NY State Senate Bill 2011-S1121

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 04, 2012	referred to insurance
Jan 05, 2011	referred to insurance

2011-S1121 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S6866
2013-2014: S2841
2015-2016: S2791
2017-2018: S2679
2019-2020: S3760
2021-2022: S3302
2023-2024: S4695

2011-S1121 (ACTIVE) - Summary

Requires coverage under the healthy New York program for mental illness.

2011-S1121 (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S1121

TITLE OF BILL:

An act
to amend the insurance law, in relation to requiring coverage under the
Healthy New York program for mental illness

PURPOSE:

The purpose of the legislation is to broaden the coverage of the
Healthy New York Program (HNY) so that eligible small employers, sole
proprietors, and uninsured working individuals will be covered for
mental health services.

SUMMARY OF PROVISIONS:

Sections 1 and 2 of this legislation amend section 3221 of the insurance
law, to extend coverage for mental health services to small
employers, sole proprietors, and uninsured working individuals
eligible for coverage under the Healthy New York Program (HNY).

Section 3 of this legislation amends section 3221 of the insurance
law, to require the superintendent of insurance to develop and
implement a method to cover the costs associated with expanding HNY's
coverage to include mental health services for eligible small

employers, sole proprietors, and uninsured working individuals.

Sections 4, 5, 7 and 8 of this legislation amend section 4303 of the
insurance law to extend coverage for mental health services to small
employers, sole proprietors, and uninsured working individuals
eligible for coverage under HNY.

Sections 6 and 9 of this legislation amend section 4303 of the
insurance law, to require the superintendent of insurance to develop
and implement a method to cover the costs associated with expanding
HNY's coverage to include mental health services for eligible small
employers, sole proprietors, and uninsured working individuals.

JUSTIFICATION:

The "Healthy NY Program" (HNY) promotes access to quality health care
by providing comprehensive health insurance to those citizens who
need it most. HNY's methodology is to assist small business owners in
providing their employees and their employees' families with the
health insurance they need and deserve. In addition, uninsured sole
proprietors and workers whose employers do not provide health
insurance may also purchase comprehensive coverage
directly through HNY.
(See,http://www.ins.state.ny.us/website2/hny.htm, last visited
12/17/10).

Persons in need of mental health services may suffer from an array of
psychological disorders which include; anxiety, depression,
behavioral and personality disorders, any of which might cause
absenteeism, productivity loss and co-morbid physical symptoms with


similar effect. Not only adults may require mental health services,
an estimated one in five children and adolescents may have mental
disorders that can be diagnosed and treated, but for lack of coverage
(See,http://www.wrongdiagnosis.com/e/emotional_disorders/intro.htm, and
http://mentalhealth.samhsa.gov/publications/allpubs/CA-0006/default.asp)

The most common disorders adolescents suffer from are anxiety
disorders ,accounting for as many as 13 out of every 100 children
between the ages of 9 and 17. Children may also suffer from severe
depression, bipolar disorders, learning disorders and schizophrenia,
and autism is an important concern for American children, affecting
10-12 individuals for every 10,000 children.
(See,http://mentalhealth.samhsa.gov/publications/allpubs/CA-0006/
default.asp)  Any or all, of these conditions can lead to excessive
absences from school, failure to thrive in the academic or home
environment, and many associated physical ailments.

With new research and innovations, advanced treatment is readably
available. In order to seek this treatment patients need coverage to
diagnose and treat themselves and their children.
(See,http://mentalhealth.samhsa.gov/publications/allpubs/CA-0006/
default.asp)  That is why this legislation expands HNY's coverage
to include coverage for mental health services for eligible
small employers, sole proprietors, and uninsured working individuals.

LEGISLATIVE HISTORY:
2009-10:  S.6866 - Referred to Insurance

FISCAL IMPLICATIONS:

To be determined.

LOCAL FISCAL IMPLICATIONS:

No local fiscal implications.

EFFECTIVE DATE:

This act shall take effect immediately.

2011-S1121 (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  1121

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             January 5, 2011
                               ___________

Introduced  by  Sen.  PARKER -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance law, in  relation  to  requiring  coverage
  under the Healthy New York program for mental illness

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. The opening paragraph of subparagraph (A) of paragraph 5 of
subsection (l) of section 3221 of the insurance law, as amended by chap-
ter 502 of the laws of 2007, is amended to read as follows:
  Every insurer delivering a group or school blanket policy OR  A  GROUP
OR  INDIVIDUAL  POLICY  PURSUANT  TO SECTION FOUR THOUSAND THREE HUNDRED
TWENTY-SIX OF THIS CHAPTER or issuing a group or school  blanket  policy
OR  A GROUP OR INDIVIDUAL POLICY PURSUANT TO SECTION FOUR THOUSAND THREE
HUNDRED TWENTY-SIX OF THIS CHAPTER for delivery, in  this  state,  which
provides  coverage for inpatient hospital care or coverage for physician
services shall provide as part of such policy broad-based  coverage  for
the diagnosis and treatment of mental, nervous or emotional disorders or
ailments, however defined in such policy, at least equal to the coverage
provided for other health conditions and:
  S  2. Item (i) of subparagraph (B) of paragraph 5 of subsection (l) of
section 3221 of the insurance law, as amended by chapter 502 of the laws
of 2007, is amended to read as follows:
  (i) Every insurer delivering a group or school  blanket  policy  OR  A
GROUP  OR  INDIVIDUAL  POLICY  PURSUANT  TO  SECTION FOUR THOUSAND THREE
HUNDRED TWENTY-SIX OF THIS CHAPTER or issuing a group or school  blanket
policy OR A GROUP OR INDIVIDUAL POLICY PURSUANT TO SECTION FOUR THOUSAND
THREE  HUNDRED  TWENTY-SIX  OF THIS CHAPTER for delivery, in this state,
which provides coverage for inpatient  hospital  care  or  coverage  for
physician  services,  shall  provide  comparable coverage for adults and
children with biologically based mental  illness.  Such  group  policies
issued  or  delivered  in  this state shall also provide such comparable

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02185-01-1

S. 1121                             2

coverage for children with serious emotional disturbances. Such coverage
shall be provided under the terms and  conditions  otherwise  applicable
under  the  policy,  including network limitations or variations, exclu-
sions,  co-pays, coinsurance, deductibles or other specific cost sharing
mechanisms. Provided further, where a policy  provides  both  in-network
and  out-of-network  benefits,  the  out-of-network  benefits  may  have
different coinsurance, co-pays,  or  deductibles,  than  the  in-network
benefits,  regardless of whether the policy is written under one license
or two licenses.
  S 3. Subparagraph (D) of paragraph 5 of subsection (l) of section 3221
of the insurance law, as amended by chapter 502 of  the  laws  of  2007,
item  (ii)  as amended by section 1 of part A of chapter 503 of the laws
of 2009, is amended to read as follows:
  (D) [(i) The provisions of subparagraph (B) of  this  paragraph  shall
not apply to any group purchaser with fifty or fewer employees that is a
policyholder  of  a  policy  that  is  subject to the provisions of this
section; provided however that an insurer must make  available,  and  if
requested  by such group purchaser, provide the coverage as specified in
subparagraph (B) of this paragraph. Written notice of  the  availability
of  the  coverage shall be delivered to the policyholder prior to incep-
tion of the group policy and annually thereafter.
  (ii)] The superintendent shall develop and implement a methodology  to
cover  the  cost  to  any [such] INDIVIDUAL PURCHASER OR group purchaser
WITH FIFTY OR FEWER EMPLOYEES THAT IS A POLICYHOLDER OF A POLICY THAT IS
SUBJECT TO THE PROVISIONS OF THIS SECTION  for  providing  the  coverage
required  in  subparagraph (A) of this paragraph. Such methodology shall
be financed from moneys appropriated from the General Fund that shall be
made available to the superintendent for such purposes, to the extent of
funds available.
  S 4. The opening paragraph of paragraph 1 of subsection (g) of section
4303 of the insurance law, as amended by chapter  502  of  the  laws  of
2007, is amended to read as follows:
  A  hospital service corporation or a health service corporation, which
provides group, group remittance or school blanket coverage OR GROUP  OR
INDIVIDUAL  COVERAGE  PURSUANT  TO  SECTION  FOUR THOUSAND THREE HUNDRED
TWENTY-SIX OF THIS ARTICLE for inpatient hospital care, shall provide as
part of its contract broad-based coverage for the diagnosis  and  treat-
ment  of  mental,  nervous  or  emotional disorders or ailments, however
defined in such contract, at least equal to the  coverage  provided  for
other health conditions and shall include:
  S 5. Subparagraph (A) of paragraph 2 of subsection (g) of section 4303
of  the insurance law, as amended by chapter 502 of the laws of 2007, is
amended to read as follows:
  (A) A hospital service corporation or a  health  service  corporation,
which  provides  group,  group  remittance or school blanket coverage OR
GROUP OR INDIVIDUAL COVERAGE PURSUANT TO  SECTION  FOUR  THOUSAND  THREE
HUNDRED  TWENTY-SIX  OF  THIS ARTICLE for inpatient hospital care, shall
provide comparable coverage for adults and  children  with  biologically
based  mental  illness.  Such  hospital  service  corporation  or health
service corporation shall also  provide  such  comparable  coverage  for
children  with  serious  emotional  disturbances. Such coverage shall be
provided under the terms and conditions otherwise applicable  under  the
contract,  including  network  limitations  or  variations,  exclusions,
co-pays, coinsurance, deductibles or other specific cost  sharing  mech-
anisms.  Provided further, where a contract provides both in-network and
out-of-network benefits, the out-of-network benefits may have  different

S. 1121                             3

coinsurance,  co-pays,  or  deductibles,  than  the in-network benefits,
regardless of whether the contract is written under one license  or  two
licenses.
  S  6.  Paragraph  4 of subsection (g) of section 4303 of the insurance
law, as amended by chapter 502 of the laws of 2007, subparagraph (B)  as
amended  by  section  2 of part A of chapter 503 of the laws of 2009, is
amended to read as follows:
  (4) [(A) The provisions of paragraph two of this subsection shall  not
apply  to any group remittance group or group contract holder with fifty
or fewer employees who is a group remittance  group  or  group  contract
holder  of  a  policy that is subject to the provisions of this section;
provided however that a hospital service corporation or  health  service
corporation  must  make available, and if requested by such group remit-
ting agent or group contract holder, provide the coverage  as  specified
in  paragraph two of this subsection. Written notice of the availability
of such coverage shall be delivered to  the  remitting  agent  or  group
contract  holder prior to inception of such contract and annually there-
after.
  (B)] The superintendent shall develop and implement a  methodology  to
cover  the  cost  to  any  [such]  INDIVIDUAL  CONTRACT  HOLDER OR group
contract holder WITH FIFTY OR FEWER EMPLOYEES THAT IS A GROUP REMITTANCE
GROUP OR GROUP CONTRACT HOLDER OF  A  POLICY  THAT  IS  SUBJECT  TO  THE
PROVISIONS  OF THIS SECTION for providing the coverage required in para-
graph one of this subsection. Such methodology shall  be  financed  from
moneys  appropriated  from the General Fund that shall be made available
to the superintendent for such purposes, to the extent of  funds  avail-
able.
  S  7.  Paragraph  1 of subsection (h) of section 4303 of the insurance
law, as amended by chapter 502 of the laws of 2007, is amended  to  read
as follows:
  (1) A medical expense indemnity corporation or a health service corpo-
ration,  which provides group, group remittance or school blanket cover-
age OR GROUP OR INDIVIDUAL COVERAGE PURSUANT TO  SECTION  FOUR  THOUSAND
THREE  HUNDRED  TWENTY-SIX OF THIS ARTICLE for physician services, shall
provide as part of its contract broad-based coverage for  the  diagnosis
and  treatment  of  mental,  nervous or emotional disorders or ailments,
however defined in  such  contract,  at  least  equal  to  the  coverage
provided  for  other  health  conditions and shall include: benefits for
outpatient care provided by a psychiatrist or psychologist  licensed  to
practice  in this state, a licensed clinical social worker who meets the
requirements of subsection (n) of this section, or a professional corpo-
ration or university faculty practice corporation thereof,  which  bene-
fits may be limited to not less than twenty visits in any contract year,
plan  year or calendar year. Such coverage may be provided on a contract
year, plan year or calendar year basis and shall be consistent with  the
provision  of  other  benefits  under the contract. Such coverage may be
subject to annual deductibles, co-pays and coinsurance as may be  deemed
appropriate  by  the  superintendent  and shall be consistent with those
imposed on other benefits under the contract. In  the  event  the  group
remittance  group or contract holder is provided coverage provided under
this paragraph and under subparagraph (B) of paragraph one of subsection
(g) of this section from the same health service corporation, or under a
contract which is jointly underwritten  by  two  health  service  corpo-
rations  or by a health service corporation and a medical expense indem-
nity corporation, the aggregate of the  benefits  for  out-patient  care
obtained  under  subparagraph  (B) of paragraph one of subsection (g) of

S. 1121                             4

this section and this paragraph may be limited to not less  than  twenty
visits in any contract year, plan year or calendar year.
  S 8. Subparagraph (A) of paragraph 2 of subsection (h) of section 4303
of  the insurance law, as amended by chapter 502 of the laws of 2007, is
amended to read as follows:
  (A) A medical expense indemnity corporation or a health service corpo-
ration, which provides group, group remittance or school blanket  cover-
age  OR  GROUP  OR INDIVIDUAL COVERAGE PURSUANT TO SECTION FOUR THOUSAND
THREE HUNDRED TWENTY-SIX OF THIS ARTICLE for physician  services,  shall
provide  comparable  coverage  for adults and children with biologically
based mental illness. Such  medical  expense  indemnity  corporation  or
health  service  corporation shall also provide such comparable coverage
for children with serious emotional disturbances. Such coverage shall be
provided under the terms and conditions otherwise applicable  under  the
contract,  including  network  limitations  or  variations,  exclusions,
co-pays, coinsurance, deductibles or other specific cost  sharing  mech-
anisms.  Provided further, where a contract provides both in-network and
out-of-network benefits, the out-of-network benefits may have  different
coinsurance,  co-pays,  or  deductibles,  than  the in-network benefits,
regardless of whether the contract is written under one license  or  two
licenses.
  S  9.  Paragraph  4 of subsection (h) of section 4303 of the insurance
law, as amended by chapter 502 of the laws of 2007, subparagraph (B)  as
amended  by  section  3 of part A of chapter 503 of the laws of 2009, is
amended to read as follows:
  (4) [(A) The provisions of paragraph two of this subsection shall  not
apply  to any group remittance group or group contract holder with fifty
or fewer employees who is a group remittance  group  or  group  contract
holder  of a contract that is subject to the provisions of this section;
provided, however, that a hospital service corporation or health service
corporation must make available, and if requested by such  group  remit-
ting  agent  or group contract holder, provide the coverage as specified
in paragraph two of this subsection. Written notice of the  availability
of the coverage shall be delivered to the group remitting agent or group
contract  holder prior to inception of such contract and annually there-
after.
  (B)] The superintendent shall develop and implement a  methodology  to
cover  the  cost  to  any  [such]  group remittance group and INDIVIDUAL
CONTRACT HOLDER OR group contract holder WITH FIFTY OR  FEWER  EMPLOYEES
THAT  IS  A  GROUP REMITTANCE GROUP OR GROUP CONTRACT HOLDER OF A POLICY
THAT IS SUBJECT TO THE PROVISIONS OF  THIS  SECTION  for  providing  the
coverage  required in paragraph one of this subsection. Such methodology
shall be financed from moneys appropriated from the  General  Fund  that
shall  be made available to the superintendent for such purposes, to the
extent of funds available.
  S 10. This act shall take effect immediately.

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Senate Bill S1121

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

2011-S1121 (ACTIVE) - Details

2011-S1121 (ACTIVE) - Summary

2011-S1121 (ACTIVE) - Sponsor Memo

2011-S1121 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S1121

Share this bill

Sponsored By

Kevin S. Parker

Archive: Last Bill Status - In Senate Committee Insurance Committee

2011-S1121 (ACTIVE) - Details

2011-S1121 (ACTIVE) - Summary

2011-S1121 (ACTIVE) - Sponsor Memo

2011-S1121 (ACTIVE) - Bill Text download pdf

Comments