Assembly Bill A8839

2023-2024 Legislative Session

Provides for a minimum reimbursement rate for ambulatory behavioral health services

download bill text pdf

Sponsored By

Current Bill Status - In Assembly Committee


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2023-A8839 (ACTIVE) - Details

See Senate Version of this Bill:
S8466
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L; amd §4403, Pub Health L

2023-A8839 (ACTIVE) - Summary

Provides for a minimum reimbursement rate for ambulatory behavioral health services.

2023-A8839 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8839
 
                           I N  A S S E M B L Y
 
                             January 18, 2024
                                ___________
 
 Introduced  by M. of A. GUNTHER -- read once and referred to the Commit-
   tee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to setting a minimum  reimbursement  rate  for  ambulatory  behavioral
   health services
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Paragraph 35 of subsection  (i)  of  section  3216  of  the
 insurance  law  is  amended  by adding a new subparagraph (K) to read as
 follows:
   (K) EVERY  POLICY  WHICH  PROVIDES MEDICAL, MAJOR MEDICAL, OR  SIMILAR
 COMPREHENSIVE-TYPE  COVERAGE  SHALL  REIMBURSE IN NETWORK, PARTICIPATING
 PROVIDERS LICENSED PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH
 LAW OR ARTICLE THIRTY-ONE OR THIRTY-TWO OF THE MENTAL  HYGIENE  LAW  FOR
 AMBULATORY  BEHAVIORAL  HEALTH  SERVICES  PROVIDED TO ITS INSUREDS, AT A
 MINIMUM, AT A RATE EQUIVALENT  TO  THE  PAYMENTS  ESTABLISHED  FOR  SUCH
 SERVICES UNDER THE AMBULATORY PATIENT GROUP (APG) RATE-SETTING METHODOL-
 OGY  AT  THE TIME OF SERVICE, UTILIZED BY THE DEPARTMENT OF HEALTH OR BY
 THE OFFICE OF  MENTAL  HEALTH  OR  OFFICES  OF  ADDICTION  SERVICES  AND
 SUPPORTS  FOR  RATE-SETTING  PURPOSES  FOR  AMBULATORY BEHAVIORAL HEALTH
 SERVICES PROVIDED TO ENROLLEES IN THE MEDICAL ASSISTANCE  PROGRAM  UNDER
 TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW. INSURERS AND IN
 NETWORK, PARTICIPATING PROVIDERS MAY NEGOTIATE DIFFERENT RATES AND METH-
 ODS  OF PAYMENTS, HOWEVER INSURERS SHALL PAY NO LESS THAN THE EQUIVALENT
 OF RATES THAT WOULD BE PAID FOR AMBULATORY  BEHAVIORAL  HEALTH  SERVICES
 PURSUANT TO THE MEDICAL ASSISTANCE PROGRAM UNDER TITLE ELEVEN OF ARTICLE
 FIVE OF THE SOCIAL SERVICES LAW.
   §  2.  Paragraph  5 of subsection (l) of section 3221 of the insurance
 law is amended by adding a new subparagraph (K) to read as follows:
   (K) EVERY INSURER DELIVERING A GROUP OR BLANKET POLICY  OR  ISSUING  A
 GROUP  OR BLANKET POLICY FOR DELIVERY IN THIS STATE THAT PROVIDES COVER-
 AGE FOR HOSPITAL,   MAJOR   MEDICAL,   OR   SIMILAR   COMPREHENSIVE-TYPE
 COVERAGE  SHALL   REIMBURSE IN NETWORK, PARTICIPATING PROVIDERS LICENSED
 PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC  HEALTH  LAW  OR  ARTICLE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

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