Assembly Bill A1792

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1792
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 14, 2025
                                ___________
 
 Introduced  by M. of A. STECK -- read once and referred to the Committee
   on Health
 
 AN ACT to amend the public health law, in relation to  including  mental
   health  services, substance use disorder treatment services and recov-
   ery support services to network adequacy requirements; and directs the
   superintendent of financial services and the commissioner of health to
   review data and update regulations regarding health maintenance organ-
   izations and network adequacy requirements
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Short  title. This act shall be known and may be cited as
 the "ensuring access to behavioral health act".
   § 2. Subdivision 3 of section 4401 of the public health law, as  added
 by chapter 938 of the laws of 1976, is amended to read as follows:
   3.  "Comprehensive  health  services"  means all those health services
 which an enrolled population might require in order to be maintained  in
 good  health,  and shall include, but shall not be limited to, physician
 services (including consultant and referral  services),  in-patient  and
 out-patient  hospital  services,  MENTAL  HEALTH SERVICES, SUBSTANCE USE
 DISORDER TREATMENT SERVICES, RECOVERY SUPPORT SERVICES, diagnostic labo-
 ratory and therapeutic and diagnostic radiologic services, and emergency
 and preventive health services. Such term  may  be  further  defined  by
 agreement with enrolled populations providing additional benefits neces-
 sary, desirable or appropriate to meet their health care needs.
   §  3.  Paragraph  (a)  of  subdivision 5 of section 4403 of the public
 health law, as amended by chapter 586 of the laws of 1998, is amended to
 read as follows:
   (a) The commissioner, at the time of initial licensure, at least every
 three years thereafter, and upon application for  expansion  of  service
 area,  shall ensure that the health maintenance organization maintains a
 network of health care providers  adequate  to  meet  the  comprehensive
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01855-01-5
              

 A. 1792                             2
 
 health  needs,  INCLUDING MENTAL HEALTH SERVICES, SUBSTANCE USE DISORDER
 TREATMENT SERVICES,  INCLUDING  BUT  NOT  LIMITED  TO  OPIOID  TREATMENT
 PROGRAMS AND MEDICATION ASSISTED TREATMENT OPTIONS, AND RECOVERY SUPPORT
 SERVICES,  of  its  enrollees  and  to  provide an appropriate choice of
 providers  sufficient  to  provide  the  services  covered   under   its
 enrollee's  contracts  by  determining  that  (i) there are a sufficient
 number of geographically accessible participating  providers,  INCLUDING
 ALL  OPIOID  TREATMENT  PROGRAMS IN ALL COUNTIES OF THE STATE AND IN THE
 CITY OF NEW YORK AND ALL AUTHORIZED  BUPRENORPHINE  PRESCRIBERS  IN  ALL
 COUNTIES OF THE STATE AND IN THE CITY OF NEW YORK; (ii) there are oppor-
 tunities  to  select from at least three primary care providers pursuant
 to travel and distance time standards,  providing  that  such  standards
 account  for the conditions of accessing providers in rural areas; (iii)
 there are sufficient providers in each area  of  specialty  practice  to
 meet  the needs of the enrollment population; (iv) there is no exclusion
 of any appropriately licensed type of  provider  as  a  class;  and  (v)
 contracts  entered  into  with  health  care  providers neither transfer
 financial  risk  to  providers,  in  a  manner  inconsistent  with   the
 provisions  of  paragraph  (c)  of  subdivision one of this section, nor
 penalize providers for unfavorable case mix  so  as  to  jeopardize  the
 quality  of  or  enrollees'  appropriate  access  to medically necessary
 services; provided, however, that payment at less  than  prevailing  fee
 for  service  rates  or capitation shall not be deemed or presumed prima
 facie to jeopardize quality or access.
   § 4.  The superintendent of financial services, in  consultation  with
 the  office  of addiction services and supports and the office of mental
 health, shall  review  data  gathered  through  the  mental  health  and
 substance use disorder parity compliance program required under 11 NYCRR
 230.3 for every insurer, corporation organized pursuant to article 43 of
 the  insurance  law, municipal cooperative health benefit plan certified
 pursuant to article 47 of the insurance law, health  maintenance  organ-
 ization  certified  pursuant  to article 44 of the public health law, or
 student health plan established or maintained pursuant to  section  1124
 of  the  insurance  law.  After  such review and review of national best
 practices for network adequacy for behavioral health, the superintendent
 of financial services shall update any regulations or guidance regarding
 network adequacy for  all  mental  health  and  substance  use  disorder
 services.  Such  updated  regulations  or  guidance  shall  be  based on
 national best practices and  shall  include  quantitative  measures  for
 geographic  distance  and/or  travel  time,  appointment  wait  time and
 provider/enrollee ratios and any other appropriate metric determined  by
 the  superintendent  to  be  necessary to ensure access to needed mental
 health and substance  use  disorder  services.  Such  regulations  shall
 include  a  review  of  the appropriate use of telephonic and telehealth
 services to supplement in-person services, as well as  the  adequacy  of
 the  network to meet the needs of specific covered groups, including but
 not limited to, low-income persons, persons with limited English  profi-
 ciency  or  illiteracy,  diverse  cultural or ethnic backgrounds, LGBTQ,
 persons with disabilities, and children and adults with serious, chronic
 or complex  health  conditions,  including  co-occurring  mental  health
 conditions and substance use disorders.
   §  5. The commissioner of health, in consultation with the independent
 substance use disorder and mental health ombudsperson, shall review  and
 update network adequacy requirements for mental health and substance use
 disorder  services covered by managed care plans as part of the periodic
 reviews of plans  network  adequacy  required  by  subdivision  11-a  of
 A. 1792                             3
 
 section  4403-f  of the public health law. Such review and updated regu-
 lations or guidance shall include quantitative measures  for  geographic
 distance and/or travel time, appointment wait time and provider/enrollee
 ratios  and  any other appropriate metric determined by the commissioner
 of health to ensure access to mental health and substance  use  disorder
 services. Such updated regulations shall be based on national best prac-
 tices  and  shall  include a review of the appropriate use of telephonic
 and telehealth services to supplement in-person services, as well as the
 adequacy of the network to meet the needs of  specific  covered  groups,
 including  but  not limited to, low-income persons, persons with limited
 English proficiency or illiteracy,  diverse  cultural  or  ethnic  back-
 grounds,  LGBTQ, persons with disabilities, and children and adults with
 serious, chronic or complex health  conditions,  including  co-occurring
 mental health conditions and substance use disorders.
   § 6.  This act shall take effect immediately.