Senate Bill S5361

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5361
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 20, 2025
                                ___________
 
 Introduced  by  Sen.  COMRIE -- 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 public health law, in relation
   to setting a minimum  reimbursement  rate  for  ambulatory  behavioral
   health services

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph 35 of subsection  (i)  of  section  3216  of  the
 insurance  law  is  amended  by adding a new subparagraph (L) to read as
 follows:
   (L) EVERY  POLICY  WHICH  PROVIDES MEDICAL, MAJOR MEDICAL, OR  SIMILAR
 COMPREHENSIVE-TYPE  COVERAGE  SHALL  REIMBURSE IN NETWORK, PARTICIPATING
 PROVIDERS LICENSED PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH
 LAW OR ARTICLE THIRTY-ONE OR THIRTY-TWO OF THE MENTAL  HYGIENE  LAW  FOR
 AMBULATORY  BEHAVIORAL  HEALTH  SERVICES  PROVIDED TO ITS INSUREDS, AT A
 MINIMUM, AT A RATE EQUIVALENT  TO  THE  PAYMENTS  ESTABLISHED  FOR  SUCH
 SERVICES UNDER THE AMBULATORY PATIENT GROUP (APG) RATE-SETTING METHODOL-
 OGY  AT  THE TIME OF SERVICE, UTILIZED BY THE DEPARTMENT OF HEALTH OR BY
 THE OFFICE OF  MENTAL  HEALTH  OR  OFFICES  OF  ADDICTION  SERVICES  AND
 SUPPORTS  FOR  RATE-SETTING  PURPOSES  FOR  AMBULATORY BEHAVIORAL HEALTH
 SERVICES PROVIDED TO ENROLLEES IN THE MEDICAL ASSISTANCE  PROGRAM  UNDER
 TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW. INSURERS AND IN
 NETWORK, PARTICIPATING PROVIDERS MAY NEGOTIATE DIFFERENT RATES AND METH-
 ODS  OF PAYMENTS, HOWEVER INSURERS SHALL PAY NO LESS THAN THE EQUIVALENT
 OF RATES THAT WOULD BE PAID FOR AMBULATORY  BEHAVIORAL  HEALTH  SERVICES
 PURSUANT TO THE MEDICAL ASSISTANCE PROGRAM UNDER TITLE ELEVEN OF ARTICLE
 FIVE OF THE SOCIAL SERVICES LAW.
   §  2.  Paragraph  5 of subsection (l) of section 3221 of the insurance
 law is amended by adding a new subparagraph (L) to read as follows:
   (L) EVERY INSURER DELIVERING A GROUP OR BLANKET POLICY  OR  ISSUING  A
 GROUP  OR BLANKET POLICY FOR DELIVERY IN THIS STATE THAT PROVIDES COVER-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09497-01-5
              

 S. 5361                             2
 
 AGE FOR HOSPITAL,   MAJOR   MEDICAL,   OR   SIMILAR   COMPREHENSIVE-TYPE
 COVERAGE  SHALL   REIMBURSE IN NETWORK, PARTICIPATING PROVIDERS LICENSED
 PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC  HEALTH  LAW  OR  ARTICLE
 THIRTY-ONE OR THIRTY-TWO OF THE MENTAL HYGIENE LAW FOR AMBULATORY BEHAV-
 IORAL  HEALTH SERVICES PROVIDED TO ITS INSUREDS, AT A MINIMUM, AT A RATE
 EQUIVALENT TO THE PAYMENTS ESTABLISHED FOR SUCH SERVICES UNDER THE AMBU-
 LATORY PATIENT GROUP (APG)  RATE-SETTING  METHODOLOGY  AT  THE  TIME  OF
 SERVICE, UTILIZED BY THE DEPARTMENT OF HEALTH OR BY THE OFFICE OF MENTAL
 HEALTH  OR  OFFICES  OF ADDICTION SERVICES AND SUPPORTS FOR RATE-SETTING
 PURPOSES FOR AMBULATORY BEHAVIORAL HEALTH SERVICES PROVIDED TO ENROLLEES
 IN THE MEDICAL ASSISTANCE PROGRAM UNDER TITLE ELEVEN OF ARTICLE FIVE  OF
 THE  SOCIAL SERVICES LAW. INSURERS AND IN NETWORK, PARTICIPATING PROVID-
 ERS MAY NEGOTIATE DIFFERENT  RATES  AND  METHODS  OF  PAYMENTS,  HOWEVER
 INSURERS  SHALL  PAY  NO LESS THAN THE EQUIVALENT OF RATES THAT WOULD BE
 PAID FOR AMBULATORY BEHAVIORAL HEALTH SERVICES PURSUANT TO  THE  MEDICAL
 ASSISTANCE  PROGRAM  UNDER  TITLE  ELEVEN  OF ARTICLE FIVE OF THE SOCIAL
 SERVICES LAW.
   § 3. Subsection (g) of section 4303 of the insurance law is amended by
 adding a new paragraph 13 to read as follows:
   (13) A MEDICAL EXPENSE INDEMNITY  CORPORATION,  A  HOSPITAL    SERVICE
 CORPORATION  OR  A HEALTH SERVICE CORPORATION THAT PROVIDES COVERAGE FOR
 MEDICAL,  MAJOR  MEDICAL, OR  SIMILAR COMPREHENSIVE-TYPE  COVERAGE SHALL
 REIMBURSE IN NETWORK, PARTICIPATING PROVIDERS LICENSED PURSUANT TO ARTI-
 CLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW OR ARTICLE THIRTY-ONE OR THIR-
 TY-TWO OF THE  MENTAL  HYGIENE  LAW  FOR  AMBULATORY  BEHAVIORAL  HEALTH
 SERVICES PROVIDED TO ITS INSUREDS, AT A MINIMUM, AT A RATE EQUIVALENT TO
 THE  PAYMENTS ESTABLISHED FOR SUCH SERVICES UNDER THE AMBULATORY PATIENT
 GROUP (APG) RATE-SETTING METHODOLOGY AT THE TIME OF SERVICE, UTILIZED BY
 THE DEPARTMENT OF HEALTH OR BY THE OFFICE OF MENTAL HEALTH OR OFFICES OF
 ADDICTION SERVICES AND SUPPORTS FOR RATE-SETTING PURPOSES FOR AMBULATORY
 BEHAVIORAL HEALTH SERVICES PROVIDED TO ENROLLEES IN THE MEDICAL  ASSIST-
 ANCE  PROGRAM  UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES
 LAW. INSURERS AND IN  NETWORK,  PARTICIPATING  PROVIDERS  MAY  NEGOTIATE
 DIFFERENT  RATES  AND METHODS OF PAYMENTS, HOWEVER INSURERS SHALL PAY NO
 LESS THAN THE EQUIVALENT OF RATES THAT  WOULD  BE  PAID  FOR  AMBULATORY
 BEHAVIORAL  HEALTH  SERVICES  PURSUANT TO THE MEDICAL ASSISTANCE PROGRAM
 UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW.
   § 4. Section 4403 of the public health law is amended by adding a  new
 subdivision 10 to read as follows:
   10.  A  HEALTH  MAINTENANCE  ORGANIZATION  SHALL REIMBURSE IN NETWORK,
 PARTICIPATING PROVIDERS LICENSED PURSUANT  TO  ARTICLE  TWENTY-EIGHT  OF
 THIS  CHAPTER  OR ARTICLE THIRTY-ONE OR THIRTY-TWO OF THE MENTAL HYGIENE
 LAW FOR AMBULATORY BEHAVIORAL HEALTH SERVICES PROVIDED TO ITS ENROLLEES,
 AT A MINIMUM, AT A RATE EQUIVALENT TO THE PAYMENTS ESTABLISHED FOR  SUCH
 SERVICES UNDER THE AMBULATORY PATIENT GROUP (APG) RATE-SETTING METHODOL-
 OGY  AT THE TIME OF SERVICE, UTILIZED BY THE DEPARTMENT OR BY THE OFFICE
 OF MENTAL HEALTH OR OFFICES OF ADDICTION SERVICES AND SUPPORTS FOR RATE-
 SETTING PURPOSES FOR AMBULATORY BEHAVIORAL HEALTH SERVICES  PROVIDED  TO
 ENROLLEES  IN THE MEDICAL ASSISTANCE PROGRAM UNDER TITLE ELEVEN OF ARTI-
 CLE FIVE OF THE SOCIAL  SERVICES  LAW.  ORGANIZATIONS  AND  IN  NETWORK,
 PARTICIPATING  PROVIDERS  MAY  NEGOTIATE  DIFFERENT RATES AND METHODS OF
 PAYMENTS, HOWEVER ORGANIZATIONS SHALL PAY NO LESS THAN THE EQUIVALENT OF
 RATES THAT WOULD BE  PAID  FOR  AMBULATORY  BEHAVIORAL  HEALTH  SERVICES
 PURSUANT TO THE MEDICAL ASSISTANCE PROGRAM UNDER TITLE ELEVEN OF ARTICLE
 FIVE OF THE SOCIAL SERVICES LAW.
 S. 5361                             3
 
   §  5.  This act shall take effect September 1, 2025 and shall apply to
 all policies and contracts issued, renewed, modified, altered or amended
 on or after such date.