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

                                  10725

                          I N  A S S E M B L Y

                              June 14, 2016
                               ___________

Introduced  by  COMMITTEE  ON RULES -- (at request of M. of A. Steck) --
  (at request of the Governor) -- read once and referred to the  Commit-
  tee on Alcoholism and Drug Abuse

AN ACT to amend the insurance law and the public health law, in relation
  to  utilization review program standards (Part A); to amend the insur-
  ance law, in relation to providing coverage for immediate access to  a
  five  day  emergency supply of certain medication; to amend the social
  services law and the public health law,  in  relation  to  prohibiting
  prior  authorization  for  a prescription for buprenorphine for opioid
  addiction detoxification or maintenance treatment (Part B);  to  amend
  the mental hygiene law, in relation to the heroin and opioid addiction
  wraparound  demonstration services program; and to amend chapter 32 of
  the laws of 2014, amending the mental  hygiene  law  relating  to  the
  heroin and opioid addiction wraparound services demonstration program,
  in  relation  to  the effectiveness thereof (Part C); and to amend the
  mental hygiene law, in relation  to  emergency  services  for  persons
  intoxicated,  impaired,  or incapacitated by alcohol and/or substances
  (Part D)

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

  Section  1.  This  act enacts into law major components of legislation
related to the treatment of heroin and opioid addictions. Each component
is wholly contained within a Part identified as Parts A through  D.  The
effective  date for each particular provision contained within such Part
is set forth in the last section of such  Part.  Any  provision  in  any
section  contained  within  a  Part, including the effective date of the
Part, which makes a reference to a section "of this act", when  used  in
connection  with  that particular component, shall be deemed to mean and
refer to the corresponding section of the Part in  which  it  is  found.
Section  three of this act sets forth the general effective date of this
act.

                                 PART A

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD12085-01-6
              

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  Section 1. Paragraph 9 of subsection (a) of section 4902 of the insur-
ance law, as added by chapter 41 of the laws of 2014, is amended to read
as follows:
  (9)  When  conducting  utilization  review for purposes of determining
health care coverage for substance use disorder treatment, a utilization
review agent shall utilize [recognized] evidence-based and peer reviewed
clinical review [criteria] TOOLS DESIGNATED BY THE OFFICE OF  ALCOHOLISM
AND SUBSTANCE ABUSE SERVICES that [is] ARE appropriate to the age of the
patient  and  [is  deemed  appropriate  and approved for such use by the
commissioner of the office of alcoholism and substance abuse services in
consultation with the commissioner of health and the superintendent.
  The office of alcoholism and substance abuse services in  consultation
with  the  commissioner of health and the superintendent shall approve a
recognized evidence-based and peer reviewed clinical review criteria, in
addition to any other approved evidence-based and peer reviewed clinical
review criteria] CONSISTENT WITH THE TREATMENT SERVICE LEVELS WITHIN THE
OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES SYSTEM.  ALL  APPROVED
TOOLS  SHALL  HAVE INTER RATER RELIABILITY TESTING COMPLETED BY DECEMBER
THIRTY-FIRST, TWO THOUSAND SIXTEEN.
  S 2. Paragraph (i) of subdivision 1 of  section  4902  of  the  public
health  law,  as  added by chapter 41 of the laws of 2014, is amended to
read as follows:
  (i) When conducting utilization review  for  purposes  of  determining
health care coverage for substance use disorder treatment, a utilization
review agent shall utilize [recognized] evidence-based and peer reviewed
clinical  review [criteria] TOOLS DESIGNATED BY THE OFFICE OF ALCOHOLISM
AND SUBSTANCE ABUSE SERVICES that [is] ARE appropriate to the age of the
patient and [is deemed appropriate and approved  for  such  use  by  the
commissioner of the office of alcoholism and substance abuse services in
consultation  with  the commissioner and the superintendent of financial
services.
  The office of alcoholism and substance abuse services in  consultation
with the commissioner and the superintendent of financial services shall
approve  a  recognized  evidence-based and peer reviewed clinical review
criteria, in addition to any  other  approved  evidence-based  and  peer
reviewed clinical review criteria] CONSISTENT WITH THE TREATMENT SERVICE
LEVELS  WITHIN  THE  OFFICE  OF  ALCOHOLISM AND SUBSTANCE ABUSE SERVICES
SYSTEM. ALL APPROVED TOOLS SHALL HAVE INTER  RATER  RELIABILITY  TESTING
COMPLETED BY DECEMBER THIRTY-FIRST, TWO THOUSAND SIXTEEN.
  S  3.  Any  utilization review agent utilizing evidence-based and peer
reviewed clinical review criteria approved by the office  of  alcoholism
and substance abuse services on or before the effective date of this act
shall  have  until December 31, 2016 to have their review tools redesig-
nated by the office of alcoholism and substance abuse services  pursuant
to paragraph 9 of subsection (a) of section 4902 of the insurance law.
  S  4.  This act shall take effect immediately and shall apply to poli-
cies and contracts issued, renewed, modified, altered or amended on  and
after January 1, 2017.

                                 PART B

  Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
amended by adding a new paragraph 31-a to read as follows:
  (31-A) (A) EVERY POLICY THAT PROVIDES MEDICAL, MAJOR MEDICAL OR  SIMI-
LAR  COMPREHENSIVE-TYPE  COVERAGE AND PROVIDES COVERAGE FOR PRESCRIPTION
DRUGS FOR MEDICATION FOR THE TREATMENT OF A SUBSTANCE USE DISORDER SHALL

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INCLUDE IMMEDIATE ACCESS, WITHOUT PRIOR AUTHORIZATION,  TO  A  FIVE  DAY
EMERGENCY  SUPPLY OF PRESCRIBED MEDICATIONS COVERED UNDER THE POLICY FOR
THE TREATMENT OF SUBSTANCE USE DISORDER  WHERE  AN  EMERGENCY  CONDITION
EXISTS,  INCLUDING  A  PRESCRIBED DRUG OR MEDICATION ASSOCIATED WITH THE
MANAGEMENT OF  OPIOID  WITHDRAWAL  AND/OR  STABILIZATION,  EXCEPT  WHERE
OTHERWISE  PROHIBITED  BY  LAW. FURTHER, COVERAGE OF AN EMERGENCY SUPPLY
SHALL INCLUDE MEDICATION FOR OPIOID OVERDOSE REVERSAL OTHERWISE  COVERED
UNDER THE POLICY PRESCRIBED TO AN INDIVIDUAL COVERED BY THE POLICY.
  (B)  FOR  PURPOSES OF THIS PARAGRAPH, AN "EMERGENCY CONDITION" MEANS A
SUBSTANCE USE DISORDER CONDITION THAT MANIFESTS ITSELF BY ACUTE SYMPTOMS
OF SUFFICIENT SEVERITY, INCLUDING SEVERE  PAIN  OR  THE  EXPECTATION  OF
SEVERE  PAIN, SUCH THAT A PRUDENT LAYPERSON, POSSESSING AN AVERAGE KNOW-
LEDGE OF MEDICINE AND HEALTH, COULD REASONABLY  EXPECT  THE  ABSENCE  OF
IMMEDIATE MEDICAL ATTENTION TO RESULT IN:
  (I)  PLACING THE HEALTH OF THE PERSON AFFLICTED WITH SUCH CONDITION IN
SERIOUS JEOPARDY, OR IN THE CASE OF A BEHAVIORAL CONDITION, PLACING  THE
HEALTH OF SUCH PERSON OR OTHERS IN SERIOUS JEOPARDY;
  (II) SERIOUS IMPAIRMENT TO SUCH PERSON'S BODILY FUNCTIONS;
  (III) SERIOUS DYSFUNCTION OF ANY BODILY ORGAN OR PART OF SUCH PERSON;
  (IV) SERIOUS DISFIGUREMENT OF SUCH PERSON; OR
  (V)  A  CONDITION  DESCRIBED  IN CLAUSE (I), (II), OR (III) OF SECTION
1867(E)(1)(A) OF THE SOCIAL SECURITY ACT.
  (C) COVERAGE PROVIDED UNDER THIS PARAGRAPH MAY BE  SUBJECT  TO  COPAY-
MENTS,  COINSURANCE,  AND  ANNUAL  DEDUCTIBLES  THAT ARE CONSISTENT WITH
THOSE IMPOSED ON OTHER BENEFITS WITHIN THE POLICY; PROVIDED, HOWEVER, NO
POLICY SHALL IMPOSE AN ADDITIONAL COPAYMENT OR COINSURANCE ON AN INSURED
WHO RECEIVED AN EMERGENCY SUPPLY OF MEDICATION AND THEN RECEIVED UP TO A
THIRTY DAY SUPPLY OF THE SAME MEDICATION IN THE SAME THIRTY  DAY  PERIOD
IN WHICH THE EMERGENCY SUPPLY OF MEDICATION WAS DISPENSED. THIS SUBPARA-
GRAPH SHALL NOT PRECLUDE THE IMPOSITION OF A COPAYMENT OR COINSURANCE ON
THE  INITIAL  EMERGENCY  SUPPLY  OF MEDICATION IN AN AMOUNT THAT IS LESS
THAN THE COPAYMENT OR COINSURANCE OTHERWISE APPLICABLE TO A  THIRTY  DAY
SUPPLY OF SUCH MEDICATION, PROVIDED THAT THE TOTAL SUM OF THE COPAYMENTS
OR  COINSURANCE  FOR  AN ENTIRE THIRTY DAY SUPPLY OF THE MEDICATION DOES
NOT EXCEED THE COPAYMENT OR COINSURANCE OTHERWISE APPLICABLE TO A THIRTY
DAY SUPPLY OF SUCH MEDICATION.
  S 2. Subsection (l) of section 3221 of the insurance law is amended by
adding two new paragraphs 7-a and 7-b to read as follows:
  (7-A) EVERY POLICY THAT PROVIDES MEDICAL,  MAJOR  MEDICAL  OR  SIMILAR
COMPREHENSIVE-TYPE LARGE GROUP COVERAGE SHALL PROVIDE COVERAGE FOR MEDI-
CATION  FOR  THE  DETOXIFICATION OR MAINTENANCE TREATMENT OF A SUBSTANCE
USE DISORDER APPROVED BY THE FOOD AND DRUG ADMINISTRATION FOR THE DETOX-
IFICATION OR MAINTENANCE TREATMENT OF SUBSTANCE USE DISORDER.
  (7-B) (A) EVERY POLICY THAT PROVIDES MEDICAL, MAJOR MEDICAL OR SIMILAR
COMPREHENSIVE-TYPE COVERAGE AND PROVIDES COVERAGE FOR PRESCRIPTION DRUGS
FOR MEDICATION FOR THE TREATMENT  OF  A  SUBSTANCE  USE  DISORDER  SHALL
INCLUDE  IMMEDIATE  ACCESS,  WITHOUT  PRIOR AUTHORIZATION, TO A FIVE DAY
EMERGENCY SUPPLY OF PRESCRIBED MEDICATIONS COVERED UNDER THE POLICY  FOR
THE  TREATMENT  OF  SUBSTANCE  USE DISORDER WHERE AN EMERGENCY CONDITION
EXISTS, INCLUDING A PRESCRIBED DRUG OR MEDICATION  ASSOCIATED  WITH  THE
MANAGEMENT  OF  OPIOID  WITHDRAWAL  AND/OR  STABILIZATION,  EXCEPT WHERE
OTHERWISE PROHIBITED BY LAW. FURTHER, COVERAGE OF  AN  EMERGENCY  SUPPLY
SHALL  INCLUDE MEDICATION FOR OPIOID OVERDOSE REVERSAL OTHERWISE COVERED
UNDER THE POLICY PRESCRIBED TO AN INDIVIDUAL COVERED BY THE POLICY.
  (B) FOR PURPOSES OF THIS PARAGRAPH, AN "EMERGENCY CONDITION"  MEANS  A
SUBSTANCE USE DISORDER CONDITION THAT MANIFESTS ITSELF BY ACUTE SYMPTOMS

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OF  SUFFICIENT  SEVERITY,  INCLUDING  SEVERE  PAIN OR THE EXPECTATION OF
SEVERE PAIN, SUCH THAT A PRUDENT LAYPERSON, POSSESSING AN AVERAGE  KNOW-
LEDGE  OF  MEDICINE  AND  HEALTH, COULD REASONABLY EXPECT THE ABSENCE OF
IMMEDIATE MEDICAL ATTENTION TO RESULT IN:
  (I)  PLACING THE HEALTH OF THE PERSON AFFLICTED WITH SUCH CONDITION IN
SERIOUS JEOPARDY, OR IN THE CASE OF A BEHAVIORAL CONDITION, PLACING  THE
HEALTH OF SUCH PERSON OR OTHERS IN SERIOUS JEOPARDY;
  (II) SERIOUS IMPAIRMENT TO SUCH PERSON'S BODILY FUNCTIONS;
  (III) SERIOUS DYSFUNCTION OF ANY BODILY ORGAN OR PART OF SUCH PERSON;
  (IV) SERIOUS DISFIGUREMENT OF SUCH PERSON; OR
  (V)  A  CONDITION  DESCRIBED  IN CLAUSE (I), (II), OR (III) OF SECTION
1867(E)(1)(A) OF THE SOCIAL SECURITY ACT.
  (C) COVERAGE PROVIDED UNDER THIS PARAGRAPH MAY BE  SUBJECT  TO  COPAY-
MENTS,  COINSURANCE,  AND  ANNUAL  DEDUCTIBLES  THAT ARE CONSISTENT WITH
THOSE IMPOSED ON OTHER BENEFITS WITHIN THE POLICY; PROVIDED, HOWEVER, NO
POLICY SHALL IMPOSE AN ADDITIONAL COPAYMENT OR COINSURANCE ON AN INSURED
WHO RECEIVED AN EMERGENCY SUPPLY OF MEDICATION AND THEN RECEIVED UP TO A
THIRTY DAY SUPPLY OF THE SAME MEDICATION IN THE SAME THIRTY  DAY  PERIOD
IN WHICH THE EMERGENCY SUPPLY OF MEDICATION WAS DISPENSED. THIS SUBPARA-
GRAPH SHALL NOT PRECLUDE THE IMPOSITION OF A COPAYMENT OR COINSURANCE ON
THE  INITIAL  EMERGENCY  SUPPLY  OF MEDICATION IN AN AMOUNT THAT IS LESS
THAN THE COPAYMENT OR COINSURANCE OTHERWISE APPLICABLE TO A  THIRTY  DAY
SUPPLY OF SUCH MEDICATION, PROVIDED THAT THE TOTAL SUM OF THE COPAYMENTS
OR  COINSURANCE  FOR  AN ENTIRE THIRTY DAY SUPPLY OF THE MEDICATION DOES
NOT EXCEED THE COPAYMENT OR COINSURANCE OTHERWISE APPLICABLE TO A THIRTY
DAY SUPPLY OF SUCH MEDICATION.
  S 3. Section 4303 of the insurance law is amended by  adding  two  new
subsections (l-1) and (l-2) to read as follows:
  (L-1)  EVERY CONTRACT THAT PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE-TYPE LARGE GROUP COVERAGE SHALL PROVIDE COVERAGE FOR MEDI-
CATION FOR THE DETOXIFICATION OR MAINTENANCE TREATMENT  OF  A  SUBSTANCE
USE DISORDER APPROVED BY THE FOOD AND DRUG ADMINISTRATION FOR THE DETOX-
IFICATION OR MAINTENANCE TREATMENT OF SUBSTANCE USE DISORDER.
  (L-2) (1) EVERY CONTRACT THAT PROVIDES MEDICAL, MAJOR MEDICAL OR SIMI-
LAR  COMPREHENSIVE-TYPE  COVERAGE AND PROVIDES COVERAGE FOR PRESCRIPTION
DRUGS FOR MEDICATION FOR THE TREATMENT OF A SUBSTANCE USE DISORDER SHALL
INCLUDE IMMEDIATE ACCESS, WITHOUT PRIOR AUTHORIZATION,  TO  A  FIVE  DAY
EMERGENCY  SUPPLY  OF  PRESCRIBED MEDICATIONS COVERED UNDER THE CONTRACT
FOR THE TREATMENT OF SUBSTANCE USE DISORDER WHERE AN EMERGENCY CONDITION
EXISTS, INCLUDING A PRESCRIBED DRUG OR MEDICATION  ASSOCIATED  WITH  THE
MANAGEMENT  OF  OPIOID  WITHDRAWAL  AND/OR  STABILIZATION,  EXCEPT WHERE
OTHERWISE PROHIBITED BY LAW. FURTHER, COVERAGE OF  AN  EMERGENCY  SUPPLY
SHALL  INCLUDE MEDICATION FOR OPIOID OVERDOSE REVERSAL OTHERWISE COVERED
UNDER THE CONTRACT PRESCRIBED TO AN INDIVIDUAL COVERED BY THE CONTRACT.
  (2) FOR PURPOSES OF THIS PARAGRAPH, AN "EMERGENCY CONDITION"  MEANS  A
SUBSTANCE USE DISORDER CONDITION THAT MANIFESTS ITSELF BY ACUTE SYMPTOMS
OF  SUFFICIENT  SEVERITY,  INCLUDING  SEVERE  PAIN OR THE EXPECTATION OF
SEVERE PAIN, SUCH THAT A PRUDENT LAYPERSON, POSSESSING AN AVERAGE  KNOW-
LEDGE  OF  MEDICINE  AND  HEALTH, COULD REASONABLY EXPECT THE ABSENCE OF
IMMEDIATE MEDICAL ATTENTION TO RESULT IN:
  (I) PLACING THE HEALTH OF THE PERSON AFFLICTED WITH SUCH CONDITION  IN
SERIOUS  JEOPARDY, OR IN THE CASE OF A BEHAVIORAL CONDITION, PLACING THE
HEALTH OF SUCH PERSON OR OTHERS IN SERIOUS JEOPARDY;
  (II) SERIOUS IMPAIRMENT TO SUCH PERSON'S BODILY FUNCTIONS;
  (III) SERIOUS DYSFUNCTION OF ANY BODILY ORGAN OR PART OF SUCH PERSON;
  (IV) SERIOUS DISFIGUREMENT OF SUCH PERSON; OR

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  (V) A CONDITION DESCRIBED IN CLAUSE (I),  (II)  OR  (III)  OF  SECTION
1867(E)(1)(A) OF THE SOCIAL SECURITY ACT.
  (3)  COVERAGE  PROVIDED UNDER THIS SUBSECTION MAY BE SUBJECT TO COPAY-
MENTS, COINSURANCE, AND ANNUAL  DEDUCTIBLES  THAT  ARE  CONSISTENT  WITH
THOSE  IMPOSED ON OTHER BENEFITS WITHIN THE CONTRACT; PROVIDED, HOWEVER,
NO CONTRACT SHALL IMPOSE AN ADDITIONAL COPAYMENT OR  COINSURANCE  ON  AN
INSURED WHO RECEIVED AN EMERGENCY SUPPLY OF MEDICATION AND THEN RECEIVED
UP  TO A THIRTY DAY SUPPLY OF THE SAME MEDICATION IN THE SAME THIRTY DAY
PERIOD IN WHICH THE EMERGENCY SUPPLY OF MEDICATION WAS  DISPENSED.  THIS
PARAGRAPH  SHALL  NOT  PRECLUDE THE IMPOSITION OF A COPAYMENT OR COINSU-
RANCE ON THE INITIAL LIMITED SUPPLY OF MEDICATION IN AN AMOUNT  THAT  IS
LESS  THAN THE COPAYMENT OR COINSURANCE OTHERWISE APPLICABLE TO A THIRTY
DAY SUPPLY OF SUCH MEDICATION, PROVIDED THAT THE TOTAL SUM OF THE COPAY-
MENTS OR COINSURANCE FOR AN ENTIRE THIRTY DAY SUPPLY OF  THE  MEDICATION
DOES  NOT  EXCEED THE COPAYMENT OR COINSURANCE OTHERWISE APPLICABLE TO A
THIRTY DAY SUPPLY OF SUCH MEDICATION.
  S 4. Section 364-j of the social services law is amended by  adding  a
new subdivision 26-b to read as follows:
  26-B. MANAGED CARE PROVIDERS SHALL NOT REQUIRE PRIOR AUTHORIZATION FOR
AN  INITIAL  OR  RENEWAL  PRESCRIPTION  FOR  BUPRENORPHINE OR INJECTABLE
NALTREXONE  FOR  DETOXIFICATION  OR  MAINTENANCE  TREATMENT  OF   OPIOID
ADDICTION  UNLESS  THE PRESCRIPTION IS FOR A NON-PREFERRED OR NON-FORMU-
LARY FORM OF THE DRUG OR AS OTHERWISE REQUIRED BY SECTION 1927(K)(6)  OF
THE SOCIAL SECURITY ACT.
  S  5.  Section 273 of the public health law is amended by adding a new
subdivision 10 to read as follows:
  10. PRIOR AUTHORIZATION SHALL  NOT  BE  REQUIRED  FOR  AN  INITIAL  OR
RENEWAL  PRESCRIPTION  FOR  BUPRENORPHINE  OR  INJECTABLE NALTREXONE FOR
DETOXIFICATION OR MAINTENANCE TREATMENT OF OPIOID ADDICTION  UNLESS  THE
PRESCRIPTION  IS  FOR A NON-PREFERRED OR NON-FORMULARY FORM OF SUCH DRUG
AS OTHERWISE REQUIRED BY SECTION 1927(K)(6) OF THE SOCIAL SECURITY ACT.
  S 6. This act shall take effect immediately; provided,  sections  one,
two,  and  three  of  this act shall take effect on the first of January
next succeeding the date on which it shall have become a law  and  shall
apply  to  policies  and contracts issued, renewed, modified, altered or
amended on and after such date; and provided further that the amendments
to section 364-j of the social services law made by section four of this
act shall not affect the repeal of such section and shall be  deemed  to
be repealed therewith.

                                 PART C

  Section  1.  Section  19.18-a  of  the mental hygiene law, as added by
chapter 32 of the laws of 2014, is amended to read as follows:
S 19.18-a Heroin and opioid addiction wraparound services  demonstration
              program.
  1.  The  commissioner,  in  consultation with the department of health
shall develop a heroin and opioid addiction wraparound  services  demon-
stration  program.  This  program  shall  provide wraparound services to
adolescent and adult  patients  during  treatment,  INCLUDING,  BUT  NOT
LIMITED  TO,  INPATIENT AND OUTPATIENT TREATMENT, and shall be available
to such patients for a clinically appropriate  period  for  up  to  nine
months  after  completion  of  such  treatment program. The commissioner
shall identify and establish where the wraparound services demonstration
program will be provided.
  2. Wraparound services shall include;

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  (a) Case management services which address:
  (i) Educational resources;
  (ii) Legal services;
  (iii) Financial services;
  (iv) Social services;
  (v) Family services; and
  (vi) Childcare services;
  (b) Peer supports, including peer to peer support groups;
  (c) Employment support; and
  (d) Transportation assistance.
  3. Not later than [two years after the effective date of this section]
JUNE  30,  2018, the commissioner shall provide the governor, the tempo-
rary president of the senate, the speaker of the assembly, the chair  of
the senate standing committee on alcoholism and drug abuse and the chair
of  the  assembly  committee on alcoholism and drug abuse with a written
evaluation of the demonstration program.   Such evaluation shall,  AT  A
MINIMUM, address the overall effectiveness of this demonstration program
[and],  IDENTIFY  BEST  PRACTICES FOR WRAPAROUND SERVICES PROVIDED UNDER
THIS DEMONSTRATION PROGRAM, AND ANY ADDITIONAL WRAPAROUND SERVICES  THAT
MAY  BE  APPROPRIATE  WITHIN  EACH  TYPE OF PROGRAM OPERATED, REGULATED,
FUNDED, OR APPROVED BY THE OFFICE AND ADDRESS  whether  continuation  or
expansion  of  this  demonstration  program  is recommended. THE WRITTEN
EVALUATION SHALL BE MADE AVAILABLE ON THE OFFICE'S WEBSITE.
  S 2. Section 2 of chapter 32 of the laws of 2014, amending the  mental
hygiene  law    relating  to  the heroin and opioid addiction wraparound
services demonstration program, is amended to read as follows:
  S 2. This act shall take effect immediately and shall  expire  and  be
deemed repealed [three years after such effective date] MARCH 31, 2019.
  S  3.  This act shall take effect immediately; provided, however, that
the amendments to section 19.18-a of the  mental  hygiene  law  made  by
section  one of this act shall not affect the repeal of such section and
shall be deemed repealed therewith.

                                 PART D

  Section 1. Section 22.09 of the mental hygiene law, as added by  chap-
ter 558 of the laws of 1999, is amended to read as follows:
S 22.09 Emergency  services  for persons intoxicated, impaired, or inca-
          pacitated by alcohol and/or substances.
  (a) As used in this article:
  1. "Intoxicated or impaired person" means a  person  whose  mental  or
physical  functioning is substantially impaired as a result of the pres-
ence of alcohol and/or substances in his or her body.
  2. "Incapacitated" means that a person, as a  result  of  the  use  of
alcohol  and/or  substances,  is  unconscious or has his or her judgment
otherwise so impaired that he or  she  is  incapable  of  realizing  and
making  a  rational  decision with respect to his or her need for treat-
ment.
  3. "Likelihood to result in harm" or "likely to result in harm"  means
(i)  a  substantial risk of physical harm to the person as manifested by
threats of or attempts at  suicide  or  serious  bodily  harm  or  other
conduct  demonstrating  that  the  person  is  dangerous  to  himself or
herself, or (ii) a substantial risk of physical harm to other persons as
manifested by homicidal or other violent behavior by  which  others  are
placed in reasonable fear of serious physical harm.

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  4.  ["Hospital" means a general hospital as defined in article twenty-
eight of the public health law]  "EMERGENCY  SERVICES"  MEANS  IMMEDIATE
PHYSICAL EXAMINATION, ASSESSMENT, CARE AND TREATMENT OF AN INCAPACITATED
PERSON  FOR  THE PURPOSE OF CONFIRMING THAT THE PERSON IS, AND CONTINUES
TO  BE,  INCAPACITATED  BY  ALCOHOL AND/OR SUBSTANCES TO THE DEGREE THAT
THERE IS A LIKELIHOOD TO RESULT IN HARM TO THE PERSON OR OTHERS.
  5. "TREATMENT FACILITY" MEANS A FACILITY DESIGNATED BY THE COMMISSION-
ER WHICH MAY ONLY INCLUDE A GENERAL HOSPITAL AS DEFINED IN ARTICLE TWEN-
TY-EIGHT OF THE PUBLIC HEALTH LAW, OR A MEDICALLY MANAGED  OR  MEDICALLY
SUPERVISED WITHDRAWAL, INPATIENT REHABILITATION, OR RESIDENTIAL STABILI-
ZATION  TREATMENT PROGRAM THAT HAS BEEN CERTIFIED BY THE COMMISSIONER TO
HAVE APPROPRIATE MEDICAL STAFF AVAILABLE ON-SITE AT ALL TIMES TO PROVIDE
EMERGENCY SERVICES AND CONTINUED EVALUATION OF CAPACITY  OF  INDIVIDUALS
RETAINED UNDER THIS SECTION.
  (b)  1.  An  intoxicated  or  impaired person may come voluntarily for
emergency [treatment] SERVICES  to  a  chemical  dependence  program  or
treatment facility authorized by the commissioner to [give such emergen-
cy  treatment]  PROVIDE SUCH EMERGENCY SERVICES. A person who appears to
be intoxicated or impaired and who consents to the proffered help may be
assisted by any peace officer acting pursuant  to  his  or  her  special
duties,  police  officer,  or by a designee of the director of community
services to return to his or her home, to a chemical dependence  program
or  treatment  facility,  or  to  any  other  facility authorized by the
commissioner  to  [give  emergency  treatment]  PROVIDE  SUCH  EMERGENCY
SERVICES.  In such cases, the peace officer, police officer, or designee
of the director of community services shall accompany the intoxicated or
impaired person in a manner which is reasonably designed to  assure  his
or  her  safety,  as  set forth in regulations promulgated in accordance
with subdivision [(f)] (D) of this section.
  [(c)] 2. A person who appears to be incapacitated  by  alcohol  and/or
substances to the degree that there is a likelihood to result in harm to
the  person or to others may be taken by a peace officer acting pursuant
to his or her special duties, or a police officer who is a member of the
state police or of an authorized police department  or  force  or  of  a
sheriff's  department  or  by  the  director  of community services or a
person duly designated by him or her to a [general hospital  or  to  any
other place authorized by the commissioner in regulations promulgated in
accordance with subdivision (f) of this section to give emergency treat-
ment,  for  immediate observation, care, and emergency treatment] TREAT-
MENT FACILITY FOR PURPOSES  OF  RECEIVING  EMERGENCY  SERVICES.    Every
reasonable effort shall be made to protect the health and safety of such
person,  including  but  not  limited  to the requirement that the peace
officer, police officer, or director of community services or his or her
designee shall accompany the apparently incapacitated person in a manner
which is reasonably designed to assure his or her safety, as  set  forth
in  regulations  promulgated in accordance with subdivision [(f)] (D) of
this section.
  [(d)] 3. A person who comes voluntarily or is brought without  his  or
her  objection  to  any such facility or program in accordance with THIS
subdivision [(c) of this section] shall  be  given  emergency  care  and
treatment at such place if found suitable therefor by authorized person-
nel,  or  referred to another suitable facility or treatment program for
care and treatment, or sent to his or her home.
  4. THE DIRECTOR OF A TREATMENT FACILITY MAY RECEIVE AS  A  PATIENT  IN
NEED OF EMERGENCY SERVICES ANY PERSON WHO APPEARS TO BE INCAPACITATED AS
DEFINED IN THIS SECTION.

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  [(e)]  5. A person who COMES VOLUNTARILY OR is brought with his or her
objection to [any] A TREATMENT facility [or treatment program in accord-
ance with subdivision (c) of this section] shall be examined as soon  as
possible BUT NOT MORE THAN TWELVE HOURS AFTER ARRIVING AT SUCH TREATMENT
FACILITY  by  an examining physician. If such examining physician deter-
mines that such person is incapacitated by alcohol and/or substances  to
the degree that there is a likelihood to result in harm to the person or
others,  he  or she may be retained [for emergency treatment] TO RECEIVE
EMERGENCY SERVICES AND SHALL BE REGULARLY REEVALUATED TO CONFIRM CONTIN-
UED INCAPACITY BY ALCOHOL AND/OR SUBSTANCES TO THE DEGREE THAT THERE  IS
A  LIKELIHOOD TO RESULT IN HARM TO THE PERSON OR OTHERS.  If the examin-
ing physician determines AT ANY TIME that such person is  not  incapaci-
tated by alcohol and/or substances to the degree that there is a likeli-
hood  to  result  in  harm  to  the  person or others, he or she must be
released. Notwithstanding any other law, in no event may such person  be
retained against his or her objection beyond whichever is the shorter of
the following: (i) the time that he or she is no longer incapacitated by
alcohol  and/or  substances  to the degree that there is a likelihood to
result in harm to the person or others or  (ii)  a  period  longer  than
[forty-eight] SEVENTY-TWO hours.
  [1.]  6.  Every  reasonable effort must be made to obtain the person's
consent to give prompt notification of a person's retention in a facili-
ty or program pursuant to this section to his or her closest relative or
friend, and, if requested by such person, to his  or  her  attorney  and
personal  physician,  in  accordance  with federal confidentiality regu-
lations.
  [2.] 7. A person may not be retained pursuant to this section beyond a
period of [forty-eight] SEVENTY-TWO hours without his  or  her  consent.
Persons  suitable  therefor  may  be  voluntarily admitted to a chemical
dependence program or facility pursuant to this article.
  (C) DISCHARGE PROCEDURES. 1. THE  DISCHARGE  PROCEDURE  PROCESS  SHALL
BEGIN  AS  SOON AS THE PATIENT IS ADMITTED TO THE TREATMENT FACILITY AND
SHALL BE CONSIDERED A  PART  OF  THE  TREATMENT  PLANNING  PROCESS.  THE
DISCHARGE  PLAN SHALL BE DEVELOPED IN COLLABORATION WITH THE PATIENT AND
ANY SIGNIFICANT OTHER(S) THE PATIENT CHOOSES TO INVOLVE. IF THE  PATIENT
IS  A  MINOR,  THE DISCHARGE PLAN MUST ALSO BE DEVELOPED IN CONSULTATION
WITH HIS OR HER PARENT OR GUARDIAN, UNLESS THE MINOR  IS  BEING  TREATED
WITHOUT PARENTAL CONSENT AS AUTHORIZED BY SECTION 22.11 OF THIS CHAPTER.
  2.  NO  PATIENT SHALL BE DISCHARGED WITHOUT A DISCHARGE PLAN WHICH HAS
BEEN COMPLETED AND REVIEWED BY THE MULTI-DISCIPLINARY TEAM PRIOR TO  THE
DISCHARGE OF THE PATIENT. THIS REVIEW MAY BE PART OF A REGULAR TREATMENT
PLAN REVIEW. THE PORTION OF THE DISCHARGE PLAN WHICH INCLUDES THE REFER-
RALS  FOR  CONTINUING CARE SHALL BE GIVEN TO THE PATIENT UPON DISCHARGE.
THIS REQUIREMENT SHALL NOT APPLY TO PATIENTS WHO REFUSE CONTINUING  CARE
PLANNING,  PROVIDED,  HOWEVER,  THAT  THE  TREATMENT FACILITY SHALL MAKE
REASONABLE EFFORTS TO PROVIDE INFORMATION ABOUT THE DANGERS OF LONG TERM
SUBSTANCE USE AS WELL AS INFORMATION RELATED TO TREATMENT INCLUDING, BUT
NOT LIMITED TO, THE OASAS HOPELINE AND THE OASAS BED AVAILABILITY  DASH-
BOARD.
  3.  THE  DISCHARGE PLAN SHALL BE DEVELOPED BY THE RESPONSIBLE CLINICAL
STAFF MEMBER, WHO, IN THE DEVELOPMENT OF SUCH PLAN, SHALL  CONSIDER  THE
PATIENT'S SELF-REPORTED CONFIDENCE IN MAINTAINING ABSTINENCE AND FOLLOW-
ING  AN INDIVIDUALIZED RELAPSE PREVENTION PLAN. THE RESPONSIBLE CLINICAL
STAFF MEMBER SHALL ALSO CONSIDER AN ASSESSMENT OF THE PATIENT'S HOME AND
FAMILY ENVIRONMENT, VOCATIONAL/EDUCATIONAL/EMPLOYMENT  STATUS,  AND  THE
PATIENT'S  RELATIONSHIPS  WITH  SIGNIFICANT  OTHERS.  THE PURPOSE OF THE

A. 10725                            9

DISCHARGE PLAN SHALL BE TO ESTABLISH THE LEVEL OF  CLINICAL  AND  SOCIAL
RESOURCES  AVAILABLE  TO  THE  PATIENT UPON DISCHARGE FROM THE INPATIENT
SERVICE AND THE NEED  FOR  THE  SERVICES  FOR  SIGNIFICANT  OTHERS.  THE
DISCHARGE PLAN SHALL INCLUDE, BUT NOT BE LIMITED TO, THE FOLLOWING:
  (I)  IDENTIFICATION OF CONTINUING CHEMICAL DEPENDENCE SERVICES INCLUD-
ING MANAGEMENT OF WITHDRAWAL OR CONTINUING STABILIZATION AND  ANY  OTHER
TREATMENT,  REHABILITATION,  SELF-HELP  AND  VOCATIONAL, EDUCATIONAL AND
EMPLOYMENT SERVICES THE PATIENT WILL NEED AFTER DISCHARGE;
  (II) IDENTIFICATION OF THE TYPE OF RESIDENCE, IF ANY, THAT THE PATIENT
WILL NEED AFTER DISCHARGE;
  (III) IDENTIFICATION OF SPECIFIC PROVIDERS OF THESE  NEEDED  SERVICES;
AND
  (IV)  SPECIFIC  REFERRALS  AND  INITIAL  APPOINTMENTS FOR THESE NEEDED
SERVICES.
  4. A DISCHARGE SUMMARY WHICH INCLUDES THE COURSE AND RESULTS  OF  CARE
AND  TREATMENT  MUST  BE  PREPARED  AND  INCLUDED IN EACH PATIENT'S CASE
RECORD WITHIN TWENTY DAYS OF DISCHARGE.
  [(f)] (D) The commissioner shall promulgate ALL RULES AND regulations,
after consulting with representatives of appropriate law enforcement and
chemical dependence providers of services, establishing  procedures  for
taking  intoxicated or impaired persons and persons apparently incapaci-
tated by alcohol and/or substances to their residences or to appropriate
public or private facilities for emergency [treatment] SERVICES and  for
minimizing the role of the police in obtaining treatment of such persons
NECESSARY TO IMPLEMENT THE PROVISIONS OF THIS SECTION, INCLUDING BUT NOT
LIMITED   TO  ESTABLISHING  PROCEDURES  FOR  TRANSPORTING  INCAPACITATED
PERSONS TO A TREATMENT FACILITY FOR EMERGENCY SERVICES.
  S 2. This act shall take effect on the ninetieth day  after  it  shall
have  become  law; provided however, that any and all regulations neces-
sary for the implementation of this  act  shall  have  been  promulgated
prior to such effective date.
  S 2. Severability clause. If any clause, sentence, paragraph, subdivi-
sion,  section  or  part  of  this act shall be adjudged by any court of
competent jurisdiction to be invalid, such judgment  shall  not  affect,
impair,  or  invalidate  the remainder thereof, but shall be confined in
its operation to the clause, sentence, paragraph,  subdivision,  section
or part thereof directly involved in the controversy in which such judg-
ment shall have been rendered. It is hereby declared to be the intent of
the  legislature  that  this  act  would  have been enacted even if such
invalid provisions had not been included herein.
  S 3. This act shall take effect immediately  provided,  however,  that
the  applicable effective date of Parts A through D of this act shall be
as specifically set forth in the last section of such Parts.