S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6586
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               March 6, 2025
                                ___________
 
 Introduced by M. of A. WEPRIN -- read once and referred to the Committee
   on Insurance
 
 AN  ACT  to  amend  the  insurance  law  and the social services law, in
   relation to requiring health insurance policies and Medicaid to  cover
   patient navigation services
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (i) of section 3216 of insurance law is  amended
 by adding a new paragraph 40 to read as follows:
   (40)  (A) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMI-
 LAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE FOR PATIENT NAVI-
 GATION SERVICES TO IMPROVE ACCESS TO CARE FOR INDIVIDUALS WHO ARE ELIGI-
 BLE FOR SCREENING, FOLLOW-UP  OR  TREATMENT  SERVICES.  ELIGIBILITY  FOR
 PATIENT NAVIGATION SERVICES COVERAGE INCLUDES INDIVIDUALS WITH A SERIOUS
 CONDITION  THAT IS EXPECTED TO LAST AT LEAST THREE MONTHS AND PLACES THE
 INDIVIDUAL AT HIGH RISK FOR ONE OR MORE OF THE FOLLOWING:
   (I) HOSPITALIZATION;
   (II) NURSING HOME PLACEMENT;
   (III) A SUDDEN WORSENING OF PREEXISTING SYMPTOMS;
   (IV) PHYSICAL OR MENTAL DECLINE; OR
   (V) DEATH.
   (B) PATIENT NAVIGATION SERVICES SHALL INCLUDE, BUT NOT BE LIMITED TO:
   (I) SCREENING FOR NONCLINICAL AND SOCIAL NEEDS THAT DO NOT  REQUIRE  A
 LICENSED HEALTHCARE PROVIDER TO COMPLETE;
   (II)  REFERRALS  AND  FOLLOW-UP  TO  CONNECT  INDIVIDUALS  TO SERVICES
 INCLUDING, BUT NOT LIMITED TO TRANSPORTATION, EMPLOYMENT, JOB  TRAINING,
 FOOD   INSECURITY,  CHILDCARE,  HOUSING,  LANGUAGE  OR  HEALTH  LITERACY
 SUPPORT;
   (III) HELP WITH ENROLLMENT OR  MAINTAINING  ENROLLMENT  IN  GOVERNMENT
 PROGRAMS OR OTHER ASSISTANCE PROGRAMS;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD08151-01-5
 A. 6586                             2
              

 
   (IV)  ARRANGING FOR AND ACCOMPANIMENT TO IN-PERSON AND VIRTUAL HEALTH-
 CARE VISITS; OR
   (V) OTHER PREVENTION, SCREENING AND TREATMENT HEALTH EDUCATION, HEALTH
 NAVIGATION, HEALTH ADVOCACY, OR INDIVIDUAL SUPPORTS INCLUDING TRANSITION
 OF CARE SUPPORTS.
   (C) REIMBURSEMENT SHALL BE PROVIDED TO INDIVIDUALS WHO ARE TRAINED AND
 HAVE  COMPLETED  A  NATIONAL PATIENT NAVIGATION CERTIFICATION OR CREDEN-
 TIALING PROGRAM, OR OTHER CERTIFICATION OR TRAINING PROGRAM APPROVED  BY
 THE  DEPARTMENT  OF HEALTH. APPROVED INDIVIDUALS SHALL BE EMPLOYED BY OR
 IN CONSULTATION WITH FACILITIES CERTIFIED UNDER ARTICLE TWENTY-EIGHT  OF
 THE PUBLIC HEALTH LAW, DIAGNOSTIC AND TREATMENT CENTERS, FEDERALLY QUAL-
 IFIED  HEALTH  CENTERS, CLINICS, PHYSICIANS OR OTHER LICENSED HEALTHCARE
 PROVIDERS, TO PROVIDE PATIENT NAVIGATION SERVICES.  INDIVIDUALS  AUTHOR-
 IZED TO PROVIDE PATIENT NAVIGATION SERVICES SHALL DO SO UNDER THE GENER-
 AL  SUPERVISION  OF  A  LICENSED  PHYSICIAN OR OTHER LICENSED HEALTHCARE
 PROVIDER.
   § 2. Subsection (l) of section 3221 of insurance  law  is  amended  by
 adding a new paragraph 23 to read as follows:
   (23) (A) EVERY INSURER DELIVERING A GROUP OR BLANKET POLICY OR ISSUING
 A  GROUP  OR  BLANKET  POLICY  FOR  DELIVERY IN THIS STATE THAT PROVIDES
 COVERAGE FOR MEDICAL, MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVER-
 AGE SHALL PROVIDE COVERAGE FOR PATIENT NAVIGATION  SERVICES  TO  IMPROVE
 ACCESS TO CARE FOR INDIVIDUALS WHO ARE ELIGIBLE FOR SCREENING, FOLLOW-UP
 OR  TREATMENT  SERVICES.    ELIGIBILITY  FOR PATIENT NAVIGATION SERVICES
 COVERAGE INCLUDES INDIVIDUALS WITH A SERIOUS CONDITION THAT IS  EXPECTED
 TO LAST AT LEAST THREE MONTHS AND PLACES THE INDIVIDUAL AT HIGH RISK FOR
 ONE OR MORE OF THE FOLLOWING:
   (I) HOSPITALIZATION;
   (II) NURSING HOME PLACEMENT;
   (III) A SUDDEN WORSENING OF PREEXISTING SYMPTOMS;
   (IV) PHYSICAL OR MENTAL DECLINE; OR
   (V) DEATH.
   (B) PATIENT NAVIGATION SERVICES SHALL INCLUDE BUT NOT BE LIMITED TO:
   (I)  SCREENING  FOR NONCLINICAL AND SOCIAL NEEDS THAT DO NOT REQUIRE A
 LICENSED HEALTHCARE PROVIDER TO COMPLETE;
   (II) REFERRALS  AND  FOLLOW-UP  TO  CONNECT  INDIVIDUALS  TO  SERVICES
 INCLUDING,  BUT NOT LIMITED TO TRANSPORTATION, EMPLOYMENT, JOB TRAINING,
 FOOD  INSECURITY,  CHILDCARE,  HOUSING,  LANGUAGE  OR  HEALTH   LITERACY
 SUPPORT;
   (III)  HELP  WITH  ENROLLMENT  OR MAINTAINING ENROLLMENT IN GOVERNMENT
 PROGRAMS OR OTHER ASSISTANCE PROGRAMS;
   (IV) ARRANGING FOR AND ACCOMPANIMENT TO IN-PERSON AND VIRTUAL  HEALTH-
 CARE VISITS; OR
   (V) OTHER PREVENTION, SCREENING AND TREATMENT HEALTH EDUCATION, HEALTH
 NAVIGATION, HEALTH ADVOCACY, OR INDIVIDUAL SUPPORTS INCLUDING TRANSITION
 OF CARE SUPPORTS.
   (C) REIMBURSEMENT SHALL BE PROVIDED TO INDIVIDUALS WHO ARE TRAINED AND
 HAVE  COMPLETED  A  NATIONAL PATIENT NAVIGATION CERTIFICATION OR CREDEN-
 TIALING PROGRAM, OR OTHER CERTIFICATION OR TRAINING PROGRAM APPROVED  BY
 THE  DEPARTMENT  OF HEALTH. APPROVED INDIVIDUALS SHALL BE EMPLOYED BY OR
 IN CONSULTATION WITH FACILITIES CERTIFIED UNDER ARTICLE TWENTY-EIGHT  OF
 THE PUBLIC HEALTH LAW, DIAGNOSTIC AND TREATMENT CENTERS, FEDERALLY QUAL-
 IFIED  HEALTH  CENTERS, CLINICS, PHYSICIANS OR OTHER LICENSED HEALTHCARE
 PROVIDERS, TO PROVIDE PATIENT NAVIGATION SERVICES.  INDIVIDUALS  AUTHOR-
 IZED TO PROVIDE PATIENT NAVIGATION SERVICES SHALL DO SO UNDER THE GENER-
 A. 6586                             3

 AL  SUPERVISION  OF  A  LICENSED  PHYSICIAN OR OTHER LICENSED HEALTHCARE
 PROVIDER.
   §  3.  Section  4303  of  the insurance law is amended by adding a new
 subsection (ww) to read as follows:
   (WW) (1) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR  SIMI-
 LAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE FOR PATIENT NAVI-
 GATION SERVICES TO IMPROVE ACCESS TO CARE FOR INDIVIDUALS WHO ARE ELIGI-
 BLE  FOR  SCREENING,  FOLLOW-UP  OR  TREATMENT SERVICES. ELIGIBILITY FOR
 PATIENT NAVIGATION SERVICES COVERAGE INCLUDES INDIVIDUALS WITH A SERIOUS
 CONDITION THAT IS EXPECTED TO LAST AT LEAST THREE MONTHS AND PLACES  THE
 INDIVIDUAL AT HIGH RISK FOR ONE OR MORE OF THE FOLLOWING:
   (A) HOSPITALIZATION;
   (B) NURSING HOME PLACEMENT;
   (C) A SUDDEN WORSENING OF PREEXISTING SYMPTOMS;
   (D) PHYSICAL OR MENTAL DECLINE; OR
   (E) DEATH.
   (2) PATIENT NAVIGATION SERVICES SHALL INCLUDE BUT NOT BE LIMITED TO:
   (A)  SCREENING  FOR NONCLINICAL AND SOCIAL NEEDS THAT DO NOT REQUIRE A
 LICENSED HEALTHCARE PROVIDER TO COMPLETE;
   (B) REFERRALS AND FOLLOW-UP TO CONNECT INDIVIDUALS TO SERVICES INCLUD-
 ING, BUT NOT LIMITED TO TRANSPORTATION, EMPLOYMENT, JOB  TRAINING,  FOOD
 INSECURITY, CHILDCARE, HOUSING, LANGUAGE OR HEALTH LITERACY SUPPORT;
   (C)  HELP  WITH  ENROLLMENT  OR  MAINTAINING  ENROLLMENT IN GOVERNMENT
 PROGRAMS OR OTHER ASSISTANCE PROGRAMS;
   (D) ARRANGING FOR AND ACCOMPANIMENT TO IN-PERSON AND  VIRTUAL  HEALTH-
 CARE VISITS; OR
   (E) OTHER PREVENTION, SCREENING AND TREATMENT HEALTH EDUCATION, HEALTH
 NAVIGATION, HEALTH ADVOCACY, OR INDIVIDUAL SUPPORTS INCLUDING TRANSITION
 OF CARE SUPPORTS.
   (3) REIMBURSEMENT SHALL BE PROVIDED TO INDIVIDUALS WHO ARE TRAINED AND
 HAVE  COMPLETED  A  NATIONAL PATIENT NAVIGATION CERTIFICATION OR CREDEN-
 TIALING PROGRAM, OR OTHER CERTIFICATION OR TRAINING PROGRAM APPROVED  BY
 THE  DEPARTMENT  OF HEALTH. APPROVED INDIVIDUALS SHALL BE EMPLOYED BY OR
 IN CONSULTATION WITH FACILITIES CERTIFIED UNDER ARTICLE TWENTY-EIGHT  OF
 THE PUBLIC HEALTH LAW, DIAGNOSTIC AND TREATMENT CENTERS, FEDERALLY QUAL-
 IFIED  HEALTH  CENTERS, CLINICS, PHYSICIANS OR OTHER LICENSED HEALTHCARE
 PROVIDERS, TO PROVIDE PATIENT NAVIGATION SERVICES.  INDIVIDUALS  AUTHOR-
 IZED TO PROVIDE PATIENT NAVIGATION SERVICES SHALL DO SO UNDER THE GENER-
 AL  SUPERVISION  OF  A  LICENSED  PHYSICIAN OR OTHER LICENSED HEALTHCARE
 PROVIDER.
   § 4. Subdivision 2 of section 365-a of  the  social  services  law  is
 amended by adding a new paragraph (nn) to read as follows:
   (NN)  (I)  PATIENT  NAVIGATION  SERVICES TO IMPROVE ACCESS TO CARE FOR
 INDIVIDUALS WHO ARE  ELIGIBLE  FOR  SCREENING,  FOLLOW-UP  OR  TREATMENT
 SERVICES.  ELIGIBILITY FOR PATIENT NAVIGATION SERVICES COVERAGE INCLUDES
 INDIVIDUALS WITH A SERIOUS CONDITION THAT IS EXPECTED TO LAST  AT  LEAST
 THREE  MONTHS  AND PLACES THE INDIVIDUAL AT HIGH RISK FOR ONE OR MORE OF
 THE FOLLOWING:
   (A) HOSPITALIZATION;
   (B) NURSING HOME PLACEMENT;
   (C) A SUDDEN WORSENING OF PREEXISTING SYMPTOMS;
   (D) PHYSICAL OR MENTAL DECLINE; OR
   (E) DEATH.
   (II) PATIENT NAVIGATION SERVICES SHALL INCLUDE BUT NOT BE LIMITED TO:
   (A) SCREENING FOR NONCLINICAL AND SOCIAL NEEDS THAT DO NOT  REQUIRE  A
 LICENSED HEALTHCARE PROVIDER TO COMPLETE;
 A. 6586                             4
 
   (B) REFERRALS AND FOLLOW-UP TO CONNECT INDIVIDUALS TO SERVICES INCLUD-
 ING,  BUT  NOT LIMITED TO TRANSPORTATION, EMPLOYMENT, JOB TRAINING, FOOD
 INSECURITY, CHILDCARE, HOUSING, LANGUAGE OR HEALTH LITERACY SUPPORT;
   (C)  HELP  WITH  ENROLLMENT  OR  MAINTAINING  ENROLLMENT IN GOVERNMENT
 PROGRAMS OR OTHER ASSISTANCE PROGRAMS;
   (D) ARRANGING FOR AND ACCOMPANIMENT TO IN-PERSON AND  VIRTUAL  HEALTH-
 CARE VISITS; OR
   (E) OTHER PREVENTION, SCREENING AND TREATMENT HEALTH EDUCATION, HEALTH
 NAVIGATION, HEALTH ADVOCACY, OR INDIVIDUAL SUPPORTS INCLUDING TRANSITION
 OF CARE SUPPORTS.
   (III)  REIMBURSEMENT  SHALL BE PROVIDED TO INDIVIDUALS WHO ARE TRAINED
 AND HAVE  COMPLETED  A  NATIONAL  PATIENT  NAVIGATION  CERTIFICATION  OR
 CREDENTIALING  PROGRAM,  OR  OTHER  CERTIFICATION  OR  TRAINING  PROGRAM
 APPROVED BY THE DEPARTMENT OF  HEALTH.  APPROVED  INDIVIDUALS  SHALL  BE
 EMPLOYED  BY  OR IN CONSULTATION WITH FACILITIES CERTIFIED UNDER ARTICLE
 TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, DIAGNOSTIC AND TREATMENT CENTERS,
 FEDERALLY  QUALIFIED  HEALTH  CENTERS,  CLINICS,  PHYSICIANS  OR   OTHER
 LICENSED  HEALTHCARE  PROVIDERS, TO PROVIDE PATIENT NAVIGATION SERVICES.
 INDIVIDUALS AUTHORIZED TO PROVIDE PATIENT NAVIGATION SERVICES  SHALL  DO
 SO  UNDER  THE  GENERAL  SUPERVISION  OF  A  LICENSED PHYSICIAN OR OTHER
 LICENSED HEALTHCARE PROVIDER.
   § 5. This act shall take effect on the first of January next  succeed-
 ing  the date on which it shall have become a law and shall apply to all
 policies and contracts issued, renewed, modified, altered or amended  on
 or  after  such  date.  Effective  immediately,  the addition, amendment
 and/or repeal of any rule or regulation necessary for the implementation
 of this act on  its  effective  date  are  authorized  to  be  made  and
 completed on or before such effective date.