STATE OF NEW YORK ________________________________________________________________________ 498 2023-2024 Regular Sessions IN SENATE January 4, 2023 ___________ Introduced by Sen. STEC -- 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 social services law, in relation to requiring insurance and Medicaid coverage for inpatient and outpatient substance abuse treatment for a period of not less than forty-five days The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subparagraph (A) of paragraph 30 of subsection (i) of 2 section 3216 of the insurance law, as amended by section 5 of subpart A 3 of part BB of chapter 57 of the laws of 2019, is amended to read as 4 follows: 5 (A) Every policy that provides hospital, major medical or similar 6 comprehensive coverage shall provide inpatient coverage for the diagno- 7 sis and treatment of substance use disorder, including detoxification 8 and rehabilitation services, for a period of not less than forty-five 9 days. Such inpatient coverage shall include unlimited medically neces- 10 sary treatment for substance use disorder treatment services provided in 11 residential settings. Further, such inpatient coverage shall not apply 12 financial requirements or treatment limitations, including utilization 13 review requirements, to inpatient substance use disorder benefits that 14 are more restrictive than the predominant financial requirements and 15 treatment limitations applied to substantially all medical and surgical 16 benefits covered by the policy. 17 § 2. Subparagraph (A) of paragraph 31 of subsection (i) of section 18 3216 of the insurance law, as amended by section 6 of subpart A of part 19 BB of chapter 57 of the laws of 2019, is amended to read as follows: 20 (A) Every policy that provides medical, major medical or similar 21 comprehensive-type coverage shall provide outpatient coverage for the 22 diagnosis and treatment of substance use disorder, including detoxifica- 23 tion and rehabilitation services, for a period of not less than forty- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD02918-01-3S. 498 2 1 five days. Such coverage shall not apply financial requirements or 2 treatment limitations to outpatient substance use disorder benefits that 3 are more restrictive than the predominant financial requirements and 4 treatment limitations applied to substantially all medical and surgical 5 benefits covered by the policy. 6 § 3. Subparagraph (A) of paragraph 6 of subsection (l) of section 3221 7 of the insurance law, as amended by section 15 of subpart A of part BB 8 of chapter 57 of the laws of 2019, is amended to read as follows: 9 (A) Every policy that provides hospital, major medical or similar 10 comprehensive coverage shall provide inpatient coverage for the diagno- 11 sis and treatment of substance use disorder, including detoxification 12 and rehabilitation services, for a period of not less than forty-five 13 days. Such inpatient coverage shall include unlimited medically neces- 14 sary treatment for substance use disorder treatment services provided in 15 residential settings. Further, such inpatient coverage shall not apply 16 financial requirements or treatment limitations, including utilization 17 review requirements, to inpatient substance use disorder benefits that 18 are more restrictive than the predominant financial requirements and 19 treatment limitations applied to substantially all medical and surgical 20 benefits covered by the policy. 21 § 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221 22 of the insurance law, as amended by section 16 of subpart A of part BB 23 of chapter 57 of the laws of 2019, is amended to read as follows: 24 (A) Every policy that provides medical, major medical or similar 25 comprehensive-type coverage shall provide outpatient coverage for the 26 diagnosis and treatment of substance use disorder, including detoxifica- 27 tion and rehabilitation services, for a period of not less than forty- 28 five days. Such coverage shall not apply financial requirements or 29 treatment limitations to outpatient substance use disorder benefits that 30 are more restrictive than the predominant financial requirements and 31 treatment limitations applied to substantially all medical and surgical 32 benefits covered by the policy. 33 § 5. Paragraph 1 of subsection (k) of section 4303 of the insurance 34 law, as amended by section 26 of subpart A of part BB of chapter 57 of 35 the laws of 2019, is amended to read as follows: 36 (1) Every contract that provides hospital, major medical or similar 37 comprehensive coverage shall provide inpatient coverage for the diagno- 38 sis and treatment of substance use disorder, including detoxification 39 and rehabilitation services, for a period of not less than forty-five 40 days. Such inpatient coverage shall include unlimited medically neces- 41 sary treatment for substance use disorder treatment services provided in 42 residential settings. Further, such inpatient coverage shall not apply 43 financial requirements or treatment limitations, including utilization 44 review requirements, to inpatient substance use disorder benefits that 45 are more restrictive than the predominant financial requirements and 46 treatment limitations applied to substantially all medical and surgical 47 benefits covered by the contract. 48 § 6. Paragraph 1 of subsection (l) of section 4303 of the insurance 49 law, as amended by section 27 of subpart A of part BB of chapter 57 of 50 the laws of 2019, is amended to read as follows: 51 (1) Every contract that provides medical, major medical or similar 52 comprehensive-type coverage shall provide outpatient coverage for the 53 diagnosis and treatment of substance use disorder, including detoxifica- 54 tion and rehabilitation services, for a period of not less than forty- 55 five days. Such coverage shall not apply financial requirements or 56 treatment limitations to outpatient substance use disorder benefits thatS. 498 3 1 are more restrictive than the predominant financial requirements and 2 treatment limitations applied to substantially all medical and surgical 3 benefits covered by the contract. 4 § 7. Paragraph (c) of subdivision 2 of section 365-a of the social 5 services law, as amended by section 12-a of part C of chapter 60 of the 6 laws of 2014, is amended to read as follows: 7 (c) out-patient hospital or clinic services in facilities operated in 8 compliance with applicable provisions of this chapter, the public health 9 law, the mental hygiene law and other laws, including any provisions 10 thereof requiring an operating certificate or license, including facili- 11 ties authorized by the appropriate licensing authority to provide inte- 12 grated mental health services, and/or alcoholism and substance abuse 13 services, and/or physical health services, and/or services to persons 14 with developmental disabilities, when such services are provided at a 15 single location or service site, or where such facilities are not 16 conveniently accessible, in any hospital located within the state and 17 care and services in a day treatment program operated by the department 18 of mental hygiene or by a voluntary agency under an agreement with such 19 department in that part of a public institution operated and approved 20 pursuant to law as an intermediate care facility for persons with devel- 21 opmental disabilities; and provided, that alcoholism and substance abuse 22 services shall be covered for a period of not less than forty-five days; 23 and provided further, that the commissioners of health, mental health, 24 alcoholism and substance abuse services and the office for people with 25 developmental disabilities may issue regulations, including emergency 26 regulations promulgated prior to October first, two thousand fifteen 27 that are required to facilitate the establishment of integrated services 28 clinics. Any such regulations promulgated under this paragraph shall be 29 described in the annual report required pursuant to section forty-five-c 30 of part A of chapter fifty-six of the laws of two thousand thirteen; 31 § 8. Paragraph (n) of subdivision 2 of section 365-a of the social 32 services law, as amended by chapter 558 of the laws of 1999, is amended 33 to read as follows: 34 (n) care, treatment, maintenance and rehabilitation services that 35 would otherwise qualify for reimbursement pursuant to this chapter to 36 persons suffering from alcoholism in alcoholism facilities or chemical 37 dependence, as such term is defined in section 1.03 of the mental 38 hygiene law, in inpatient chemical dependence facilities, services, or 39 programs operated in compliance with applicable provisions of this chap- 40 ter and the mental hygiene law, and certified by the office of alcohol- 41 ism and substance abuse services, provided however that such services 42 shall be limited to such periods of time as may be determined necessary 43 in accordance with a utilization review procedure established by the 44 commissioner of the office of alcoholism and substance abuse services 45 and that such services shall be covered for a period of not less than 46 forty-five days, and provided further, that this paragraph shall not 47 apply to any hospital or part of a hospital as defined in section two 48 thousand eight hundred one of the public health law. 49 § 9. This act shall take effect immediately and shall apply to all 50 policies and contracts issued, renewed, modified, altered or amended on 51 or after such date.