S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6052
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                               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:
 
   Section  1.  Subparagraph  (A)  of  paragraph  30 of subsection (i) of
 section 3216 of the insurance law, as amended by section 1 of part B  of
 chapter 71 of the laws of 2016, is amended to read as follows:
   (A)  Every  policy  that  provides  hospital, major medical or similar
 comprehensive coverage must provide inpatient coverage for the diagnosis
 and treatment of substance use disorder,  including  detoxification  and
 rehabilitation  services, FOR A PERIOD OF NOT LESS THAN FORTY-FIVE DAYS.
 Such inpatient coverage  shall  include  unlimited  medically  necessary
 treatment  for  substance  use  disorder  treatment services provided in
 residential settings  as  required  by  the  Mental  Health  Parity  and
 Addiction  Equity  Act of 2008 (29 U.S.C. § 1185a).  Further, such inpa-
 tient coverage shall not apply financial requirements or treatment limi-
 tations,  including  utilization  review  requirements,   to   inpatient
 substance  use  disorder  benefits  that  are  more restrictive than the
 predominant financial requirements and treatment limitations applied  to
 substantially  all  medical and surgical benefits covered by the policy.
 Further, such coverage shall be provided  consistent  with  the  federal
 Paul  Wellstone  and  Pete  Domenici  Mental Health Parity and Addiction
 Equity Act of 2008 (29 U.S.C. § 1185a).
   § 2. Subparagraph (A) of paragraph 31 of  subsection  (i)  of  section
 3216  of  the insurance law, as added by chapter 41 of the laws of 2014,
 is amended to read as follows:

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10981-01-7
              

 S. 6052                             2
 
   (A) Every policy that  provides  medical,  major  medical  or  similar
 comprehensive-type  coverage  must  provide  outpatient coverage for the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion and rehabilitation services, FOR A PERIOD OF NOT LESS  THAN  FORTY-
 FIVE  DAYS.  Such  coverage  shall  not  apply financial requirements or
 treatment limitations to outpatient substance use disorder benefits that
 are more restrictive than the  predominant  financial  requirements  and
 treatment  limitations applied to substantially all medical and surgical
 benefits covered by  the  policy.    Further,  such  coverage  shall  be
 provided  consistent  with  the federal Paul Wellstone and Pete Domenici
 Mental Health Parity and Addiction Equity  Act  of  2008  (29  U.S.C.  §
 1185a).
   § 3. Subparagraph (A) of paragraph 6 of subsection (l) of section 3221
 of the insurance law, as amended by section 2 of part B of chapter 71 of
 the laws of 2016, is amended to read as follows:
   (A)  Every  policy  that  provides  hospital, major medical or similar
 comprehensive coverage must provide inpatient coverage for the diagnosis
 and treatment of substance use disorder,  including  detoxification  and
 rehabilitation  services, FOR A PERIOD OF NOT LESS THAN FORTY-FIVE DAYS.
 Such inpatient coverage  shall  include  unlimited  medically  necessary
 treatment  for  substance  use  disorder  treatment services provided in
 residential settings  as  required  by  the  Mental  Health  Parity  and
 Addiction  Equity  Act of 2008 (29 U.S.C. § 1185a).  Further, such inpa-
 tient coverage shall not apply financial requirements or treatment limi-
 tations,  including  utilization  review  requirements,   to   inpatient
 substance  use  disorder  benefits  that  are  more restrictive than the
 predominant financial requirements and treatment limitations applied  to
 substantially  all  medical and surgical benefits covered by the policy.
 Further, such coverage shall be provided  consistent  with  the  federal
 Paul  Wellstone  and  Pete  Domenici  Mental Health Parity and Addiction
 Equity Act of 2008 (29 U.S.C. § 1185a).
   § 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221
 of the insurance law, as amended by chapter 41 of the laws of  2014,  is
 amended to read as follows:
   (A)  Every  policy  that  provides  medical,  major medical or similar
 comprehensive-type coverage must provide  outpatient  coverage  for  the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion  and  rehabilitation services, FOR A PERIOD OF NOT LESS THAN FORTY-
 FIVE DAYS. Such coverage  shall  not  apply  financial  requirements  or
 treatment limitations to outpatient substance use disorder benefits that
 are  more  restrictive  than  the predominant financial requirements and
 treatment limitations applied to substantially all medical and  surgical
 benefits  covered  by  the  policy.    Further,  such  coverage shall be
 provided consistent with the federal Paul Wellstone  and  Pete  Domenici
 Mental  Health  Parity  and  Addiction  Equity  Act of 2008 (29 U.S.C. §
 1185a).
   § 5. Paragraph 1 of subsection (k) of section 4303  of  the  insurance
 law,  as  amended  by  section  3 of part B of chapter 71 of the laws of
 2016, is amended to read as follows:
   (1) Every contract that provides hospital, major  medical  or  similar
 comprehensive coverage must provide inpatient coverage for the diagnosis
 and  treatment  of  substance use disorder, including detoxification and
 rehabilitation services, FOR A PERIOD OF NOT LESS THAN FORTY-FIVE  DAYS.
 Such  inpatient  coverage  shall  include  unlimited medically necessary
 treatment for substance use  disorder  treatment  services  provided  in
 residential  settings  as  required  by  the  Mental  Health  Parity and

 S. 6052                             3

 Addiction Equity Act of 2008 (29 U.S.C. § 1185a).   Further, such  inpa-
 tient coverage shall not apply financial requirements or treatment limi-
 tations,   including   utilization  review  requirements,  to  inpatient
 substance  use  disorder  benefits  that  are  more restrictive than the
 predominant financial requirements and treatment limitations applied  to
 substantially all medical and surgical benefits covered by the contract.
 Further,  such  coverage  shall  be provided consistent with the federal
 Paul Wellstone and Pete Domenici  Mental  Health  Parity  and  Addiction
 Equity Act of 2008 (29 U.S.C. § 1185a).
   §  6.  Paragraph  1 of subsection (l) of section 4303 of the insurance
 law, as amended by chapter 41 of the laws of 2014, is amended to read as
 follows:
   (1) Every contract that provides medical,  major  medical  or  similar
 comprehensive-type  coverage  must  provide  outpatient coverage for the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion and rehabilitation services, FOR A PERIOD NOT LESS THAN  FORTY-FIVE
 DAYS.  Such coverage shall not apply financial requirements or treatment
 limitations to outpatient substance use disorder benefits that are  more
 restrictive  than  the  predominant financial requirements and treatment
 limitations applied to substantially all medical and  surgical  benefits
 covered  by  the  contract.    Further,  such coverage shall be provided
 consistent with the federal Paul  Wellstone  and  Pete  Domenici  Mental
 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
   §  7.  Paragraph  (c)  of subdivision 2 of section 365-a of the social
 services law, as amended by section 12-a of part C of chapter 60 of  the
 laws of 2014, is amended to read as follows:
   (c)  out-patient hospital or clinic services in facilities operated in
 compliance with applicable provisions of this chapter, the public health
 law, the mental hygiene law and other  laws,  including  any  provisions
 thereof requiring an operating certificate or license, including facili-
 ties  authorized by the appropriate licensing authority to provide inte-
 grated mental health services, and/or  alcoholism  and  substance  abuse
 services,  and/or  physical  health services, and/or services to persons
 with developmental disabilities, when such services are  provided  at  a
 single  location  or  service  site,  or  where  such facilities are not
 conveniently accessible, in any hospital located within  the  state  and
 care  and services in a day treatment program operated by the department
 of mental hygiene or by a voluntary agency under an agreement with  such
 department  in  that  part of a public institution operated and approved
 pursuant to law as an intermediate care facility for persons with devel-
 opmental disabilities; AND PROVIDED, THAT ALCOHOLISM AND SUBSTANCE ABUSE
 SERVICES SHALL BE COVERED FOR A PERIOD OF NOT LESS THAN FORTY-FIVE DAYS;
 and provided FURTHER, that the commissioners of health,  mental  health,
 alcoholism  and  substance abuse services and the office for people with
 developmental disabilities may issue  regulations,  including  emergency
 regulations  promulgated  prior  to  October first, two thousand fifteen
 that are required to facilitate the establishment of integrated services
 clinics. Any such regulations promulgated under this paragraph shall  be
 described in the annual report required pursuant to section forty-five-c
 of part A of chapter fifty-six of the laws of two thousand thirteen;
   §  8.  Paragraph  (n)  of subdivision 2 of section 365-a of the social
 services law, as amended by chapter 558 of the laws of 1999, is  amended
 to read as follows:
   (n)  care,  treatment,  maintenance  and  rehabilitation services that
 would otherwise qualify for reimbursement pursuant to  this  chapter  to
 persons  suffering  from alcoholism in alcoholism facilities or chemical

 S. 6052                             4
 
 dependence, as such term is  defined  in  section  1.03  of  the  mental
 hygiene  law,  in inpatient chemical dependence facilities, services, or
 programs operated in compliance with applicable provisions of this chap-
 ter  and the mental hygiene law, and certified by the office of alcohol-
 ism and substance abuse services, provided however  that  such  services
 shall  be limited to such periods of time as may be determined necessary
 in accordance with a utilization review  procedure  established  by  the
 commissioner  of  the  office of alcoholism and substance abuse services
 and THAT SUCH SERVICES SHALL BE COVERED FOR A PERIOD OF  NOT  LESS  THAN
 FORTY-FIVE  DAYS,  AND  provided  further, that this paragraph shall not
 apply to any hospital or part of a hospital as defined  in  section  two
 thousand eight hundred one of the public health law.
   §  9.  This  act  shall take effect immediately and shall apply to all
 policies and contracts issued, renewed, modified, altered or amended  on
 or after such date.