NY State Assembly Bill 2025-A7038A

Assembly Bill A7038A

2025-2026 Legislative Session

Requires rates paid for rehabilitation and opioid treatment be pursuant to certain fee schedules published by the office of addiction services and supports

download bill text pdf

Current Bill Status - On Floor Calendar

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

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Apr 29, 2025	amended on third reading 7038a
Apr 03, 2025	advanced to third reading cal.96
Apr 02, 2025	reported
Mar 18, 2025	referred to insurance

Bill Amendments

Original

A (Active)

co-Sponsors

2025-A7038 - Details

See Senate Version of this Bill:: S6897
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L

2025-A7038 - Summary

Requires rates paid for rehabilitation and opioid treatment be pursuant to certain fee schedules published by the office of addiction services and supports.

2025-A7038 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7038
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 18, 2025
                                ___________
 
 Introduced by M. of A. WEPRIN -- read once and referred to the Committee
   on Insurance
 
 AN  ACT  to amend the insurance law, in relation to requiring rates paid
   for rehabilitation and opioid treatment be  pursuant  to  certain  fee
   schedules published by the office of addiction services and supports

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (J) of  paragraph  31  of  subsection  (i)  of
 section  3216  of the insurance law, as added by section 1 of part AA of
 chapter 57 of the laws of 2024, is amended to read as follows:
   (J) This subparagraph shall apply to facilities in this state that are
 licensed, certified, or otherwise authorized by the office of  addiction
 services  and supports for the provision of outpatient, intensive outpa-
 tient, outpatient rehabilitation and opioid treatment that  are  partic-
 ipating  in  the  insurer's  provider network. Reimbursement for covered
 outpatient treatment provided by such facilities shall be at rates nego-
 tiated between the insurer and the participating facility, provided that
 such rates are not less than the rates  that  would  be  paid  for  such
 treatment  pursuant to the medical assistance program under title eleven
 of article five of the social services law. For  the  purposes  of  this
 subparagraph,  the  rates that would be paid for such treatment pursuant
 to the medical assistance program under title eleven of article five  of
 the  social  services law SHALL BE SET FORTH IN A PUBLISHED FEE SCHEDULE
 SETTING FORTH THE SPECIFIC FEE FOR EACH INDIVIDUAL  SERVICE  COVERED  BY
 THIS  SUBPARAGRAPH  BY THE OFFICE OF ADDICTION SERVICES AND SUPPORTS AND
 shall be the rates with an effective date of April first of the  preced-
 ing  year,  which  shall  be  established  prior to October first of the
 preceding calendar year. Prior to the submission of premium rate filings
 and applications, the superintendent shall provide insurers  with  guid-
 ance  on  factors  to consider in calculating the impact of rate changes
 for the purposes of submitting premium rate filings and applications  to
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11143-01-5

 A. 7038                             2
 
 the  superintendent  for  the subsequent policy year. To the extent that
 the rates with an effective date of April first differ  from  the  esti-
 mated  rates  incorporated  in  premium  rate  filings and applications,
 insurers may account for such differences in future premium rate filings
 and applications submitted to the superintendent for approval.
   §  2.  Subparagraph  (K)  of paragraph 35 of subsection (i) of section
 3216 of the insurance law, as added by section 2 of part AA  of  chapter
 57 of the laws of 2024, is amended to read as follows:
   (K)  This subparagraph shall apply to outpatient treatment provided in
 a facility issued an operating certificate by the commissioner of mental
 health pursuant to the provisions of article thirty-one  of  the  mental
 hygiene  law,  or in a facility operated by the office of mental health,
 or in a crisis stabilization center licensed pursuant to  section  36.01
 of  the  mental  hygiene  law,  that  is  participating in the insurer's
 provider  network.  Reimbursement  for  covered   outpatient   treatment
 provided  by  such  a  facility shall be at rates negotiated between the
 insurer and the participating facility, provided that such rates are not
 less than the rates that would be paid for such  treatment  pursuant  to
 the medical assistance program under title eleven of article five of the
 social  services  law.  For the purposes of this subparagraph, the rates
 that would be paid for such treatment pursuant to the medical assistance
 program under title eleven of article five of the  social  services  law
 SHALL BE SET FORTH IN A PUBLISHED FEE SCHEDULE SETTING FORTH THE SPECIF-
 IC  FEE  FOR EACH INDIVIDUAL SERVICE COVERED BY THIS SUBPARAGRAPH BY THE
 OFFICE OF MENTAL HEALTH AND shall be the rates with an effective date of
 April first of the preceding year, which shall be established  prior  to
 October first of the preceding calendar year. Prior to the submission of
 premium  rate filings and applications, the superintendent shall provide
 insurers with guidance on factors to consider in calculating the  impact
 of  rate changes for the purposes of submitting premium rate filings and
 applications to the superintendent for the subsequent  policy  year.  To
 the  extent  that the rates with an effective date of April first differ
 from the estimated rates incorporated in premium rate filings and appli-
 cations, insurers may account for such  differences  in  future  premium
 rate  filings  and  applications  submitted  to  the  superintendent for
 approval.
   § 3. Subparagraph (K) of paragraph 5 of subsection (l) of section 3221
 of the insurance law, as added by section 3 of part AA of chapter 57  of
 the laws of 2024, is amended to read as follows:
   (K)  This subparagraph shall apply to outpatient treatment provided in
 a facility issued an operating certificate by the commissioner of mental
 health pursuant to the provisions of article thirty-one  of  the  mental
 hygiene  law,  or in a facility operated by the office of mental health,
 or in a crisis stabilization center licensed pursuant to  section  36.01
 of  the  mental  hygiene  law,  that  is  participating in the insurer's
 provider  network.  Reimbursement  for  covered   outpatient   treatment
 provided  by  such  a  facility shall be at rates negotiated between the
 insurer and the participating facility, provided that such rates are not
 less than the rates that would be paid for such  treatment  pursuant  to
 the medical assistance program under title eleven of article five of the
 social  services  law.  For the purposes of this subparagraph, the rates
 that would be paid for such treatment pursuant to the medical assistance
 program under title eleven of article five of the  social  services  law
 SHALL BE SET FORTH IN A PUBLISHED FEE SCHEDULE SETTING FORTH THE SPECIF-
 IC  FEE  FOR EACH INDIVIDUAL SERVICE COVERED BY THIS SUBPARAGRAPH BY THE
 OFFICE OF MENTAL HEALTH AND shall be the rates with an effective date of
 A. 7038                             3
 
 April first of the preceding year, which shall be established  prior  to
 October first of the preceding calendar year. Prior to the submission of
 premium  rate filings and applications, the superintendent shall provide
 insurers  with guidance on factors to consider in calculating the impact
 of rate changes for the purposes of submitting premium rate filings  and
 applications  to  the  superintendent for the subsequent policy year. To
 the extent that the rates with an effective date of April  first  differ
 from the estimated rates incorporated in premium rate filings and appli-
 cations,  insurers  may  account  for such differences in future premium
 rate filings  and  applications  submitted  to  the  superintendent  for
 approval.
   § 4. Subparagraph (J) of paragraph 7 of subsection (l) of section 3221
 of  the insurance law, as added by section 4 of part AA of chapter 57 of
 the laws of 2024, is amended to read as follows:
   (J) This subparagraph shall apply to facilities in this state that are
 licensed, certified, or otherwise authorized by the office of  addiction
 services  and supports for the provision of outpatient, intensive outpa-
 tient, outpatient rehabilitation and opioid treatment that  are  partic-
 ipating  in  the  insurer's  provider network. Reimbursement for covered
 outpatient treatment provided by such facilities shall be at rates nego-
 tiated between the insurer and the participating facility, provided that
 such rates are not less than the rates  that  would  be  paid  for  such
 treatment  pursuant to the medical assistance program under title eleven
 of article five of the social services law. For  the  purposes  of  this
 subparagraph,  the  rates that would be paid for such treatment pursuant
 to the medical assistance program under title eleven of article five  of
 the  social  services law SHALL BE SET FORTH IN A PUBLISHED FEE SCHEDULE
 SETTING FORTH THE SPECIFIC FEE FOR EACH INDIVIDUAL  SERVICE  COVERED  BY
 THIS  SUBPARAGRAPH  BY THE OFFICE OF ADDICTION SERVICES AND SUPPORTS AND
 shall be the rates with an effective date of April first of the  preced-
 ing  year,  which  shall  be  established  prior to October first of the
 preceding calendar year. Prior to the submission of premium rate filings
 and applications, the superintendent shall provide insurers  with  guid-
 ance  on  factors  to consider in calculating the impact of rate changes
 for the purposes of submitting premium rate filings and applications  to
 the  superintendent  for  the subsequent policy year. To the extent that
 the rates with an effective date of April first differ  from  the  esti-
 mated  rates  incorporated  in  premium  rate  filings and applications,
 insurers may account for such differences in future premium rate filings
 and applications submitted to the superintendent for approval.
   § 5. Paragraph 12 of subsection (g) of section 4303 of  the  insurance
 law, as added by section 5 of part AA of chapter 57 of the laws of 2024,
 is amended to read as follows:
   (12)  This paragraph shall apply to outpatient treatment provided in a
 facility issued an operating certificate by the commissioner  of  mental
 health  pursuant  to  the provisions of article thirty-one of the mental
 hygiene law, or in a facility operated by the office of  mental  health,
 or  in  a crisis stabilization center licensed pursuant to section 36.01
 of the mental hygiene law, that is participating  in  the  corporation's
 provider   network.   Reimbursement  for  covered  outpatient  treatment
 provided by such facility shall  be  at  rates  negotiated  between  the
 corporation and the participating facility, provided that such rates are
 not  less  than the rates that would be paid for such treatment pursuant
 to the medical assistance program under title eleven of article five  of
 the  social  services law. For the purposes of this paragraph, the rates
 that would be paid for such treatment pursuant to the medical assistance
 A. 7038                             4
 
 program under title eleven of article five of the  social  services  law
 SHALL BE SET FORTH IN A PUBLISHED FEE SCHEDULE SETTING FORTH THE SPECIF-
 IC  FEE  FOR  EACH  INDIVIDUAL  SERVICE COVERED BY THIS PARAGRAPH BY THE
 OFFICE OF MENTAL HEALTH AND shall be the rates with an effective date of
 April  first  of the preceding year, which shall be established prior to
 October first of the preceding calendar year. Prior to the submission of
 premium rate filings and applications, the superintendent shall  provide
 corporations  with  guidance  on  factors to consider in calculating the
 impact of rate changes for  the  purposes  of  submitting  premium  rate
 filings and applications to the superintendent for the subsequent policy
 year. To the extent that the rates with an effective date of April first
 differ from the estimated rates incorporated in premium rate filings and
 applications,  corporations  may  account for such differences in future
 premium rate filings and applications submitted  to  the  superintendent
 for approval.
   §  6.  Paragraph 10 of subsection (l) of section 4303 of the insurance
 law, as added by section 6 of part AA of chapter 57 of the laws of 2024,
 is amended to read as follows:
   (10) This paragraph shall apply to facilities in this state  that  are
 licensed,  certified, or otherwise authorized by the office of addiction
 services and supports for the provision of outpatient, intensive  outpa-
 tient,  outpatient  rehabilitation and opioid treatment that are partic-
 ipating in the corporation's provider network. Reimbursement for covered
 outpatient treatment provided by such facilities shall be at rates nego-
 tiated between the corporation and the participating facility,  provided
 that  such rates are not less than the rates that would be paid for such
 treatment pursuant to the medical assistance program under title  eleven
 of  article  five  of  the social services law. For the purposes of this
 paragraph, the rates that would be paid for such treatment  pursuant  to
 the medical assistance program under title eleven of article five of the
 social  services  law  SHALL  BE  SET  FORTH IN A PUBLISHED FEE SCHEDULE
 SETTING FORTH THE SPECIFIC FEE FOR EACH INDIVIDUAL  SERVICE  COVERED  BY
 THIS  PARAGRAPH  BY  THE  OFFICE  OF ADDICTION SERVICES AND SUPPORTS AND
 shall be the rates with an effective date of April first of the  preced-
 ing  year,  which  shall  be  established  prior to October first of the
 preceding calendar year. Prior to the submission of premium rate filings
 and applications, the superintendent  shall  provide  corporations  with
 guidance on factors to consider in calculating the impact of rate chang-
 es  for the purposes of submitting premium rate filings and applications
 to the superintendent for the subsequent policy year. To the extent that
 the rates with an effective date of April first differ  from  the  esti-
 mated  rates  incorporated  in  premium  rate  filings and applications,
 corporations may account for such differences  in  future  premium  rate
 filings and applications submitted to the superintendent for approval.
   §  7.  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.

co-Sponsors

2025-A7038A (ACTIVE) - Details

See Senate Version of this Bill:: S6897
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L

2025-A7038A (ACTIVE) - Summary

Requires rates paid for rehabilitation and opioid treatment be pursuant to certain fee schedules published by the office of addiction services and supports.

2025-A7038A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7038--A
                                                          Cal. No. 96
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 18, 2025
                                ___________
 
 Introduced by M. of A. WEPRIN, SANTABARBARA -- read once and referred to
   the  Committee  on Insurance -- reported from committee, advanced 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 requiring rates paid
   for rehabilitation and opioid treatment be  pursuant  to  certain  fee
   schedules published by the office of addiction services and supports
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (J) of  paragraph  31  of  subsection  (i)  of
 section  3216  of the insurance law, as added by section 1 of part AA of
 chapter 57 of the laws of 2024, is amended to read as follows:
   (J) This subparagraph shall apply to facilities in this state that are
 licensed, certified, or otherwise authorized by the office of  addiction
 services  and supports for the provision of outpatient, intensive outpa-
 tient, outpatient rehabilitation and opioid treatment that  are  partic-
 ipating  in  the  insurer's  provider network. Reimbursement for covered
 outpatient treatment provided by such facilities shall be at rates nego-
 tiated between the insurer and the participating facility, provided that
 such rates are not less than the rates  that  would  be  paid  for  such
 treatment  pursuant to the medical assistance program under title eleven
 of article five of the social services law. For  the  purposes  of  this
 subparagraph,  the  rates that would be paid for such treatment pursuant
 to the medical assistance program under title eleven of article five  of
 the  social  services  law  SHALL BE SET FORTH IN A FEE SCHEDULE SETTING
 FORTH THE SPECIFIC FEE FOR  EACH  INDIVIDUAL  SERVICE  COVERED  BY  THIS
 SUBPARAGRAPH  PUBLISHED BY THE OFFICE OF ADDICTION SERVICES AND SUPPORTS
 BY NOVEMBER FIRST OF THE PRECEDING CALENDAR YEAR AND shall be the  rates
 with an effective date of April first of the preceding year, which shall
 be  established  prior  to October first of the preceding calendar year.
 Prior to the submission of premium rate filings  and  applications,  the
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD11143-02-5
 A. 7038--A                          2
 
 superintendent  shall  provide  insurers  with  guidance  on  factors to
 consider in calculating the impact of rate changes for the  purposes  of
 submitting  premium  rate filings and applications to the superintendent
 for  the  subsequent  policy  year. To the extent that the rates with an
 effective date of April first differ from the estimated  rates  incorpo-
 rated in premium rate filings and applications, insurers may account for
 such differences in future premium rate filings and applications submit-
 ted to the superintendent for approval.
   §  2.  Subparagraph  (K)  of paragraph 35 of subsection (i) of section
 3216 of the insurance law, as added by section 2 of part AA  of  chapter
 57 of the laws of 2024, is amended to read as follows:
   (K)  This subparagraph shall apply to outpatient treatment provided in
 a facility issued an operating certificate by the commissioner of mental
 health pursuant to the provisions of article thirty-one  of  the  mental
 hygiene  law,  or in a facility operated by the office of mental health,
 or in a crisis stabilization center licensed pursuant to  section  36.01
 of  the  mental  hygiene  law,  that  is  participating in the insurer's
 provider  network.  Reimbursement  for  covered   outpatient   treatment
 provided  by  such  a  facility shall be at rates negotiated between the
 insurer and the participating facility, provided that such rates are not
 less than the rates that would be paid for such  treatment  pursuant  to
 the medical assistance program under title eleven of article five of the
 social  services  law.  For the purposes of this subparagraph, the rates
 that would be paid for such treatment pursuant to the medical assistance
 program under title eleven of article five of the  social  services  law
 SHALL  BE SET FORTH IN A FEE SCHEDULE SETTING FORTH THE SPECIFIC FEE FOR
 EACH INDIVIDUAL SERVICE COVERED BY THIS SUBPARAGRAPH  PUBLISHED  BY  THE
 OFFICE OF MENTAL HEALTH BY NOVEMBER FIRST OF THE PRECEDING CALENDAR YEAR
 AND  shall  be  the  rates  with an effective date of April first of the
 preceding year, which shall be established prior to October first of the
 preceding calendar year. Prior to the submission of premium rate filings
 and applications, the superintendent shall provide insurers  with  guid-
 ance  on  factors  to consider in calculating the impact of rate changes
 for the purposes of submitting premium rate filings and applications  to
 the  superintendent  for  the subsequent policy year. To the extent that
 the rates with an effective date of April first differ  from  the  esti-
 mated  rates  incorporated  in  premium  rate  filings and applications,
 insurers may account for such differences in future premium rate filings
 and applications submitted to the superintendent for approval.
   § 3. Subparagraph (K) of paragraph 5 of subsection (l) of section 3221
 of the insurance law, as added by section 3 of part AA of chapter 57  of
 the laws of 2024, is amended to read as follows:
   (K)  This subparagraph shall apply to outpatient treatment provided in
 a facility issued an operating certificate by the commissioner of mental
 health pursuant to the provisions of article thirty-one  of  the  mental
 hygiene  law,  or in a facility operated by the office of mental health,
 or in a crisis stabilization center licensed pursuant to  section  36.01
 of  the  mental  hygiene  law,  that  is  participating in the insurer's
 provider  network.  Reimbursement  for  covered   outpatient   treatment
 provided  by  such  a  facility shall be at rates negotiated between the
 insurer and the participating facility, provided that such rates are not
 less than the rates that would be paid for such  treatment  pursuant  to
 the medical assistance program under title eleven of article five of the
 social  services  law.  For the purposes of this subparagraph, the rates
 that would be paid for such treatment pursuant to the medical assistance
 program under title eleven of article five of the  social  services  law
 A. 7038--A                          3
 
 SHALL  BE SET FORTH IN A FEE SCHEDULE SETTING FORTH THE SPECIFIC FEE FOR
 EACH INDIVIDUAL SERVICE COVERED BY THIS SUBPARAGRAPH  PUBLISHED  BY  THE
 OFFICE OF MENTAL HEALTH BY NOVEMBER FIRST OF THE PRECEDING CALENDAR YEAR
 AND  shall  be  the  rates  with an effective date of April first of the
 preceding year, which shall be established prior to October first of the
 preceding calendar year. Prior to the submission of premium rate filings
 and applications, the superintendent shall provide insurers  with  guid-
 ance  on  factors  to consider in calculating the impact of rate changes
 for the purposes of submitting premium rate filings and applications  to
 the  superintendent  for  the subsequent policy year. To the extent that
 the rates with an effective date of April first differ  from  the  esti-
 mated  rates  incorporated  in  premium  rate  filings and applications,
 insurers may account for such differences in future premium rate filings
 and applications submitted to the superintendent for approval.
   § 4. Subparagraph (J) of paragraph 7 of subsection (l) of section 3221
 of the insurance law, as added by section 4 of part AA of chapter 57  of
 the laws of 2024, is amended to read as follows:
   (J) This subparagraph shall apply to facilities in this state that are
 licensed,  certified, or otherwise authorized by the office of addiction
 services and supports for the provision of outpatient, intensive  outpa-
 tient,  outpatient  rehabilitation and opioid treatment that are partic-
 ipating in the insurer's provider  network.  Reimbursement  for  covered
 outpatient treatment provided by such facilities shall be at rates nego-
 tiated between the insurer and the participating facility, provided that
 such  rates  are  not  less  than  the rates that would be paid for such
 treatment pursuant to the medical assistance program under title  eleven
 of  article  five  of  the social services law. For the purposes of this
 subparagraph, the rates that would be paid for such  treatment  pursuant
 to  the medical assistance program under title eleven of article five of
 the social services law SHALL BE SET FORTH IN  A  FEE  SCHEDULE  SETTING
 FORTH  THE  SPECIFIC  FEE  FOR  EACH  INDIVIDUAL SERVICE COVERED BY THIS
 SUBPARAGRAPH PUBLISHED BY THE OFFICE OF ADDICTION SERVICES AND  SUPPORTS
 BY  NOVEMBER FIRST OF THE PRECEDING CALENDAR YEAR AND shall be the rates
 with an effective date of April first of the preceding year, which shall
 be established prior to October first of the  preceding  calendar  year.
 Prior  to  the  submission of premium rate filings and applications, the
 superintendent shall  provide  insurers  with  guidance  on  factors  to
 consider  in  calculating the impact of rate changes for the purposes of
 submitting premium rate filings and applications to  the  superintendent
 for  the  subsequent  policy  year. To the extent that the rates with an
 effective date of April first differ from the estimated  rates  incorpo-
 rated in premium rate filings and applications, insurers may account for
 such differences in future premium rate filings and applications submit-
 ted to the superintendent for approval.
   §  5.  Paragraph 12 of subsection (g) of section 4303 of the insurance
 law, as added by section 5 of part AA of chapter 57 of the laws of 2024,
 is amended to read as follows:
   (12) This paragraph shall apply to outpatient treatment provided in  a
 facility  issued  an operating certificate by the commissioner of mental
 health pursuant to the provisions of article thirty-one  of  the  mental
 hygiene  law,  or in a facility operated by the office of mental health,
 or in a crisis stabilization center licensed pursuant to  section  36.01
 of  the  mental  hygiene law, that is participating in the corporation's
 provider  network.  Reimbursement  for  covered   outpatient   treatment
 provided  by  such  facility  shall  be  at rates negotiated between the
 corporation and the participating facility, provided that such rates are
 A. 7038--A                          4
 
 not less than the rates that would be paid for such  treatment  pursuant
 to  the medical assistance program under title eleven of article five of
 the social services law. For the purposes of this paragraph,  the  rates
 that would be paid for such treatment pursuant to the medical assistance
 program  under  title  eleven of article five of the social services law
 SHALL BE SET FORTH IN A FEE SCHEDULE SETTING FORTH THE SPECIFIC FEE  FOR
 EACH  INDIVIDUAL  SERVICE  COVERED  BY  THIS  PARAGRAPH PUBLISHED BY THE
 OFFICE OF MENTAL HEALTH BY NOVEMBER FIRST OF THE PRECEDING CALENDAR YEAR
 AND shall be the rates with an effective date  of  April  first  of  the
 preceding year, which shall be established prior to October first of the
 preceding calendar year. Prior to the submission of premium rate filings
 and  applications,  the  superintendent  shall provide corporations with
 guidance on factors to consider in calculating the impact of rate chang-
 es for the purposes of submitting premium rate filings and  applications
 to the superintendent for the subsequent policy year. To the extent that
 the  rates  with  an effective date of April first differ from the esti-
 mated rates incorporated  in  premium  rate  filings  and  applications,
 corporations  may  account  for  such differences in future premium rate
 filings and applications submitted to the superintendent for approval.
   § 6. Paragraph 10 of subsection (l) of section 4303 of  the  insurance
 law, as added by section 6 of part AA of chapter 57 of the laws of 2024,
 is amended to read as follows:
   (10)  This  paragraph shall apply to facilities in this state that are
 licensed, certified, or otherwise authorized by the office of  addiction
 services  and supports for the provision of outpatient, intensive outpa-
 tient, outpatient rehabilitation and opioid treatment that  are  partic-
 ipating in the corporation's provider network. Reimbursement for covered
 outpatient treatment provided by such facilities shall be at rates nego-
 tiated  between the corporation and the participating facility, provided
 that such rates are not less than the rates that would be paid for  such
 treatment  pursuant to the medical assistance program under title eleven
 of article five of the social services law. For  the  purposes  of  this
 paragraph,  the  rates that would be paid for such treatment pursuant to
 the medical assistance program under title eleven of article five of the
 social services law SHALL BE SET FORTH IN A FEE SCHEDULE  SETTING  FORTH
 THE  SPECIFIC  FEE FOR EACH INDIVIDUAL SERVICE COVERED BY THIS PARAGRAPH
 PUBLISHED BY THE OFFICE OF ADDICTION SERVICES AND SUPPORTS  BY  NOVEMBER
 FIRST  OF  THE  PRECEDING  CALENDAR  YEAR AND shall be the rates with an
 effective date of April first of the  preceding  year,  which  shall  be
 established prior to October first of the preceding calendar year. Prior
 to  the  submission of premium rate filings and applications, the super-
 intendent shall provide corporations with guidance on factors to consid-
 er in calculating the impact of rate changes for the purposes of submit-
 ting premium rate filings and applications to the superintendent for the
 subsequent policy year. To the extent that the rates with  an  effective
 date  of  April  first  differ  from the estimated rates incorporated in
 premium rate filings and applications, corporations may account for such
 differences in future premium rate filings and applications submitted to
 the superintendent for approval.
   § 7. 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.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Assembly Bill A7038A

Share this bill

Sponsored By

WEPRIN

Current Bill Status - On Floor Calendar

Bill Amendments

co-Sponsors

Angelo Santabarbara

2025-A7038 - Details

2025-A7038 - Summary

2025-A7038 - Bill Text download pdf

co-Sponsors

Angelo Santabarbara

2025-A7038A (ACTIVE) - Details

2025-A7038A (ACTIVE) - Summary

2025-A7038A (ACTIVE) - Bill Text download pdf

Comments