Senate Bill S498

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    498
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                              January 4, 2023
                                ___________
 
 Introduced  by  Sen.  STEC  --  read twice and ordered printed, and when
   printed to be committed 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 5 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  hospital,  major  medical  or  similar
 comprehensive  coverage shall provide inpatient coverage for the diagno-
 sis 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  neces-
 sary treatment for substance use disorder treatment services provided in
 residential  settings.  Further, such inpatient coverage shall not apply
 financial requirements or treatment limitations,  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.
   § 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, FOR A PERIOD OF NOT LESS  THAN  FORTY-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02918-01-3
              

 S. 498                              2
 
 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.
   § 3. Subparagraph (A) 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:
   (A)  Every  policy  that  provides  hospital, major medical or similar
 comprehensive coverage shall provide inpatient coverage for the  diagno-
 sis  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 neces-
 sary treatment for substance use disorder treatment services provided in
 residential settings. Further, such inpatient coverage shall  not  apply
 financial  requirements  or treatment limitations, 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.
   § 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, 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.
   § 5. Paragraph 1 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:
   (1) Every contract that provides hospital, major  medical  or  similar
 comprehensive  coverage shall provide inpatient coverage for the diagno-
 sis 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  neces-
 sary treatment for substance use disorder treatment services provided in
 residential  settings.  Further, such inpatient coverage shall not apply
 financial requirements or treatment limitations,  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.
   § 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:
   (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, 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
 S. 498                              3
 
 are more restrictive than the  predominant  financial  requirements  and
 treatment  limitations applied to substantially all medical and surgical
 benefits covered by the contract.
   §  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
 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.