Senate Bill S5426

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5426
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                              April 30, 2019
                                ___________
 
 Introduced  by Sen. HARCKHAM -- 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  mandating  commercial
   insurance  coverage  of peer support services as part of treatment for
   substance use disorder

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  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:
   (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  AND  ALSO  INCLUDING  PEER  SUPPORT
 SERVICES  PROVIDED  BY  A CERTIFIED RECOVERY PEER ADVOCATE AS DEFINED BY
 THE OFFICE OF ALCOHOLISM AND SUBSTANCE  ABUSE  SERVICES.  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).
   §  2.  Subparagraph  (A)  of paragraph 31 of subsection (i) of section
 3216 of the insurance law, as amended by section 6 of subpart A of  part
 BB of chapter 57 of the laws of 2019, is amended to read as follows:
   (A)  Every  policy  that  provides  medical,  major medical or similar
 comprehensive-type coverage shall provide outpatient  coverage  for  the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion  and  rehabilitation  services  AND  ALSO  INCLUDING  PEER  SUPPORT
 SERVICES PROVIDED BY A CERTIFIED RECOVERY PEER ADVOCATE  AS  DEFINED  BY
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD11397-01-9

 S. 5426                             2
 
 THE  OFFICE  OF  ALCOHOLISM  AND SUBSTANCE ABUSE SERVICES. 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.
   § 3. 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  AND  ALSO  INCLUDING  PEER  SUPPORT
 SERVICES  PROVIDED  BY  A CERTIFIED RECOVERY PEER ADVOCATE AS DEFINED BY
 THE OFFICE OF ALCOHOLISM AND SUBSTANCE  ABUSE  SERVICES.  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).
   § 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221
 of  the  insurance law, as amended by section 16 of subpart A of part BB
 of chapter 57 of the laws of 2019, is amended to read as follows:
   (A) Every policy that  provides  medical,  major  medical  or  similar
 comprehensive-type  coverage  shall  provide outpatient coverage for the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion  and  rehabilitation  services  AND  ALSO  INCLUDING  PEER  SUPPORT
 SERVICES  PROVIDED  BY  A CERTIFIED RECOVERY PEER ADVOCATE AS DEFINED BY
 THE OFFICE OF ALCOHOLISM AND SUBSTANCE  ABUSE  SERVICES.  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.
   §  5.  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  AND  ALSO  INCLUDING  PEER  SUPPORT
 SERVICES  PROVIDED  BY  A CERTIFIED RECOVERY PEER ADVOCATE AS DEFINED BY
 THE OFFICE OF ALCOHOLISM AND SUBSTANCE  ABUSE  SERVICES.  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).
   §  6.  Paragraph  1 of subsection (l) of section 4303 of the insurance
 law, as amended by section 27 of subpart A of part BB of chapter  57  of
 the laws of 2019, is amended to read as follows:

 S. 5426                             3
 
   (1)  Every  contract  that  provides medical, major medical or similar
 comprehensive-type coverage shall provide outpatient  coverage  for  the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion  and  rehabilitation  services  AND  ALSO  INCLUDING  PEER  SUPPORT
 SERVICES  PROVIDED  BY  A CERTIFIED RECOVERY PEER ADVOCATE AS DEFINED BY
 THE OFFICE OF ALCOHOLISM AND SUBSTANCE  ABUSE  SERVICES.  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.
   §  7.  This  act shall take effect on the thirtieth day after it shall
 have become a law; provided that the amendments to subparagraph  (A)  of
 paragraph  (31)  of  subsection (i) of section 3216 of the insurance law
 made by section two of this act, the amendments to subparagraph  (A)  of
 paragraph  (7)  of  subsection  (l) of section 3221 of the insurance law
 made by section four of this act and the amendments to paragraph (1)  of
 subsection  (l) of section 4303 of the insurance law made by section six
 of this act shall take effect on the same date and in the same manner as
 subpart A of part BB of chapter 57 of the laws of 2019, takes effect.