more restrictive than the
predominant financial requirements and treatment limitations applied to
substantially all medical and surgical benefits covered by the contract.
Further, such coverage shall be provided consistent with the federal
Paul Wellstone and Pete Domenici Mental Health Parity and Addiction
Equity Act of 2008 (29 U.S.C. § 1185a).
§ 6. Paragraph 1 of subsection (l) of section 4303 of the insurance
law, as amended by chapter 41 of the laws of 2014, is amended to read as
follows:
(1) Every contract that provides medical, major medical or similar
comprehensive-type coverage must provide outpatient coverage for the
diagnosis and treatment of substance use disorder, including detoxifica-
tion and rehabilitation services, FOR A PERIOD NOT LESS THAN FORTY-FIVE
DAYS. Such coverage shall not apply financial requirements or treatment
limitations to outpatient substance use disorder benefits that are more
restrictive than the predominant financial requirements and treatment
limitations applied to substantially all medical and surgical benefits
covered by the contract. Further, such coverage shall be provided
consistent with the federal Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
§ 7. Paragraph (c) of subdivision 2 of section 365-a of the social
services law, as amended by section 12-a of part C of chapter 60 of the
laws of 2014, is amended to read as follows:
(c) out-patient hospital or clinic services in facilities operated in
compliance with applicable provisions of this chapter, the public health
law, the mental hygiene law and other laws, including any provisions
thereof requiring an operating certificate or license, including facili-
ties authorized by the appropriate licensing authority to provide inte-
grated mental health services, and/or alcoholism and substance abuse
services, and/or physical health services, and/or services to persons
with developmental disabilities, when such services are provided at a
single location or service site, or where such facilities are not
conveniently accessible, in any hospital located within the state and
care and services in a day treatment program operated by the department
of mental hygiene or by a voluntary agency under an agreement with such
department in that part of a public institution operated and approved
pursuant to law as an intermediate care facility for persons with devel-
opmental disabilities; AND PROVIDED, THAT ALCOHOLISM AND SUBSTANCE ABUSE
SERVICES SHALL BE COVERED FOR A PERIOD OF NOT LESS THAN FORTY-FIVE DAYS;
and provided FURTHER, that the commissioners of health, mental health,
alcoholism and substance abuse services and the office for people with
developmental disabilities may issue regulations, including emergency
regulations promulgated prior to October first, two thousand fifteen
that are required to facilitate the establishment of integrated services
clinics. Any such regulations promulgated under this paragraph shall be
described in the annual report required pursuant to section forty-five-c
of part A of chapter fifty-six of the laws of two thousand thirteen;
§ 8. Paragraph (n) of subdivision 2 of section 365-a of the social
services law, as amended by chapter 558 of the laws of 1999, is amended
to read as follows:
(n) care, treatment, maintenance and rehabilitation services that
would otherwise qualify for reimbursement pursuant to this chapter to
persons suffering from alcoholism in alcoholism facilities or chemical
A. 7585 4
dependence, as such term is defined in section 1.03 of the mental
hygiene law, in inpatient chemical dependence facilities, services, or
programs operated in compliance with applicable provisions of this chap-
ter and the mental hygiene law, and certified by the office of alcohol-
ism and substance abuse services, provided however that such services
shall be limited to such periods of time as may be determined necessary
in accordance with a utilization review procedure established by the
commissioner of the office of alcoholism and substance abuse services
and THAT SUCH SERVICES SHALL BE COVERED FOR A PERIOD OF NOT LESS THAN
FORTY-FIVE DAYS, AND provided further, that this paragraph shall not
apply to any hospital or part of a hospital as defined in section two
thousand eight hundred one of the public health law.
§ 9. This act shall take effect immediately and shall apply to all
policies and contracts issued, renewed, modified, altered or amended on
or after such date.