S T A T E O F N E W Y O R K
________________________________________________________________________
2452
2013-2014 Regular Sessions
I N S E N A T E
January 17, 2013
___________
Introduced by Sen. HOYLMAN -- 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 providing certain
coverage for diagnosis and treatment of chemical abuse and chemical
dependence
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 6 of subsection (l) of section 3221 of the insur-
ance law, as amended by chapter 558 of the laws of 1999, is amended to
read as follows:
(6) (A) Every insurer delivering a group or school blanket policy or
issuing a group or school blanket policy for delivery, in this state,
which provides coverage for inpatient hospital care [must make available
and, if requested by the policyholder,] OR COVERAGE FOR PHYSICIAN
SERVICES SHALL provide AS PART OF SUCH POLICY BROAD-BASED coverage for
the diagnosis and treatment of chemical abuse and chemical dependence,
however defined in such policy, AT LEAST EQUAL TO THE COVERAGE PROVIDED
FOR OTHER HEALTH CONDITIONS, provided, however, that the term chemical
abuse shall mean and include alcohol and substance abuse and chemical
dependence shall mean and include alcoholism and substance dependence,
however defined in such policy. [Written notice of the availability of
such coverage shall be delivered to the policyholder prior to inception
of such group policy and annually thereafter, except that this notice
shall not be required where a policy covers two hundred or more employ-
ees or where the benefit structure was the subject of collective
bargaining affecting persons who are employed in more than one state.]
(B) Such coverage shall, WHERE THE POLICY PROVIDES COVERAGE FOR INPA-
TIENT HOSPITAL CARE, be at least equal to the following:
(i) with respect to benefits for detoxification as a consequence of
chemical dependence, inpatient benefits in a hospital or a detoxifica-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04284-01-3
S. 2452 2
tion facility may not be limited to less than seven days of active
treatment in any CONTRACT YEAR, PLAN YEAR, OR calendar year; and
(ii) with respect to benefits for rehabilitation services, such bene-
fits may not be limited to less than thirty days of inpatient care in
any calendar year.
(C) Such coverage may be limited to facilities in New York state which
are certified by the office of alcoholism and substance abuse services
and, in other states, to those which are accredited by the joint commis-
sion on accreditation of hospitals as alcoholism, substance abuse or
chemical dependence treatment programs.
(D) Such coverage shall be [made available] PROVIDED at the inception
of all new policies and with respect to all other policies at any anni-
versary date of the policy [subject to evidence of insurability].
(E) Such coverage may be subject to annual deductibles, CO-PAYS and
co-insurance as may be deemed appropriate by the superintendent and are
consistent with those imposed on other benefits [within a given] UNDER
THE policy. [Further, each insurer shall report to the superintendent
each year the number of contract holders to whom it has issued policies
for the inpatient treatment of chemical dependence, and the approximate
number of persons covered by such policies] IN THE EVENT THAT A POLICY
PROVIDES COVERAGE FOR BOTH INPATIENT HOSPITAL CARE AND PHYSICIAN
SERVICES, THE AGGREGATE OF THE BENEFITS FOR OUTPATIENT CARE OBTAINED
UNDER THIS PARAGRAPH MAY BE LIMITED TO NOT LESS THAN SIXTY VISITS IN ANY
CONTRACT YEAR, PLAN YEAR OR CALENDAR YEAR.
(F) Such coverage shall not replace, restrict or eliminate existing
coverage provided by the policy.
(G) THE SUPERINTENDENT SHALL DEVELOP AND IMPLEMENT A METHODOLOGY TO
FULLY COVER THE COST TO ANY GROUP PURCHASER WITH FIFTY OR FEWER EMPLOY-
EES THAT IS A POLICYHOLDER OF A POLICY THAT IS SUBJECT TO THE PROVISIONS
OF THIS SECTION FOR PROVIDING THE COVERAGE REQUIRED IN THIS PARAGRAPH
AND PARAGRAPH SEVEN OF THIS SUBSECTION. SUCH METHODOLOGY SHALL BE
FINANCED FROM FUNDS FROM THE GENERAL FUND THAT SHALL BE MADE AVAILABLE
TO THE SUPERINTENDENT FOR SUCH PURPOSE.
S 2. Paragraph 7 of subsection (1) of section 3221 of the insurance
law, as amended by chapter 565 of the laws of 2000, is amended to read
as follows:
(7) Every insurer delivering a group or school blanket policy or issu-
ing a group or school blanket policy for delivery in this state which
provides coverage for inpatient hospital care [must] OR COVERAGE FOR
PHYSICIAN SERVICES SHALL provide AS PART OF SUCH POLICY coverage for at
least sixty outpatient visits in any CONTRACT YEAR, PLAN YEAR OR calen-
dar year for the diagnosis and treatment of chemical dependence of which
up to twenty may be for family members, except that this provision shall
not apply to a policy which covers persons employed in more than one
state or the benefit structure of which was the subject of collective
bargaining affecting persons who are employed in more than one state.
Such coverage may be limited to facilities in New York state certified
by the office of alcoholism and substance abuse services or licensed by
such office as outpatient clinics or medically supervised ambulatory
substance abuse programs and, in other states, to those which are
accredited by the joint commission on accreditation of hospitals as
alcoholism or chemical dependence treatment programs. WHERE THE POLICY
PROVIDES COVERAGE FOR PHYSICIAN SERVICES, IT 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 SUBPARAGRAPH (D) OF PARAGRAPH FOUR OF THIS SUBSECTION,
S. 2452 3
OR A PROFESSIONAL CORPORATION OR UNIVERSITY FACULTY PRACTICE CORPORATION
THEREOF. Such coverage may be subject to annual deductibles, CO-PAYS and
co-insurance as may be deemed appropriate by the superintendent and
[are] SHALL BE consistent with those imposed on other benefits [within a
given] UNDER THE policy. IN THE EVENT THAT A POLICY PROVIDES COVERAGE
FOR BOTH INPATIENT HOSPITAL CARE AND PHYSICIAN SERVICES, THE AGGREGATE
OF THE BENEFITS FOR OUTPATIENT CARE OBTAINED UNDER THIS PARAGRAPH MAY BE
LIMITED TO NOT LESS THAN SIXTY VISITS IN ANY CONTRACT YEAR, PLAN YEAR OR
CALENDAR YEAR. Such coverage shall not replace, restrict, or eliminate
existing coverage provided by the policy. Except as otherwise provided
in the applicable policy or contract, no insurer delivering a group or
school blanket policy or issuing a group or school blanket policy
providing coverage for alcoholism or substance abuse services pursuant
to this section shall deny coverage to a family member who identifies
[themself] HIMSELF OR HERSELF as a family member of a person suffering
from the disease of alcoholism, substance abuse or chemical dependency
and who seeks treatment as a family member who is otherwise covered by
the applicable policy or contract pursuant to this section. The coverage
required by this paragraph shall include treatment as a family member
pursuant to such family members' own policy or contract provided such
family member (i) does not exceed the allowable number of family visits
provided by the applicable policy or contract pursuant to this section,
and (ii) is otherwise entitled to coverage pursuant to this section and
such family members' applicable policy or contract.
S 3. Subsection (k) of section 4303 of the insurance law, as amended
by chapter 558 of the laws of 1999, is amended to read as follows:
(k) A hospital service corporation or a health service corporation
which provides group, group remittance or school blanket coverage for
inpatient hospital care [must make available and if requested by the
contract holder] SHALL provide AS PART OF ITS CONTRACT BROAD-BASED
coverage for the diagnosis and treatment of chemical abuse and chemical
dependence, however defined in such policy, AT LEAST EQUAL TO THE COVER-
AGE PROVIDED FOR OTHER HEALTH CONDITIONS, provided, however, that the
term chemical abuse shall mean and include alcohol and substance abuse
and chemical dependence shall mean and include alcoholism and substance
dependence, however defined in such policy, except that this provision
shall not apply to a policy which covers persons employed in more than
one state or the benefit structure of which was the subject of collec-
tive bargaining affecting persons who are employed in more than one
state. Such coverage shall be at least equal to the following: (1) with
respect to benefits for detoxification as a consequence of chemical
dependence, inpatient benefits for care in a hospital or detoxification
facility may not be limited to less than seven days of active treatment
in any CONTRACT YEAR, PLAN YEAR OR calendar year; and (2) with respect
to benefits for inpatient rehabilitation services, such benefits may not
be limited to less than thirty days of inpatient rehabilitation in a
hospital based or free standing chemical dependence facility in any
CONTRACT YEAR, PLAN YEAR OR calendar year. Such coverage may be limited
to facilities in New York state which are certified by the office of
alcoholism and substance abuse services and, in other states, to those
which are accredited by the joint commission on accreditation of hospi-
tals as alcoholism, substance abuse, or chemical dependence treatment
programs. Such coverage [shall be made available at the inception of all
new policies and with respect to policies issued before the effective
date of this subsection at the first annual anniversary date thereafter,
without evidence of insurability and at any subsequent annual anniver-
S. 2452 4
sary date subject to evidence of insurability] MAY BE PROVIDED ON A
CONTRACT YEAR, PLAN YEAR OR CALENDAR YEAR BASIS AND SHALL BE CONSISTENT
WITH THE PROVISIONS OF OTHER BENEFITS UNDER THE CONTRACT. Such coverage
may be subject to annual deductibles, CO-PAYS and co-insurance as may be
deemed appropriate by the superintendent and are consistent with those
imposed on other benefits [within a given policy. Further, each hospital
service corporation or health service corporation shall report to the
superintendent each year the number of contract holders to whom it has
issued policies for the inpatient treatment of chemical dependence, and
the approximate number of persons covered by such policies] UNDER THE
CONTRACT. Such coverage shall not replace, restrict or eliminate exist-
ing coverage provided by the policy. [Written notice of the availability
of such coverage shall be delivered to the group remitting agent or
group contract holder prior to inception of such contract and annually
thereafter, except that this notice shall not be required where a policy
covers two hundred or more employees or where the benefit structure was
the subject of collective bargaining affecting persons who are employed
in more than one state] THE SUPERINTENDENT SHALL DEVELOP AND IMPLEMENT A
METHODOLOGY TO FULLY COVER THE COST 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 FOR PROVIDING THE COVERAGE REQUIRED IN
THIS SUBSECTION AND SUBSECTION (L) OF THIS SECTION. SUCH METHODOLOGY
SHALL BE FINANCED FROM FUNDS FROM THE GENERAL FUND THAT SHALL BE MADE
AVAILABLE TO THE SUPERINTENDENT FOR SUCH PURPOSE.
S 4. Subsection (l) of section 4303 of the insurance law, as amended
by chapter 565 of the laws of 2000, is amended to read as follows:
(l) A hospital service corporation or a health service corporation
which provides group, group remittance or school blanket coverage for
inpatient hospital care [must] SHALL provide AS PART OF ITS CONTRACT
coverage for at least sixty outpatient visits in any CONTRACT YEAR, PLAN
YEAR OR calendar year for the diagnosis and treatment of chemical
dependence of which up to twenty may be for family members, except that
this provision shall not apply to a contract issued pursuant to section
four thousand three hundred five of this article which covers persons
employed in more than one state or the benefit structure of which was
the subject of collective bargaining affecting persons who are employed
in more than one state. Such coverage may be limited to facilities in
New York state certified by the office of alcoholism and substance abuse
services or licensed by such office as outpatient clinics or medically
supervised ambulatory substance abuse programs and, in other states, to
those which are accredited by the joint commission on accreditation of
hospitals as alcoholism or chemical dependence substance abuse treatment
programs. 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 annu-
al deductibles, CO-PAYS and co-insurance as may be deemed appropriate by
the superintendent and are consistent with those imposed on other bene-
fits [within a given policy] UNDER THE CONTRACT. Such coverage shall
not replace, restrict or eliminate existing coverage provided by the
policy. Except as otherwise provided in the applicable policy or
contract, no hospital service corporation or health service corporation
providing coverage for alcoholism or substance abuse services pursuant
to this section shall deny coverage to a family member who identifies
[themself] HIMSELF OR HERSELF as a family member of a person suffering
from the disease of alcoholism, substance abuse or chemical dependency
S. 2452 5
and who seeks treatment as a family member who is otherwise covered by
the applicable policy or contract pursuant to this section. The coverage
required by this subsection shall include treatment as a family member
pursuant to such family members' own policy or contract provided such
family member (i) does not exceed the allowable number of family visits
provided by the applicable policy or contract pursuant to this section,
and (ii) is otherwise entitled to coverage pursuant to this section and
such family members' applicable policy or contract.
S 5. The superintendent of financial services shall monitor the imple-
mentation of the coverage required pursuant to paragraphs 6 and 7 of
subsection (l) of section 3221, and subsections (k) and (l) of section
4303 of the insurance law, and take such action as may be necessary, to
ensure that insurers' contracts or policies do not contain unreasonable
definitions of chemical abuse, alcohol and substance abuse, chemical
dependence, alcoholism and substance dependence in their contracts or
policies. In determining whether such definitions may be unreasonable,
the superintendent of financial services shall ensure that any exclu-
sions and limitations on covered benefits are consistent with benefits
provided to public officers and employees pursuant to article 11 of the
civil service law.
S 6. This act shall take effect on the first of January next succeed-
ing the date on which it shall have become a law; and the provisions of
this act shall apply to policies and contracts issued, renewed, modi-
fied, altered or amended on or after such effective date.