S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7704--A
                                                         Cal. No. 270
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 20, 2021
                                ___________
 
 Introduced  by  M.  of  A.  FERNANDEZ,  ABBATE,  DAVILA -- read once and
   referred to the Committee on Insurance -- ordered to a third  reading,
   amended  and  ordered  reprinted,  retaining its place on the order of
   third reading

 AN ACT to amend the insurance law, in relation to  providing  behavioral
   health parity (Part A); and to amend the insurance law, in relation to
   the  authorization for certain drugs for the detoxification or mainte-
   nance of a substance use disorder (Part B)
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  This  act enacts into law components of legislation which
 are necessary to effectuate provisions relating  to  mental  health  and
 substance use disorder parity.  Each component is wholly contained with-
 in  a  Part identified as Parts A through B. The effective date for each
 particular provision contained within such Part is set forth in the last
 section of such Part. Any provision in any section  contained  within  a
 Part,  including  the  effective date of the Part, which makes reference
 to a section "of this act", when used in connection with that    partic-
 ular  component, shall  be  deemed  to mean and refer to the correspond-
 ing section of the Part in which it is found. Section three of this  act
 sets forth the general effective date of this act.
 
                                  PART A
 
   Section  1.  Subparagraph  (D)  of  paragraph  30 of subsection (i) of
 section 3216 of the insurance law, as amended by section 5 of subpart  A
 of  part  BB  of  chapter  57 of the laws of 2019, is amended to read as
 follows:
   (D) This subparagraph shall apply to facilities in this state that are
 licensed, certified or otherwise authorized by the office of [alcoholism
 and substance abuse services] ADDICTION SERVICES AND SUPPORTS  that  are

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

                                                            LBD09970-03-2
 A. 7704--A                          2
 
 participating in the insurer's provider network. Coverage provided under
 this  paragraph  shall  not  be  subject  to  preauthorization. Coverage
 provided under this paragraph shall also not be  subject  to  concurrent
 utilization  review  during the first twenty-eight days of the inpatient
 admission provided that the facility notifies the insurer  of  both  the
 admission and the initial treatment plan within two business days of the
 admission  ON A STANDARDIZED FORM DEVELOPED BY THE DEPARTMENT IN CONSUL-
 TATION WITH THE  DEPARTMENT  OF  HEALTH  AND  THE  OFFICE  OF  ADDICTION
 SERVICES  AND SUPPORTS. The facility shall perform daily clinical review
 of the patient[, including periodic] AND CONSULT PERIODICALLY  WITH  THE
 INSURER  REGARDING  THE  PATIENT'S  PROGRESS,  COURSE  OF TREATMENT, AND
 DISCHARGE PLAN. PERIODIC consultation with the insurer [at or just prior
 to] SHALL OCCUR NO LATER THAN the fourteenth day of treatment [to ensure
 that the facility is using the evidence-based and peer reviewed clinical
 review tool utilized by the insurer which is designated by the office of
 alcoholism and substance abuse services and appropriate to  the  age  of
 the  patient, to ensure that the inpatient treatment is medically neces-
 sary for the patient]. Prior to discharge, the  facility  shall  provide
 the  patient  and  the insurer with a written discharge plan which shall
 describe arrangements for additional services needed following discharge
 from the inpatient facility as determined using the  evidence-based  and
 peer-reviewed  clinical  review  tool  utilized  by the insurer which is
 designated by the office of [alcoholism and  substance  abuse  services]
 ADDICTION  SERVICES AND SUPPORTS. Prior to discharge, the facility shall
 indicate to the insurer whether services included in the discharge  plan
 are  secured  or  determined  to be reasonably available. [Any] INSURERS
 SHALL ACTIVELY PARTICIPATE IN FACILITY-INITIATED PERIODIC  CONSULTATIONS
 PRIOR  TO  THE PATIENT'S DISCHARGE AND EXCEPT WHERE THE INSURER FAILS TO
 DO SO, ANY utilization review of treatment provided under this  subpara-
 graph  may  include  a review of all services provided during such inpa-
 tient treatment, including all services provided during the first  twen-
 ty-eight  days  of  such  inpatient  treatment.  Provided,  however, the
 insurer SHALL BE REQUIRED TO PROCESS CLAIMS FOR THE  PROVISION  OF  SUCH
 SERVICES  WITHIN THE TIMEFRAMES ESTABLISHED IN SUBSECTION (A) OF SECTION
 THREE THOUSAND TWO HUNDRED TWENTY-FOUR-A OF THIS ARTICLE AND shall  only
 deny  coverage for any portion of the initial twenty-eight day inpatient
 treatment on the basis that such treatment was not  medically  necessary
 if  such inpatient treatment was contrary to the evidence-based and peer
 reviewed clinical review tool utilized by the insurer  which  is  desig-
 nated  by  the  office  of  [alcoholism  and  substance  abuse services]
 ADDICTION SERVICES AND SUPPORTS. An insured shall not have any financial
 obligation to the facility for any  treatment  under  this  subparagraph
 other  than any copayment, coinsurance, or deductible otherwise required
 under the policy.
   § 2. Subparagraph (E) 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:
   (E) This subparagraph shall apply to facilities in this state that are
 licensed, certified or otherwise authorized by the office of [alcoholism
 and substance abuse services] ADDICTION SERVICES AND  SUPPORTS  for  the
 provision of outpatient, intensive outpatient, outpatient rehabilitation
 and  opioid  treatment  that are participating in the insurer's provider
 network. Coverage provided under this paragraph shall not be subject  to
 preauthorization.  Coverage  provided  under this paragraph shall not be
 subject to concurrent review for the  first  four  weeks  of  continuous
 treatment,  not  to  exceed  twenty-eight  visits, provided the facility
 A. 7704--A                          3
 
 notifies the insurer of both the start  of  treatment  and  the  initial
 treatment plan within two business days ON A STANDARDIZED FORM DEVELOPED
 BY  THE DEPARTMENT IN CONSULTATION WITH THE DEPARTMENT OF HEALTH AND THE
 OFFICE  OF  ADDICTION  SERVICES AND SUPPORTS. The facility shall perform
 clinical assessment of the patient at each visit[,  including  periodic]
 AND  CONSULT  PERIODICALLY  WITH  THE  INSURER  REGARDING  THE PATIENT'S
 PROGRESS, COURSE OF TREATMENT, AND DISCHARGE PLAN. PERIODIC consultation
 with the insurer [at or just prior to] SHALL OCCUR  NO  LATER  THAN  the
 fourteenth  day  of  treatment [to ensure that the facility is using the
 evidence-based and peer reviewed clinical review tool  utilized  by  the
 insurer  which  is  designated by the office of alcoholism and substance
 abuse services and appropriate to the age of the patient, to ensure that
 the outpatient treatment is medically necessary for the patient].  [Any]
 INSURERS  SHALL  ACTIVELY  PARTICIPATE  IN  FACILITY-INITIATED  PERIODIC
 CONSULTATIONS PRIOR TO THE PATIENT'S  DISCHARGE  AND  EXCEPT  WHERE  THE
 INSURER FAILS TO DO SO, ANY utilization review of the treatment provided
 under  this  subparagraph  may include a review of all services provided
 during such outpatient treatment, including all services provided during
 the first four weeks of continuous treatment, not to exceed twenty-eight
 visits, of such outpatient treatment.  Provided,  however,  the  insurer
 shall  only  deny  coverage for any portion of the initial four weeks of
 continuous treatment, not to exceed twenty-eight visits, for  outpatient
 treatment  on  the basis that such treatment was not medically necessary
 if such outpatient treatment was contrary to the evidence-based and peer
 reviewed clinical review tool utilized by the insurer  which  is  desig-
 nated  by  the  office  of  [alcoholism  and  substance  abuse services]
 ADDICTION SERVICES AND SUPPORTS.  An insured shall not have  any  finan-
 cial  obligation  to  the facility for any treatment under this subpara-
 graph other than any copayment,  coinsurance,  or  deductible  otherwise
 required under the policy.
   §  3.  Subparagraph  (G)  of paragraph 35 of subsection (i) of section
 3216 of the insurance law, as added by section 8 of subpart A of part BB
 of chapter 57 of the laws of 2019, is amended to read as follows:
   (G) This subparagraph shall apply to hospitals in this state that  are
 licensed,  CERTIFIED  OR  OTHERWISE  AUTHORIZED  by the office of mental
 health that are participating in the insurer's provider  network.  Where
 the  policy  provides coverage for inpatient hospital care, benefits for
 inpatient hospital care in a hospital as defined by subdivision  ten  of
 section 1.03 of the mental hygiene law [provided to individuals who have
 not  attained  the  age of eighteen] shall not be subject to preauthori-
 zation. Coverage provided under this  subparagraph  shall  also  not  be
 subject  to concurrent utilization review during the first fourteen days
 of the inpatient admission, provided the facility notifies  the  insurer
 of both the admission and the initial treatment plan within two business
 days of the admission ON A STANDARDIZED FORM DEVELOPED BY THE DEPARTMENT
 IN  CONSULTATION  WITH THE DEPARTMENT OF HEALTH AND THE OFFICE OF MENTAL
 HEALTH, performs daily clinical review of the patient, and [participates
 in periodic consultation with the insurer to ensure that the facility is
 using the evidence-based and  peer  reviewed  clinical  review  criteria
 utilized by the insurer which is approved by the office of mental health
 and  appropriate to the age of the patient, to ensure that the inpatient
 care is medically necessary for the patient] CONSULTS PERIODICALLY  WITH
 THE  INSURER  REGARDING THE PATIENT'S PROGRESS, COURSE OF TREATMENT, AND
 DISCHARGE PLAN. [All] INSURERS SHALL ACTIVELY PARTICIPATE  IN  FACILITY-
 INITIATED  PERIODIC  CONSULTATIONS  PRIOR TO THE PATIENT'S DISCHARGE AND
 EXCEPT WHERE THE INSURER FAILS TO DO SO, ALL  treatment  provided  under
 A. 7704--A                          4
 
 this  subparagraph may be reviewed retrospectively. Where care is denied
 retrospectively, an insured shall not have any financial  obligation  to
 the  facility  for  any treatment under this subparagraph other than any
 copayment, coinsurance, or deductible otherwise required under the poli-
 cy.
   § 4. Subparagraph (G) of paragraph 5 of subsection (l) of section 3221
 of  the insurance law, as added by section 14 of subpart A of part BB of
 chapter 57 of the laws of 2019, is amended to read as follows:
   (G) This subparagraph shall apply to hospitals in this state that  are
 licensed,  CERTIFIED  OR  OTHERWISE  AUTHORIZED  by the office of mental
 health that are participating in the insurer's provider  network.  Where
 the  policy  provides coverage for inpatient hospital care, benefits for
 inpatient hospital care in a hospital as defined by subdivision  ten  of
 section 1.03 of the mental hygiene law [provided to individuals who have
 not  attained  the  age of eighteen] shall not be subject to preauthori-
 zation. Coverage provided under this  subparagraph  shall  also  not  be
 subject  to concurrent utilization review during the first fourteen days
 of the inpatient admission, provided the facility notifies  the  insurer
 of both the admission and the initial treatment plan within two business
 days of the admission ON A STANDARDIZED FORM DEVELOPED BY THE DEPARTMENT
 IN  CONSULTATION  WITH THE DEPARTMENT OF HEALTH AND THE OFFICE OF MENTAL
 HEALTH, performs daily clinical review of the patient, and [participates
 in periodic consultation with the insurer to ensure that the facility is
 using the evidence-based and  peer  reviewed  clinical  review  criteria
 utilized by the insurer which is approved by the office of mental health
 and  appropriate to the age of the patient, to ensure that the inpatient
 care is medically necessary for the patient] CONSULTS PERIODICALLY  WITH
 THE  INSURER  REGARDING THE PATIENT'S PROGRESS, COURSE OF TREATMENT, AND
 DISCHARGE PLAN. [All] INSURERS SHALL ACTIVELY PARTICIPATE  IN  FACILITY-
 INITIATED  PERIODIC  CONSULTATIONS  PRIOR TO THE PATIENT'S DISCHARGE AND
 EXCEPT WHERE THE INSURER FAILS TO DO SO, ALL  treatment  provided  under
 this  subparagraph may be reviewed retrospectively. Where care is denied
 retrospectively, an insured shall not have any financial  obligation  to
 the  facility  for  any treatment under this subparagraph other than any
 copayment, coinsurance, or deductible otherwise required under the poli-
 cy.
   § 5. Subparagraph (D) of paragraph 6 of subsection (l) of section 3221
 of the insurance law, as amended by section 15 of subpart A of  part  BB
 of chapter 57 of the laws of 2019, is amended to read as follows:
   (D) This subparagraph shall apply to facilities in this state that are
 licensed, certified or otherwise authorized by the office of [alcoholism
 and  substance  abuse services] ADDICTION SERVICES AND SUPPORTS that are
 participating in the insurer's provider network. Coverage provided under
 this paragraph  shall  not  be  subject  to  preauthorization.  Coverage
 provided  under  this  paragraph shall also not be subject to concurrent
 utilization review during the first twenty-eight days of  the  inpatient
 admission  provided  that  the facility notifies the insurer of both the
 admission and the initial treatment plan within two business days of the
 admission ON A STANDARDIZED FORM DEVELOPED BY THE DEPARTMENT IN  CONSUL-
 TATION  WITH  THE  DEPARTMENT  OF  HEALTH  AND  THE  OFFICE OF ADDICTION
 SERVICES AND SUPPORTS. The facility shall perform daily clinical  review
 of  the  patient[, including periodic] AND CONSULT PERIODICALLY WITH THE
 INSURER REGARDING THE  PATIENT'S  PROGRESS,  COURSE  OF  TREATMENT,  AND
 DISCHARGE PLAN. PERIODIC consultation with the insurer [at or just prior
 to] SHALL OCCUR NO LATER THAN the fourteenth day of treatment [to ensure
 that the facility is using the evidence-based and peer reviewed clinical
 A. 7704--A                          5

 review tool utilized by the insurer which is designated by the office of
 alcoholism  and  substance  abuse services and appropriate to the age of
 the patient, to ensure that the inpatient treatment is medically  neces-
 sary  for  the  patient]. Prior to discharge, the facility shall provide
 the patient and the insurer with a written discharge  plan  which  shall
 describe arrangements for additional services needed following discharge
 from  the  inpatient facility as determined using the evidence-based and
 peer-reviewed clinical review tool utilized  by  the  insurer  which  is
 designated  by  the  office of [alcoholism and substance abuse services]
 ADDICTION SERVICES AND SUPPORTS. Prior to discharge, the facility  shall
 indicate  to the insurer whether services included in the discharge plan
 are secured or determined to be  reasonably  available.  [Any]  INSURERS
 SHALL  ACTIVELY PARTICIPATE IN FACILITY-INITIATED PERIODIC CONSULTATIONS
 PRIOR TO THE PATIENT'S DISCHARGE AND EXCEPT WHERE THE INSURER  FAILS  TO
 DO  SO, ANY utilization review of treatment provided under this subpara-
 graph may include a review of all services provided  during  such  inpa-
 tient  treatment, including all services provided during the first twen-
 ty-eight days  of  such  inpatient  treatment.  Provided,  however,  the
 insurer  SHALL  BE  REQUIRED TO PROCESS CLAIMS FOR THE PROVISION OF SUCH
 SERVICES WITHIN THE TIMEFRAMES ESTABLISHED IN SUBSECTION (A) OF  SECTION
 THREE  THOUSAND TWO HUNDRED TWENTY-FOUR-A OF THIS ARTICLE AND shall only
 deny coverage for any portion of the initial twenty-eight day  inpatient
 treatment  on  the basis that such treatment was not medically necessary
 if such inpatient treatment was contrary to the evidence-based and  peer
 reviewed  clinical  review  tool utilized by the insurer which is desig-
 nated by  the  office  of  [alcoholism  and  substance  abuse  services]
 ADDICTION SERVICES AND SUPPORTS. An insured shall not have any financial
 obligation  to  the  facility  for any treatment under this subparagraph
 other than any copayment, coinsurance, or deductible otherwise  required
 under the policy.
   § 6. Subparagraph (E) of paragraph 7 of subsection (l) of section 3221
 of  the  insurance law, as amended by section 17 of subpart A of part BB
 of chapter 57 of the laws of 2019, is amended to read as follows:
   (E) This subparagraph shall apply to facilities in this state that are
 licensed, certified or otherwise authorized by the office of [alcoholism
 and substance abuse services] ADDICTION SERVICES AND  SUPPORTS  for  the
 provision of outpatient, intensive outpatient, outpatient rehabilitation
 and  opioid  treatment  that are participating in the insurer's provider
 network. Coverage provided under this paragraph shall not be subject  to
 preauthorization.  Coverage  provided  under this paragraph shall not be
 subject to concurrent review for the  first  four  weeks  of  continuous
 treatment,  not  to  exceed  twenty-eight  visits, provided the facility
 notifies the insurer of both the start  of  treatment  and  the  initial
 treatment plan within two business days ON A STANDARDIZED FORM DEVELOPED
 BY  THE DEPARTMENT IN CONSULTATION WITH THE DEPARTMENT OF HEALTH AND THE
 OFFICE OF ADDICTION SERVICES AND SUPPORTS. The  facility  shall  perform
 clinical  assessment  of the patient at each visit[, including periodic]
 AND CONSULT  PERIODICALLY  WITH  THE  INSURER  REGARDING  THE  PATIENT'S
 PROGRESS, COURSE OF TREATMENT, AND DISCHARGE PLAN. PERIODIC consultation
 with  the  insurer  [at  or just prior to] SHALL OCCUR NO LATER THAN the
 fourteenth day of treatment [to ensure that the facility  is  using  the
 evidence-based  and  peer  reviewed clinical review tool utilized by the
 insurer which is designated by the office of  alcoholism  and  substance
 abuse services and appropriate to the age of the patient, to ensure that
 the  outpatient treatment is medically necessary for the patient]. [Any]
 INSURERS  SHALL  ACTIVELY  PARTICIPATE  IN  FACILITY-INITIATED  PERIODIC
 A. 7704--A                          6
 
 CONSULTATIONS  PRIOR  TO  THE  PATIENT'S  DISCHARGE AND EXCEPT WHERE THE
 INSURER FAILS TO DO SO, ANY utilization review of the treatment provided
 under this subparagraph may include a review of  all  services  provided
 during such outpatient treatment, including all services provided during
 the first four weeks of continuous treatment, not to exceed twenty-eight
 visits,  of  such  outpatient  treatment. Provided, however, the insurer
 shall only deny coverage for any portion of the initial  four  weeks  of
 continuous  treatment, not to exceed twenty-eight visits, for outpatient
 treatment on the basis that such treatment was not  medically  necessary
 if such outpatient treatment was contrary to the evidence-based and peer
 reviewed  clinical  review  tool utilized by the insurer which is desig-
 nated by  the  office  of  [alcoholism  and  substance  abuse  services]
 ADDICTION  SERVICES  AND SUPPORTS.  An insured shall not have any finan-
 cial obligation to the facility for any treatment  under  this  subpara-
 graph  other  than  any  copayment, coinsurance, or deductible otherwise
 required under the policy.
   § 7. Subsection (a) of section 3224-a of the insurance law, as amended
 by chapter 237 of the laws of 2009, is amended to read as follows:
   (a) Except in a case where the obligation of an insurer or  an  organ-
 ization  or corporation licensed or certified pursuant to article forty-
 three or forty-seven of this chapter or article forty-four of the public
 health law to pay a claim submitted by a policyholder or person  covered
 under  such policy ("covered person") or make a payment to a health care
 provider is not reasonably clear, or when there is  a  reasonable  basis
 supported  by  specific  information  available for review by the super-
 intendent that such claim or bill for health care services rendered  was
 submitted  fraudulently,  such  insurer  or  organization or corporation
 shall pay the claim to a  policyholder  or  covered  person  or  make  a
 payment  to  a  health  care provider within thirty days of receipt of a
 claim or bill for services rendered that is transmitted via the internet
 or electronic mail, or forty-five days of receipt of a claim or bill for
 services rendered that is submitted by other means,  such  as  paper  or
 facsimile.  THE OBLIGATION OF AN INSURER OR ORGANIZATION TO MAKE PAYMENT
 TO A HEALTH CARE PROVIDER FOR MENTAL HEALTH OR  SUBSTANCE  USE  DISORDER
 SERVICES  THAT  ARE NOT SUBJECT TO PREAUTHORIZATION OR CONCURRENT REVIEW
 PURSUANT TO SECTIONS THREE THOUSAND TWO HUNDRED SIXTEEN, THREE  THOUSAND
 TWO  HUNDRED  TWENTY-ONE,  OR  FOUR THOUSAND THREE HUNDRED THREE OF THIS
 CHAPTER SHALL NOT BE CONSIDERED NOT REASONABLY CLEAR SOLELY BECAUSE  THE
 INSURER  OR  ORGANIZATION  INTENDS TO PERFORM CONCURRENT REVIEW FOR SUCH
 SERVICES BEFORE OR AFTER THE EXPIRATION OF THE TIMEFRAMES ESTABLISHED BY
 THIS SUBSECTION.
   § 8. Paragraph 8 of subsection (g) of section 4303  of  the  insurance
 law, as added by section 23 of subpart A of part BB of chapter 57 of the
 laws of 2019, is amended to read as follows:
   (8)  This  paragraph  shall  apply to hospitals in this state that are
 licensed, CERTIFIED OR OTHERWISE AUTHORIZED  by  the  office  of  mental
 health  that are participating in the [corporation's] INSURER'S provider
 network. Where the contract provides  coverage  for  inpatient  hospital
 care,  benefits  for inpatient hospital care in a hospital as defined by
 subdivision ten of section 1.03 of the mental hygiene law  [provided  to
 individuals  who  have  not  attained  the age of eighteen] shall not be
 subject to preauthorization.  Coverage  provided  under  this  paragraph
 shall  also  not  be subject to concurrent utilization review during the
 first fourteen days of the inpatient admission,  provided  the  facility
 notifies the [corporation] INSURER of both the admission and the initial
 treatment  plan within two business days of the admission ON A STANDARD-
 A. 7704--A                          7
 
 IZED FORM DEVELOPED BY THE DEPARTMENT IN CONSULTATION WITH  THE  DEPART-
 MENT  OF HEALTH AND THE OFFICE OF MENTAL HEALTH, performs daily clinical
 review of the patient, and [participates in periodic  consultation  with
 the  corporation to ensure that the facility is using the evidence-based
 and peer reviewed clinical review criteria utilized by  the  corporation
 which  is approved by the office of mental health and appropriate to the
 age of the patient, to ensure  that  the  inpatient  care  is  medically
 necessary  for  the  patient]  CONSULTS  PERIODICALLY  WITH  THE INSURER
 REGARDING THE PATIENT'S PROGRESS, COURSE  OF  TREATMENT,  AND  DISCHARGE
 PLAN.    [All] INSURERS SHALL ACTIVELY PARTICIPATE IN FACILITY-INITIATED
 PERIODIC CONSULTATIONS PRIOR TO THE PATIENT'S DISCHARGE AND EXCEPT WHERE
 THE INSURER FAILS TO DO SO, ALL treatment provided under this  paragraph
 may  be  reviewed retrospectively. Where care is denied retrospectively,
 an insured shall not have any financial obligation to the  facility  for
 any  treatment  under  this  paragraph other than any copayment, coinsu-
 rance, or deductible otherwise required under the contract.
   § 9. Paragraph 4 of subsection (k) of section 4303  of  the  insurance
 law,  as  amended by section 26 of subpart A of part BB of chapter 57 of
 the laws of 2019, is amended to read as follows:
   (4) This paragraph shall apply to facilities in this  state  that  are
 licensed, certified or otherwise authorized by the office of [alcoholism
 and  substance  abuse services] ADDICTION SERVICES AND SUPPORTS that are
 participating in the [corporation's] INSURER'S provider network.  Cover-
 age  provided  under this subsection shall not be subject to preauthori-
 zation. Coverage provided  under  this  subsection  shall  also  not  be
 subject  to  concurrent utilization review during the first twenty-eight
 days of the inpatient admission provided that the facility notifies  the
 [corporation]  INSURER  of  both the admission and the initial treatment
 plan within two business days of the admission ON  A  STANDARDIZED  FORM
 DEVELOPED  BY  THE  DEPARTMENT  IN  CONSULTATION  WITH THE DEPARTMENT OF
 HEALTH AND THE OFFICE OF ADDICTION SERVICES AND SUPPORTS.  The  facility
 shall  perform daily clinical review of the patient[, including periodic
 consultation] AND CONSULT PERIODICALLY WITH THE  INSURER  REGARDING  THE
 PATIENT'S  PROGRESS,  COURSE OF TREATMENT, AND DISCHARGE PLAN.  PERIODIC
 CONSULTATION with the [corporation at or just prior  to]  INSURER  SHALL
 OCCUR NOT LATER THAN the fourteenth day of treatment [to ensure that the
 facility  is  using the evidence-based and peer reviewed clinical review
 tool utilized by the corporation which is designated by  the  office  of
 alcoholism  and  substance  abuse services and appropriate to the age of
 the patient, to ensure that the inpatient treatment is medically  neces-
 sary  for  the  patient]. Prior to discharge, the facility shall provide
 the patient and the [corporation] INSURER with a written discharge  plan
 which shall describe arrangements for additional services needed follow-
 ing  discharge  from  the  inpatient  facility  as  determined using the
 evidence-based and peer-reviewed clinical review tool  utilized  by  the
 [corporation]  INSURER  which is designated by the office of [alcoholism
 and substance abuse services] ADDICTION SERVICES AND SUPPORTS. Prior  to
 discharge,  the  facility  shall  indicate  to the [corporation] INSURER
 whether services included in the discharge plan are  secured  or  deter-
 mined to be reasonably available.  [Any] INSURERS SHALL ACTIVELY PARTIC-
 IPATE   IN   FACILITY-INITIATED  PERIODIC  CONSULTATIONS  PRIOR  TO  THE
 PATIENT'S DISCHARGE AND EXCEPT WHERE THE INSURER FAILS  TO  DO  SO,  ANY
 utilization  review  of  treatment  provided  under  this  paragraph may
 include a review of all services provided during such  inpatient  treat-
 ment, including all services provided during the first twenty-eight days
 of such inpatient treatment. Provided, however, the [corporation] INSUR-
 A. 7704--A                          8
 
 ER  SHALL  BE  REQUIRED  TO  PROCESS  CLAIMS  FOR  THE PROVISION OF SUCH
 SERVICES WITHIN THE TIMEFRAMES ESTABLISHED IN SUBSECTION (A) OF  SECTION
 THREE  THOUSAND TWO HUNDRED TWENTY-FOUR-A OF THIS CHAPTER AND shall only
 deny  coverage for any portion of the initial twenty-eight day inpatient
 treatment on the basis that such treatment was not  medically  necessary
 if  such inpatient treatment was contrary to the evidence-based and peer
 reviewed clinical review tool  utilized  by  the  [corporation]  INSURER
 which  is  designated  by  the office of [alcoholism and substance abuse
 services] ADDICTION SERVICES AND SUPPORTS.   An insured shall  not  have
 any  financial  obligation  to the facility for any treatment under this
 paragraph other than any copayment, coinsurance, or deductible otherwise
 required under the contract.
   § 10. Paragraph 5 of subsection (l) of section 4303 of  the  insurance
 law,  as  amended by section 28 of subpart A of part BB of chapter 57 of
 the laws of 2019, is amended to read as follows:
   (5) This paragraph shall apply to facilities in this  state  that  are
 licensed, certified or otherwise authorized by the office of [alcoholism
 and  substance  abuse  services] ADDICTION SERVICES AND SUPPORTS for the
 provision of outpatient, intensive outpatient, outpatient rehabilitation
 and opioid treatment that are participating in the corporation's provid-
 er network. Coverage provided under this subsection shall not be subject
 to preauthorization. Coverage provided under this subsection  shall  not
 be  subject  to concurrent review for the first four weeks of continuous
 treatment, not to exceed  twenty-eight  visits,  provided  the  facility
 notifies  the corporation of both the start of treatment and the initial
 treatment plan within two business days ON A STANDARDIZED FORM DEVELOPED
 BY THE DEPARTMENT IN CONSULTATION WITH THE DEPARTMENT OF HEALTH AND  THE
 OFFICE  OF  ADDICTION  SERVICES AND SUPPORTS. The facility shall perform
 clinical assessment of the patient at each visit[,  including  periodic]
 AND  CONSULT  PERIODICALLY  WITH  THE  INSURER  REGARDING  THE PATIENT'S
 PROGRESS, COURSE OF TREATMENT, AND DISCHARGE PLAN. PERIODIC consultation
 with the corporation [at or just prior to] SHALL OCCUR NO LATER THAN the
 fourteenth day of treatment [to ensure that the facility  is  using  the
 evidence-based  and  peer  reviewed clinical review tool utilized by the
 corporation  which  is  designated  by  the  office  of  alcoholism  and
 substance  abuse  services and appropriate to the age of the patient, to
 ensure that the outpatient treatment  is  medically  necessary  for  the
 patient]. [Any] INSURERS SHALL ACTIVELY PARTICIPATE IN FACILITY-INITIAT-
 ED  PERIODIC  CONSULTATIONS  PRIOR TO THE PATIENT'S DISCHARGE AND EXCEPT
 WHERE THE INSURER FAILS TO DO SO, ANY utilization review of  the  treat-
 ment  provided under this paragraph may include a review of all services
 provided  during  such  outpatient  treatment,  including  all  services
 provided  during  the  first  four weeks of continuous treatment, not to
 exceed twenty-eight visits, of such  outpatient  treatment.    Provided,
 however, the corporation shall only deny coverage for any portion of the
 initial  four  weeks of continuous treatment, not to exceed twenty-eight
 visits, for outpatient treatment on the basis that  such  treatment  was
 not medically necessary if such outpatient treatment was contrary to the
 evidence-based  and  peer  reviewed clinical review tool utilized by the
 corporation which  is  designated  by  the  office  of  [alcoholism  and
 substance  abuse services] ADDICTION SERVICES AND SUPPORTS. [A subscrib-
 er] AN INSURED shall not have any financial obligation to  the  facility
 for any treatment under this paragraph other than any copayment, coinsu-
 rance, or deductible otherwise required under the contract.
   §  11.  Section  109  of  the insurance law is amended by adding a new
 subsection (e) to read as follows:
 A. 7704--A                          9
 
   (E) IN ADDITION TO ANY RIGHT OF ACTION GRANTED TO  THE  SUPERINTENDENT
 PURSUANT TO THIS SECTION, ANY PERSON WHO HAS BEEN INJURED BY REASON OF A
 VIOLATION OF PARAGRAPHS THIRTY, THIRTY-ONE, THIRTY-ONE-A AND THIRTY-FIVE
 OF  SUBSECTION  (I) OF SECTION THREE THOUSAND TWO HUNDRED SIXTEEN, PARA-
 GRAPHS  FIVE,  SIX, SEVEN AND SEVEN-A OF SUBSECTION (L) OF SECTION THREE
 THOUSAND TWO HUNDRED TWENTY-ONE, AND SUBSECTIONS (G), (K), (L) OR  (L-1)
 OF  SECTION  FOUR  THOUSAND  THREE  HUNDRED  THREE OF THIS CHAPTER BY AN
 INSURER SUBJECT TO ARTICLE THIRTY-TWO OR FORTY-THREE OF THIS CHAPTER MAY
 BRING AN ACTION IN HIS OR HER OWN NAME TO ENJOIN SUCH  UNLAWFUL  ACT  OR
 PRACTICE, AN ACTION TO RECOVER HIS OR HER ACTUAL DAMAGES OR ONE THOUSAND
 DOLLARS,  WHICHEVER  IS GREATER, OR BOTH SUCH ACTIONS. THE COURT MAY, IN
 ITS DISCRETION, AWARD THE PREVAILING PLAINTIFF IN SUCH ACTION  AN  ADDI-
 TIONAL AWARD NOT TO EXCEED FIVE THOUSAND DOLLARS, IF THE COURT FINDS THE
 DEFENDANT  WILLFULLY  VIOLATED THE PROVISIONS OF THIS SECTION. THE COURT
 MAY AWARD REASONABLE ATTORNEYS' FEES TO A PREVAILING PLAINTIFF.
   § 12. This act shall take effect January 1, 2023.
 
                                  PART B

   Section 1. Subparagraph (A) of paragraph 31-a  of  subsection  (i)  of
 section  3216  of the insurance law, as added by chapter 748 of the laws
 of 2019, is amended to read as follows:
   (A) No policy that provides medical, major medical or similar  compre-
 hensive-type  coverage  and provides coverage for prescription drugs for
 medication for the treatment of a substance use disorder  shall  require
 prior  authorization  for  an  initial  or renewal prescription for SUCH
 DRUGS FOR THE DETOXIFICATION OR MAINTENANCE OF A SUBSTANCE USE DISORDER,
 INCLUDING  all  buprenorphine  products,  methadone  [or],  long  acting
 injectable  naltrexone [for detoxification or maintenance treatment of a
 substance use disorder] AND  MEDICATION  FOR  OPIOID  OVERDOSE  REVERSAL
 PRESCRIBED  OR  DISPENSED  TO  AN  INDIVIDUAL  COVERED UNDER THE POLICY,
 except where otherwise prohibited by law.
   § 2. Subparagraph (A) of paragraph 7-a of subsection  (l)  of  section
 3221  of the insurance law, as added by chapter 748 of the laws of 2019,
 is amended to read as follows:
   (A) NO POLICY THAT PROVIDES MEDICAL, MAJOR MEDICAL OR SIMILAR  COMPRE-
 HENSIVE-TYPE SMALL GROUP COVERAGE AND PROVIDES COVERAGE FOR PRESCRIPTION
 DRUGS FOR MEDICATION FOR THE TREATMENT OF A SUBSTANCE USE DISORDER SHALL
 REQUIRE  PRIOR  AUTHORIZATION FOR AN INITIAL OR RENEWAL PRESCRIPTION FOR
 SUCH DRUGS FOR THE DETOXIFICATION OR  MAINTENANCE  OF  A  SUBSTANCE  USE
 DISORDER,  INCLUDING  ALL BUPRENORPHINE PRODUCTS, METHADONE, LONG ACTING
 INJECTABLE NALTREXONE,  AND  MEDICATION  FOR  OPIOID  OVERDOSE  REVERSAL
 PRESCRIBED  OR  DISPENSED  TO  AN  INDIVIDUAL  COVERED UNDER THE POLICY,
 EXCEPT WHERE OTHERWISE PROHIBITED BY LAW.  Every  policy  that  provides
 medical,  major medical or similar comprehensive-type large group cover-
 age shall provide COVERAGE FOR PRESCRIPTION DRUGS FOR MEDICATION FOR THE
 TREATMENT OF A SUBSTANCE USE DISORDER AND SHALL PROVIDE immediate cover-
 age for all buprenorphine products, methadone [or], long acting injecta-
 ble naltrexone, AND MEDICATION FOR OPIOID OVERDOSE  REVERSAL  PRESCRIBED
 OR  DISPENSED  TO  AN  INDIVIDUAL COVERED UNDER THE POLICY without prior
 authorization for the  detoxification  or  maintenance  treatment  of  a
 substance use disorder, EXCEPT WHERE OTHERWISE PROHIBITED BY LAW.
   § 3. Subparagraph (A) of paragraph (l-1) of section 4303 of the insur-
 ance  law,  as  added  by chapter 748 of the laws of 2019, is amended to
 read as follows:
 A. 7704--A                         10
 
   (A) NO CONTRACT  THAT  PROVIDES  MEDICAL,  MAJOR  MEDICAL  OR  SIMILAR
 COMPREHENSIVE-TYPE  INDIVIDUAL  OR  SMALL  GROUP  COVERAGE  AND PROVIDES
 COVERAGE FOR PRESCRIPTION DRUGS FOR MEDICATION FOR THE  TREATMENT  OF  A
 SUBSTANCE  USE DISORDER SHALL REQUIRE PRIOR AUTHORIZATION FOR AN INITIAL
 OR RENEWAL PRESCRIPTION FOR SUCH DRUGS FOR THE DETOXIFICATION OR MAINTE-
 NANCE OF A SUBSTANCE USE DISORDER, INCLUDING ALL BUPRENORPHINE PRODUCTS,
 METHADONE,  LONG ACTING INJECTABLE NALTREXONE, AND MEDICATION FOR OPIOID
 OVERDOSE REVERSAL PRESCRIBED OR DISPENSED TO AN INDIVIDUAL COVERED UNDER
 THE CONTRACT, EXCEPT WHERE OTHERWISE PROHIBITED BY LAW.  Every  contract
 that  provides  medical,  major  medical,  or similar comprehensive-type
 large group coverage shall provide COVERAGE FOR PRESCRIPTION  DRUGS  FOR
 MEDICATION  FOR  THE  TREATMENT  OF  A  SUBSTANCE USE DISORDER AND SHALL
 PROVIDE immediate coverage for  all  buprenorphine  products,  methadone
 [or], long acting injectable naltrexone, AND MEDICATION FOR OPIOID OVER-
 DOSE REVERSAL PRESCRIBED OR DISPENSED TO AN INDIVIDUAL COVERED UNDER THE
 CONTRACT  without  prior authorization for the detoxification or mainte-
 nance treatment of a substance  use  disorder,  EXCEPT  WHERE  OTHERWISE
 PROHIBITED BY LAW.
   § 4. This act shall take effect immediately.
   § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion,  section  or  part  of  this act shall be adjudged by any court of
 competent  jurisdiction to be invalid, such judgment  shall  not affect,
 impair,  or  invalidate  the remainder thereof, but shall be confined in
 its operation to the clause, sentence, paragraph, subdivision,   section
 or part thereof directly involved in the controversy in which such judg-
 ment shall have been rendered. It is hereby declared to be the intent of
 the  legislature  that  this  act  would  have been enacted even if such
 invalid provisions had not been included herein.
   § 3. This act shall take effect immediately  provided,  however,  that
 the  applicable effective date of Parts A through B of this act shall be
 as specifically set forth in the last section of such Parts.