Bill Text: NY S08466 | 2023-2024 | General Assembly | Introduced

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Bill Title: Provides for a minimum reimbursement rate for ambulatory behavioral health services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-02-01 - REFERRED TO INSURANCE [S08466 Detail]

Download: New_York-2023-S08466-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          8466

                    IN SENATE

                                    February 1, 2024
                                       ___________

        Introduced  by  Sen. BRESLIN -- 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:

     1    Section 1. Paragraph 35 of subsection  (i)  of  section  3216  of  the
     2  insurance  law  is  amended  by adding a new subparagraph (K) to read as
     3  follows:
     4    (K) Every  policy  which  provides medical, major medical, or  similar
     5  comprehensive-type  coverage  shall  reimburse in network, participating
     6  providers licensed pursuant to article twenty-eight of the public health
     7  law or article thirty-one or thirty-two of the mental  hygiene  law  for
     8  ambulatory  behavioral  health  services  provided to its insureds, at a
     9  minimum, at a rate equivalent  to  the  payments  established  for  such
    10  services under the ambulatory patient group (APG) rate-setting methodol-
    11  ogy  at  the time of service, utilized by the department of health or by
    12  the office of  mental  health  or  offices  of  addiction  services  and
    13  supports  for  rate-setting  purposes  for  ambulatory behavioral health
    14  services provided to enrollees in the medical assistance  program  under
    15  title eleven of article five of the social services law. Insurers and in
    16  network, participating providers may negotiate different rates and meth-
    17  ods  of payments, however insurers shall pay no less than the equivalent
    18  of rates that would be paid for ambulatory  behavioral  health  services
    19  pursuant to the medical assistance program under title eleven of article
    20  five of the social services law.
    21    §  2.  Paragraph  5 of subsection (l) of section 3221 of the insurance
    22  law is amended by adding a new subparagraph (K) to read as follows:
    23    (K) Every insurer delivering a group or blanket policy  or  issuing  a
    24  group  or blanket policy for delivery in this state that provides cover-
    25  age for hospital,   major   medical,   or   similar   comprehensive-type
    26  coverage  shall   reimburse in network, participating providers licensed
    27  pursuant to article twenty-eight of the public  health  law  or  article

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD13904-01-3
        S. 8466                             2

     1  thirty-one or thirty-two of the mental hygiene law for ambulatory behav-
     2  ioral  health services provided to its insureds, at a minimum, at a rate
     3  equivalent to the payments established for such services under the ambu-
     4  latory  patient  group  (APG)  rate-setting  methodology  at the time of
     5  service, utilized by the department of health or by the office of mental
     6  health or offices of addiction services and  supports  for  rate-setting
     7  purposes for ambulatory behavioral health services provided to enrollees
     8  in  the medical assistance program under title eleven of article five of
     9  the social services law. Insurers and in network, participating  provid-
    10  ers  may  negotiate  different  rates  and  methods of payments, however
    11  insurers shall pay no less than the equivalent of rates  that  would  be
    12  paid  for  ambulatory behavioral health services pursuant to the medical
    13  assistance program under title eleven of  article  five  of  the  social
    14  services law.
    15    § 3. Subsection (g) of section 4303 of the insurance law is amended by
    16  adding a new paragraph 12 to read as follows:
    17    (12)  A  medical  expense  indemnity corporation, a hospital   service
    18  corporation  or  a health service corporation that provides coverage for
    19  medical, major medical, or  similar comprehensive-type   coverage  shall
    20  reimburse in network, participating providers licensed pursuant to arti-
    21  cle twenty-eight of the public health law or article thirty-one or thir-
    22  ty-two  of  the  mental  hygiene  law  for  ambulatory behavioral health
    23  services provided to its insureds, at a minimum, at a rate equivalent to
    24  the payments established for such services under the ambulatory  patient
    25  group (APG) rate-setting methodology at the time of service, utilized by
    26  the department of health or by the office of mental health or offices of
    27  addiction services and supports for rate-setting purposes for ambulatory
    28  behavioral  health services provided to enrollees in the medical assist-
    29  ance program under title eleven of article five of the  social  services
    30  law.  Insurers  and  in  network,  participating providers may negotiate
    31  different rates and methods of payments, however insurers shall  pay  no
    32  less  than  the  equivalent  of  rates that would be paid for ambulatory
    33  behavioral health services pursuant to the  medical  assistance  program
    34  under title eleven of article five of the social services law.
    35    §  4. Section 4403 of the public health law is amended by adding a new
    36  subdivision 10 to read as follows:
    37    10. A health maintenance  organization  shall  reimburse  in  network,
    38  participating  providers  licensed  pursuant  to article twenty-eight of
    39  this chapter or article thirty-one or thirty-two of the  mental  hygiene
    40  law for ambulatory behavioral health services provided to its enrollees,
    41  at  a minimum, at a rate equivalent to the payments established for such
    42  services under the ambulatory patient group (APG) rate-setting methodol-
    43  ogy at the time of service, utilized by the department or by the  office
    44  of mental health or offices of addiction services and supports for rate-
    45  setting  purposes  for ambulatory behavioral health services provided to
    46  enrollees in the medical assistance program under title eleven of  arti-
    47  cle  five  of  the  social  services  law. Organizations and in network,
    48  participating providers may negotiate different  rates  and  methods  of
    49  payments, however organizations shall pay no less than the equivalent of
    50  rates  that  would  be  paid  for  ambulatory behavioral health services
    51  pursuant to the medical assistance program under title eleven of article
    52  five of the social services law.
    53    § 5. This act shall take effect September 1, 2024 and shall  apply  to
    54  all policies and contracts issued, renewed, modified, altered or amended
    55  on or after such date.