S T A T E O F N E W Y O R K
________________________________________________________________________
9509
I N A S S E M B L Y
January 8, 2026
___________
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 the calculation of
rates for certain treatment pursuant to the medical assistance
program; and to amend a chapter of the laws of 2025 amending the
insurance law relating to requiring rates paid for rehabilitation and
opioid treatment be pursuant to certain fee schedules published by the
office of addiction services and supports, as proposed in legislative
bills numbers S. 6897-A and A. 7038-A, in relation to the effective-
ness thereof
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 amended by a chapter of the laws
of 2025 amending the insurance law relating to requiring rates paid for
rehabilitation and opioid treatment be pursuant to certain fee schedules
published by the office of addiction services and supports, as proposed
in legislative bills numbers S. 6897-A and A. 7038-A, is amended to read
as follows:
(J) (I) This [subparagraph] CLAUSE 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 outpa-
tient, intensive outpatient, outpatient rehabilitation and opioid treat-
ment that are participating in the insurer's provider network.
Reimbursement for covered outpatient treatment provided by such facili-
ties shall be at rates negotiated between the insurer and the partic-
ipating 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] CLAUSE, 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 individ-
ual service covered by this subparagraph published by the office of
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11143-04-6
A. 9509 2
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.
(II) THE OFFICE OF ADDICTION SERVICES AND SUPPORTS SHALL PUBLISH
INFORMATION ADEQUATE TO CALCULATE 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. SUCH INFORMATION SHALL BE
PROVIDED IN A FORM AND MANNER TO BE DETERMINED BY THE COMMISSIONER OF
ADDICTION SERVICES AND SUPPORTS. NOTHING IN THIS CLAUSE SHALL BE
CONSTRUED TO RELIEVE AN INSURER OF THE OBLIGATION TO REIMBURSE AT NO
LESS THAN THE APPLICABLE MINIMUM RATE SET FORTH IN CLAUSE (I) OF THIS
SUBPARAGRAPH. Prior to the submission of premium rate filings and appli-
cations, 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 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 amended by a chapter of the laws of 2025
amending the insurance law relating to requiring rates paid for rehabil-
itation and opioid treatment be pursuant to certain fee schedules
published by the office of addiction services and supports, as proposed
in legislative bills numbers S. 6897-A and A. 7038-A, is amended to read
as follows:
(K) (I) This [subparagraph] CLAUSE shall apply to outpatient treatment
provided in a facility issued an operating certificate by the commis-
sioner 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 treat-
ment 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] CLAUSE,
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.
(II) THE OFFICE OF MENTAL HEALTH SHALL PUBLISH INFORMATION ADEQUATE TO
CALCULATE 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. SUCH INFORMATION SHALL BE PROVIDED IN A FORM AND
MANNER TO BE DETERMINED BY THE COMMISSIONER OF MENTAL HEALTH. NOTHING IN
THIS CLAUSE SHALL BE CONSTRUED TO RELIEVE AN INSURER OF THE OBLIGATION
TO REIMBURSE AT NO LESS THAN THE APPLICABLE MINIMUM RATE SET FORTH IN
CLAUSE (I) OF THIS SUBPARAGRAPH. Prior to the submission of premium rate
A. 9509 3
filings and applications, the superintendent shall provide insurers 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,
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 amended by a chapter of the laws of 2025 amend-
ing the insurance law relating to requiring rates paid for rehabili-
tation and opioid treatment be pursuant to certain fee schedules
published by the office of addiction services and supports, as proposed
in legislative bills numbers S. 6897-A and A. 7038-A, is amended to read
as follows:
(K) (I) This [subparagraph] CLAUSE shall apply to outpatient treatment
provided in a facility issued an operating certificate by the commis-
sioner 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 treat-
ment 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] CLAUSE,
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.
(II) THE OFFICE OF MENTAL HEALTH SHALL PUBLISH INFORMATION ADEQUATE TO
CALCULATE 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. SUCH INFORMATION SHALL BE PROVIDED IN A FORM AND
MANNER TO BE DETERMINED BY THE COMMISSIONER OF MENTAL HEALTH. NOTHING IN
THIS CLAUSE SHALL BE CONSTRUED TO RELIEVE AN INSURER OF THE OBLIGATION
TO REIMBURSE AT NO LESS THAN THE APPLICABLE MINIMUM RATE SET FORTH IN
CLAUSE (I) OF THIS SUBPARAGRAPH. 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 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,
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 amended by a chapter of the laws of 2025 amend-
ing the insurance law relating to requiring rates paid for rehabili-
tation and opioid treatment be pursuant to certain fee schedules
published by the office of addiction services and supports, as proposed
A. 9509 4
in legislative bills numbers S. 6897-A and A. 7038-A, is amended to read
as follows:
(J) (I) This [subparagraph] CLAUSE 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 outpa-
tient, intensive outpatient, outpatient rehabilitation and opioid treat-
ment that are participating in the insurer's provider network.
Reimbursement for covered outpatient treatment provided by such facili-
ties shall be at rates negotiated between the insurer and the partic-
ipating 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] CLAUSE, 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 individ-
ual 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.
(II) THE OFFICE OF ADDICTION SERVICES AND SUPPORTS SHALL PUBLISH
INFORMATION ADEQUATE TO CALCULATE 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. SUCH INFORMATION SHALL BE
PROVIDED IN A FORM AND MANNER TO BE DETERMINED BY THE COMMISSIONER OF
ADDICTION SERVICES AND SUPPORTS. NOTHING IN THIS CLAUSE SHALL BE
CONSTRUED TO RELIEVE AN INSURER OF THE OBLIGATION TO REIMBURSE AT NO
LESS THAN THE APPLICABLE MINIMUM RATE SET FORTH IN CLAUSE (I) OF THIS
SUBPARAGRAPH. Prior to the submission of premium rate filings and appli-
cations, 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 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 amended by a chapter of the laws of 2025 amending the insurance
law relating to requiring rates paid for rehabilitation and opioid
treatment be pursuant to certain fee schedules published by the office
of addiction services and supports, as proposed in legislative bills
numbers S. 6897-A and A. 7038-A, is amended to read as follows:
(12) (A) This [paragraph] 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 participat-
ing in the corporation's provider network. Reimbursement for covered
outpatient treatment provided by such facility shall be at rates negoti-
ated 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
A. 9509 5
[paragraph] SUBPARAGRAPH, the rates that would be paid for such treat-
ment 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.
(B) THE OFFICE OF MENTAL HEALTH SHALL PUBLISH INFORMATION ADEQUATE TO
CALCULATE 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. SUCH INFORMATION SHALL BE PROVIDED IN A FORM AND
MANNER TO BE DETERMINED BY THE COMMISSIONER OF MENTAL HEALTH. NOTHING IN
THIS SUBPARAGRAPH SHALL BE CONSTRUED TO RELIEVE AN INSURER OF THE OBLI-
GATION TO REIMBURSE AT NO LESS THAN THE APPLICABLE MINIMUM RATE SET
FORTH IN SUBPARAGRAPH (A) OF THIS PARAGRAPH. 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 amended by a chapter of the laws of 2025 amending the insurance
law relating to requiring rates paid for rehabilitation and opioid
treatment be pursuant to certain fee schedules published by the office
of addiction services and supports, as proposed in legislative bills
numbers S. 6897-A and A. 7038-A, is amended to read as follows:
(10) (A) This [paragraph] 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 outpa-
tient, intensive outpatient, outpatient rehabilitation and opioid treat-
ment that are participating in the corporation's provider network.
Reimbursement for covered outpatient treatment provided by such facili-
ties 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] 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 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.
(B) THE OFFICE OF ADDICTION SERVICES AND SUPPORTS SHALL PUBLISH INFOR-
MATION ADEQUATE TO CALCULATE 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. SUCH INFORMATION SHALL BE
PROVIDED IN A FORM AND MANNER TO BE DETERMINED BY THE COMMISSIONER OF
ADDICTION SERVICES AND SUPPORTS. NOTHING IN THIS SUBPARAGRAPH SHALL BE
A. 9509 6
CONSTRUED TO RELIEVE AN INSURER OF THE OBLIGATION TO REIMBURSE AT NO
LESS THAN THE APPLICABLE MINIMUM RATE SET FORTH IN SUBPARAGRAPH (A) OF
THIS PARAGRAPH. Prior to the submission of premium rate filings and
applications, the superintendent shall provide corporations 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,
corporations may account for such differences in future premium rate
filings and applications submitted to the superintendent for approval.
§ 7. Section 7 of a chapter of the laws of 2025 amending the insurance
law relating to requiring rates paid for rehabilitation and opioid
treatment be pursuant to certain fee schedules published by the office
of addiction services and supports, as proposed in legislative bills
numbers S. 6897-A and A. 7038-A, is amended to read as follows:
§ 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].
§ 8. This act shall take effect immediately; provided, however, that
sections one, two, three, four, five and six of this act shall take
effect on the same date and in the same manner as a chapter of the laws
of 2025 amending the insurance law relating to requiring rates paid for
rehabilitation and opioid treatment be pursuant to certain fee schedules
published by the office of addiction services and supports, as proposed
in legislative bills numbers S. 6897-A and A. 7038-A, takes effect.