Bill Text: NY A04938 | 2015-2016 | General Assembly | Introduced
Bill Title: Allows health insurance reimbursements for certain mental health services provided by licensed mental health counselors.
Spectrum: Partisan Bill (Republican 4-0)
Status: (Introduced - Dead) 2016-01-06 - referred to insurance [A04938 Detail]
Download: New_York-2015-A04938-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
4938
2015-2016 Regular Sessions
I N A S S E M B L Y
February 9, 2015
___________
Introduced by M. of A. CURRAN, DUPREY, FINCH, RAIA -- read once and
referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to allowing reimburse-
ments for certain services provided by licensed mental health counse-
lors
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Paragraph 4 of subsection (i) of section 3216 of the insur-
2 ance law is amended to read as follows:
3 (4) If a policy provides for reimbursement for psychiatric or psycho-
4 logical services or for diagnosis and treatment of mental, nervous, or
5 emotional disorders or ailments, however defined in the policy, the
6 insured shall be entitled to reimbursement for such services, diagnosis
7 or treatment whether performed by a physician, psychiatrist [or], a
8 certified and registered psychologist, OR A LICENSED MENTAL HEALTH COUN-
9 SELOR when the services rendered are within the lawful scope of their
10 practice.
11 S 2. Paragraph 4 of subsection (l) of section 3221 of the insurance
12 law, subparagraph (A) as amended by chapter 230 of the laws of 2004,
13 subparagraph (B) as amended by chapter 420 of the laws of 2002, and
14 subparagraphs (D) and (E) as amended by section 50 of part D of chapter
15 56 of the laws of 2013, is amended to read as follows:
16 (4) (A) Every insurer delivering a group policy or issuing a group
17 policy for delivery, in this state, which provides reimbursement for
18 psychiatric or psychological services or for the diagnosis and treatment
19 of mental, nervous or emotional disorders and ailments, however defined
20 in such policy, by physicians, psychiatrists or psychologists, must make
21 available and if requested by the policyholder provide the same coverage
22 to insureds for such services when performed by a licensed clinical
23 social worker, within the lawful scope of his or her practice, who is
24 licensed pursuant to article one hundred fifty-four of the education law
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08188-01-5
A. 4938 2
1 OR A LICENSED MENTAL HEALTH COUNSELOR, WITHIN THE LAWFUL SCOPE OF HIS OR
2 HER PRACTICE, WHO IS LICENSED PURSUANT TO ARTICLE ONE HUNDRED
3 SIXTY-THREE OF THE EDUCATION LAW. Written notice of the availability of
4 such coverage shall be delivered to the policyholder prior to inception
5 of such group policy and annually thereafter, except that this notice
6 shall not be required where a policy covers two hundred or more employ-
7 ees or where the benefit structure was the subject of collective
8 bargaining affecting persons who are employed in more than one state.
9 (B) The state board for social work shall maintain a list of all
10 licensed clinical social workers qualified for reimbursement under this
11 paragraph. THE STATE BOARD OF MENTAL HEALTH PRACTITIONERS SHALL MAINTAIN
12 A LIST OF ALL LICENSED MENTAL HEALTH COUNSELORS QUALIFIED FOR REIMBURSE-
13 MENT UNDER THIS PARAGRAPH.
14 (C) Such coverage shall be made available at the inception of all new
15 policies and, with respect to all other policies at any subsequent annu-
16 al anniversary date of the policy subject to evidence of insurability.
17 (D) In addition to the requirements of subparagraph (A) of this para-
18 graph, every insurer issuing a group policy for delivery in this state
19 where the policy provides reimbursement to insureds for psychiatric or
20 psychological services or for the diagnosis and treatment of mental,
21 nervous or emotional disorders and ailments, however defined in such
22 policy, by physicians, psychiatrists or psychologists, shall provide the
23 same coverage to insureds for such services when performed by a licensed
24 clinical social worker, within the lawful scope of his or her practice,
25 who is licensed pursuant to subdivision two of section seven thousand
26 seven hundred four of the education law OR A LICENSED MENTAL HEALTH
27 COUNSELOR, WITHIN THE LAWFUL SCOPE OF HIS OR HER PRACTICE, WHO IS
28 LICENSED PURSUANT TO SUBDIVISION THREE OF SECTION EIGHT THOUSAND FOUR
29 HUNDRED TWO OF THE EDUCATION LAW and in addition shall have either: (i)
30 three or more additional years experience in psychotherapy, which for
31 the purposes of this subparagraph shall mean the use of verbal methods
32 in interpersonal relationships with the intent of assisting a person or
33 persons to modify attitudes and behavior that are intellectually,
34 socially or emotionally maladaptive, under supervision, satisfactory to
35 the state board for social work, OR THE STATE BOARD OF MENTAL HEALTH
36 PRACTITIONERS, in a facility, licensed or incorporated by an appropriate
37 governmental department, providing services for diagnosis or treatment
38 of mental, nervous or emotional disorders or ailments; (ii) three or
39 more additional years experience in psychotherapy under the supervision,
40 satisfactory to the state board for social work, OR THE STATE BOARD OF
41 MENTAL HEALTH PRACTITIONERS, of a psychiatrist, a licensed and regis-
42 tered psychologist [or], a licensed clinical social worker OR A LICENSED
43 MENTAL HEALTH COUNSELOR qualified for reimbursement pursuant to
44 subsection (e) of this section, or (iii) a combination of the experience
45 specified in items (i) and (ii) of this subparagraph totaling three
46 years, satisfactory to the state board for social work. THE STATE BOARD
47 OF MENTAL HEALTH PRACTITIONERS SHALL MAINTAIN A LIST OF ALL LICENSED
48 MENTAL HEALTH COUNSELORS QUALIFIED FOR REIMBURSEMENT UNDER THIS SUBPARA-
49 GRAPH.
50 (E) The state board for social work shall maintain a list of all
51 licensed clinical social workers qualified for reimbursement under
52 subparagraph (D) of this paragraph.
53 S 3. Item (ii) of subparagraph (A) of paragraph 5 of subsection (l) of
54 section 3221 of the insurance law, as amended by chapter 502 of the laws
55 of 2007, is amended to read as follows:
A. 4938 3
1 (ii) where the policy provides coverage for physician services, it
2 shall include benefits for outpatient care provided by a psychiatrist or
3 psychologist licensed to practice in this state, a licensed clinical
4 social worker OR A LICENSED MENTAL HEALTH COUNSELOR who meets the
5 requirements of subparagraph (D) of paragraph four of this subsection,
6 or a professional corporation or university faculty practice corporation
7 thereof. Such benefits may be limited to not less than twenty visits in
8 any contract year, plan year, or calendar year.
9 S 4. Subparagraph (G) of paragraph 4 of subsection (f) of section 4235
10 of the insurance law, as relettered by chapter 456 of the laws of 1993,
11 is amended to read as follows:
12 (G) psychiatric or psychological services or for the diagnosis and
13 treatment of mental, nervous, or emotional disorders or ailments, howev-
14 er defined in such policy, a subscriber to such policy shall be entitled
15 to reimbursement for such psychiatric or psychological services or diag-
16 nosis or treatment whether performed by a physician, psychiatrist [or],
17 a certified and registered psychologist OR A LICENSED MENTAL HEALTH
18 COUNSELOR when the services rendered are within the lawful scope of
19 their practice, and when such policy or any certificate issued there-
20 under is delivered or issued for delivery without this state by an
21 authorized insurer, covered persons residing in this state shall be
22 entitled to reimbursement for such diagnosis and treatment by a physi-
23 cian, psychiatrist or a certified and registered psychologist as herein-
24 above provided; and
25 S 5. Paragraph 1 of subsection (h) and subsections (i) and (n) of
26 section 4303 of the insurance law, paragraph 1 of subsection (h) as
27 amended by chapter 502 of the laws of 2007 and subsections (i) and (n)
28 as amended by chapter 230 of the laws of 2004, are amended to read as
29 follows:
30 (1) A medical expense indemnity corporation or a health service corpo-
31 ration, which provides group, group remittance or school blanket cover-
32 age for physician services, shall provide as part of its contract broad-
33 based coverage for the diagnosis and treatment of mental, nervous or
34 emotional disorders or ailments, however defined in such contract, at
35 least equal to the coverage provided for other health conditions and
36 shall include: benefits for outpatient care provided by a psychiatrist
37 or psychologist licensed to practice in this state, a licensed clinical
38 social worker OR A LICENSED MENTAL HEALTH COUNSELOR who meets the
39 requirements of subsection (n) of this section, or a professional corpo-
40 ration or university faculty practice corporation thereof, which bene-
41 fits may be limited to not less than twenty visits in any contract year,
42 plan year or calendar year. Such coverage may be provided on a contract
43 year, plan year or calendar year basis and shall be consistent with the
44 provision of other benefits under the contract. Such coverage may be
45 subject to annual deductibles, co-pays and coinsurance as may be deemed
46 appropriate by the superintendent and shall be consistent with those
47 imposed on other benefits under the contract. In the event the group
48 remittance group or contract holder is provided coverage provided under
49 this paragraph and under subparagraph (B) of paragraph one of subsection
50 (g) of this section from the same health service corporation, or under a
51 contract which is jointly underwritten by two health service corpo-
52 rations or by a health service corporation and a medical expense indem-
53 nity corporation, the aggregate of the benefits for out-patient care
54 obtained under subparagraph (B) of paragraph one of subsection (g) of
55 this section and this paragraph may be limited to not less than twenty
56 visits in any contract year, plan year or calendar year.
A. 4938 4
1 (i) A medical expense indemnity corporation or health service corpo-
2 ration which provides coverage for physicians, psychiatrists or psychol-
3 ogists for psychiatric or psychological services or for the diagnosis
4 and treatment of mental, nervous or emotional disorders and ailments,
5 however defined in such contract, must make available and if requested
6 by all persons holding individual contracts in a group whose premiums
7 are paid by a remitting agent or by the contract holder in the case of a
8 group contract issued pursuant to section four thousand three hundred
9 five of this article, provide the same coverage for such services when
10 performed by a licensed clinical social worker, within the lawful scope
11 of his or her practice, who is licensed pursuant to article one hundred
12 fifty-four of the education law OR A LICENSED MENTAL HEALTH COUNSELOR,
13 WITHIN THE LAWFUL SCOPE OF HIS OR HER PRACTICE, WHO IS LICENSED PURSUANT
14 TO ARTICLE ONE HUNDRED SIXTY-THREE OF THE EDUCATION LAW. The state board
15 for social work shall maintain a list of all licensed clinical social
16 workers qualified for reimbursement under this subsection. THE STATE
17 BOARD OF MENTAL HEALTH PRACTITIONERS SHALL MAINTAIN A LIST OF ALL
18 LICENSED CLINICAL SOCIAL WORKERS QUALIFIED FOR REIMBURSEMENT UNDER THIS
19 SUBSECTION. Such coverage shall be made available at the inception of
20 all new contracts and, with respect to all other contracts, at any anni-
21 versary date subject to evidence of insurability. Written notice of the
22 availability of such coverage shall be delivered to the group remitting
23 agent or group contract holder prior to inception of such contract and
24 annually thereafter, except that this notice shall not be required where
25 a policy covers two hundred or more employees or where the benefit
26 structure was the subject of collective bargaining affecting persons who
27 are employed in more than one state.
28 (n) In addition to the requirements of subsection (i) of this section,
29 every health service or medical expense indemnity corporation issuing a
30 group contract pursuant to this section or a group remittance contract
31 for delivery in this state which contract provides reimbursement to
32 subscribers or physicians, psychiatrists or psychologists for psychiat-
33 ric or psychological services or for the diagnosis and treatment of
34 mental, nervous or emotional disorders and ailments, however defined in
35 such contract, must provide the same coverage to persons covered under
36 the group contract for such services when performed by a licensed clin-
37 ical social worker, within the lawful scope of his or her practice, who
38 is licensed pursuant to subdivision two of section seven thousand seven
39 hundred four of the education law OR A LICENSED MENTAL HEALTH COUNSELOR,
40 WITHIN THE LAWFUL SCOPE OF HIS OR HER PRACTICE, WHO IS LICENSED PURSUANT
41 TO SUBDIVISION THREE OF SECTION EIGHT THOUSAND FOUR HUNDRED TWO OF THE
42 EDUCATION LAW and in addition shall have either (i) three or more addi-
43 tional years experience in psychotherapy, which for the purposes of this
44 subsection shall mean the use of verbal methods in interpersonal
45 relationships with the intent of assisting a person or persons to modify
46 attitudes and behavior which are intellectually, socially or emotionally
47 maladaptive, under supervision, satisfactory to the state board for
48 social work OR THE STATE BOARD OF MENTAL HEALTH PRACTITIONERS, in a
49 facility, licensed or incorporated by an appropriate governmental
50 department, providing services for diagnosis or treatment of mental,
51 nervous or emotional disorders or ailments, or (ii) three or more addi-
52 tional years experience in psychotherapy under the supervision, satis-
53 factory to the state board for social work OR THE STATE BOARD OF MENTAL
54 HEALTH PRACTITIONERS, of a psychiatrist, a licensed and registered
55 psychologist or a licensed clinical social worker OR LICENSED MENTAL
56 HEALTH PRACTITIONER qualified for reimbursement pursuant to subsection
A. 4938 5
1 (i) of this section, or (iii) a combination of the experience specified
2 in [paragraphs] ITEMS (i) and (ii) OF THIS SUBPARAGRAPH totaling three
3 years, satisfactory to the state board for social work OR THE STATE
4 BOARD OF MENTAL HEALTH PRACTITIONERS. The state board for social work
5 shall maintain a list of all licensed clinical social workers qualified
6 for reimbursement under this subsection. THE STATE BOARD OF MENTAL
7 HEALTH PRACTITIONERS SHALL MAINTAIN A LIST OF ALL LICENSED MENTAL HEALTH
8 COUNSELORS QUALIFIED FOR REIMBURSEMENT UNDER THIS SUBSECTION.
9 S 6. This act shall take effect on the ninetieth day after it shall
10 have become a law.
