STATE OF NEW YORK ________________________________________________________________________ 6052 2017-2018 Regular Sessions IN SENATE May 10, 2017 ___________ Introduced by Sen. LITTLE -- 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 1 of part B of 3 chapter 71 of the laws of 2016, is amended to read as follows: 4 (A) Every policy that provides hospital, major medical or similar 5 comprehensive coverage must provide inpatient coverage for the diagnosis 6 and treatment of substance use disorder, including detoxification and 7 rehabilitation services, for a period of not less than forty-five days. 8 Such inpatient coverage shall include unlimited medically necessary 9 treatment for substance use disorder treatment services provided in 10 residential settings as required by the Mental Health Parity and 11 Addiction Equity Act of 2008 (29 U.S.C. § 1185a). Further, such inpa- 12 tient coverage shall not apply financial requirements or treatment limi- 13 tations, including utilization review requirements, to inpatient 14 substance use disorder benefits that are more restrictive than the 15 predominant financial requirements and treatment limitations applied to 16 substantially all medical and surgical benefits covered by the policy. 17 Further, such coverage shall be provided consistent with the federal 18 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction 19 Equity Act of 2008 (29 U.S.C. § 1185a). 20 § 2. Subparagraph (A) of paragraph 31 of subsection (i) of section 21 3216 of the insurance law, as added by chapter 41 of the laws of 2014, 22 is amended to read as follows: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD10981-01-7S. 6052 2 1 (A) Every policy that provides medical, major medical or similar 2 comprehensive-type coverage must provide outpatient coverage for the 3 diagnosis and treatment of substance use disorder, including detoxifica- 4 tion and rehabilitation services, for a period of not less than forty- 5 five days. Such coverage shall not apply financial requirements or 6 treatment limitations to outpatient substance use disorder benefits that 7 are more restrictive than the predominant financial requirements and 8 treatment limitations applied to substantially all medical and surgical 9 benefits covered by the policy. Further, such coverage shall be 10 provided consistent with the federal Paul Wellstone and Pete Domenici 11 Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 12 1185a). 13 § 3. Subparagraph (A) of paragraph 6 of subsection (l) of section 3221 14 of the insurance law, as amended by section 2 of part B of chapter 71 of 15 the laws of 2016, is amended to read as follows: 16 (A) Every policy that provides hospital, major medical or similar 17 comprehensive coverage must provide inpatient coverage for the diagnosis 18 and treatment of substance use disorder, including detoxification and 19 rehabilitation services, for a period of not less than forty-five days. 20 Such inpatient coverage shall include unlimited medically necessary 21 treatment for substance use disorder treatment services provided in 22 residential settings as required by the Mental Health Parity and 23 Addiction Equity Act of 2008 (29 U.S.C. § 1185a). Further, such inpa- 24 tient coverage shall not apply financial requirements or treatment limi- 25 tations, including utilization review requirements, to inpatient 26 substance use disorder benefits that are more restrictive than the 27 predominant financial requirements and treatment limitations applied to 28 substantially all medical and surgical benefits covered by the policy. 29 Further, such coverage shall be provided consistent with the federal 30 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction 31 Equity Act of 2008 (29 U.S.C. § 1185a). 32 § 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221 33 of the insurance law, as amended by chapter 41 of the laws of 2014, is 34 amended to read as follows: 35 (A) Every policy that provides medical, major medical or similar 36 comprehensive-type coverage must provide outpatient coverage for the 37 diagnosis and treatment of substance use disorder, including detoxifica- 38 tion and rehabilitation services, for a period of not less than forty- 39 five days. Such coverage shall not apply financial requirements or 40 treatment limitations to outpatient substance use disorder benefits that 41 are more restrictive than the predominant financial requirements and 42 treatment limitations applied to substantially all medical and surgical 43 benefits covered by the policy. Further, such coverage shall be 44 provided consistent with the federal Paul Wellstone and Pete Domenici 45 Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 46 1185a). 47 § 5. Paragraph 1 of subsection (k) of section 4303 of the insurance 48 law, as amended by section 3 of part B of chapter 71 of the laws of 49 2016, is amended to read as follows: 50 (1) Every contract that provides hospital, major medical or similar 51 comprehensive coverage must provide inpatient coverage for the diagnosis 52 and treatment of substance use disorder, including detoxification and 53 rehabilitation services, for a period of not less than forty-five days. 54 Such inpatient coverage shall include unlimited medically necessary 55 treatment for substance use disorder treatment services provided in 56 residential settings as required by the Mental Health Parity andS. 6052 3 1 Addiction Equity Act of 2008 (29 U.S.C. § 1185a). Further, such inpa- 2 tient coverage shall not apply financial requirements or treatment limi- 3 tations, including utilization review requirements, to inpatient 4 substance use disorder benefits that are more restrictive than the 5 predominant financial requirements and treatment limitations applied to 6 substantially all medical and surgical benefits covered by the contract. 7 Further, such coverage shall be provided consistent with the federal 8 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction 9 Equity Act of 2008 (29 U.S.C. § 1185a). 10 § 6. Paragraph 1 of subsection (l) of section 4303 of the insurance 11 law, as amended by chapter 41 of the laws of 2014, is amended to read as 12 follows: 13 (1) Every contract that provides medical, major medical or similar 14 comprehensive-type coverage must provide outpatient coverage for the 15 diagnosis and treatment of substance use disorder, including detoxifica- 16 tion and rehabilitation services, for a period not less than forty-five 17 days. Such coverage shall not apply financial requirements or treatment 18 limitations to outpatient substance use disorder benefits that are more 19 restrictive than the predominant financial requirements and treatment 20 limitations applied to substantially all medical and surgical benefits 21 covered by the contract. Further, such coverage shall be provided 22 consistent with the federal Paul Wellstone and Pete Domenici Mental 23 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a). 24 § 7. Paragraph (c) of subdivision 2 of section 365-a of the social 25 services law, as amended by section 12-a of part C of chapter 60 of the 26 laws of 2014, is amended to read as follows: 27 (c) out-patient hospital or clinic services in facilities operated in 28 compliance with applicable provisions of this chapter, the public health 29 law, the mental hygiene law and other laws, including any provisions 30 thereof requiring an operating certificate or license, including facili- 31 ties authorized by the appropriate licensing authority to provide inte- 32 grated mental health services, and/or alcoholism and substance abuse 33 services, and/or physical health services, and/or services to persons 34 with developmental disabilities, when such services are provided at a 35 single location or service site, or where such facilities are not 36 conveniently accessible, in any hospital located within the state and 37 care and services in a day treatment program operated by the department 38 of mental hygiene or by a voluntary agency under an agreement with such 39 department in that part of a public institution operated and approved 40 pursuant to law as an intermediate care facility for persons with devel- 41 opmental disabilities; and provided, that alcoholism and substance abuse 42 services shall be covered for a period of not less than forty-five days; 43 and provided further, that the commissioners of health, mental health, 44 alcoholism and substance abuse services and the office for people with 45 developmental disabilities may issue regulations, including emergency 46 regulations promulgated prior to October first, two thousand fifteen 47 that are required to facilitate the establishment of integrated services 48 clinics. Any such regulations promulgated under this paragraph shall be 49 described in the annual report required pursuant to section forty-five-c 50 of part A of chapter fifty-six of the laws of two thousand thirteen; 51 § 8. Paragraph (n) of subdivision 2 of section 365-a of the social 52 services law, as amended by chapter 558 of the laws of 1999, is amended 53 to read as follows: 54 (n) care, treatment, maintenance and rehabilitation services that 55 would otherwise qualify for reimbursement pursuant to this chapter to 56 persons suffering from alcoholism in alcoholism facilities or chemicalS. 6052 4 1 dependence, as such term is defined in section 1.03 of the mental 2 hygiene law, in inpatient chemical dependence facilities, services, or 3 programs operated in compliance with applicable provisions of this chap- 4 ter and the mental hygiene law, and certified by the office of alcohol- 5 ism and substance abuse services, provided however that such services 6 shall be limited to such periods of time as may be determined necessary 7 in accordance with a utilization review procedure established by the 8 commissioner of the office of alcoholism and substance abuse services 9 and that such services shall be covered for a period of not less than 10 forty-five days, and provided further, that this paragraph shall not 11 apply to any hospital or part of a hospital as defined in section two 12 thousand eight hundred one of the public health law. 13 § 9. This act shall take effect immediately and shall apply to all 14 policies and contracts issued, renewed, modified, altered or amended on 15 or after such date.