S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5834
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 19, 2019
                                ___________
 
 Introduced  by  M.  of  A. GIGLIO, DeSTEFANO, KOLB, LAWRENCE, McDONOUGH,
   MIKULIN, B. MILLER, MORINELLO, RA, REILLY, SMITH, WALSH -- Multi-Spon-
   sored by -- M. of A. SAYEGH, TAGUE -- read once and  referred  to  the
   Committee on Insurance
 
 AN  ACT  to  amend  the  insurance  law, in relation to requiring health
   insurance coverage for substance use disorder treatment services
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  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 by adding a new subparagraph (E) to read as
 follows:
   (E) COVERAGE PROVIDED UNDER THIS PARAGRAPH FOR  DETOXIFICATION,  SHALL
 BE  AT  A  MINIMUM,  SEVEN  DAYS. REHABILITATION SERVICES SHALL BE, AT A
 MINIMUM, THIRTY DAYS.
   § 2. Subparagraphs (D) and (E) of paragraph 31 of  subsection  (i)  of
 section  3216  of the insurance law are relettered subparagraphs (E) and
 (F) and a new subparagraph (D) is added to read as follows:
   (D) COVERAGE PROVIDED UNDER THIS PARAGRAPH FOR  DETOXIFICATION,  SHALL
 BE  AT  A  MINIMUM,  SEVEN  DAYS. REHABILITATION SERVICES SHALL BE, AT A
 MINIMUM, THIRTY DAYS.
   § 3. Paragraph 6 of subsection (l) of section 3221  of  the  insurance
 law is amended by adding a new subparagraph (E) to read as follows:
   (E)  COVERAGE  PROVIDED UNDER THIS PARAGRAPH FOR DETOXIFICATION, SHALL
 BE AT A MINIMUM, SEVEN DAYS. REHABILITATION  SERVICES  SHALL  BE,  AT  A
 MINIMUM, THIRTY DAYS.
   §  4.  Subparagraphs  (D)  and (E) of paragraph 7 of subsection (l) of
 section 3221 of the insurance law are relettered subparagraphs  (E)  and
 (F) and a new subparagraph (D) is added to read as follows:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD06860-01-9

              

 A. 5834                             2
 
   (D)  COVERAGE  PROVIDED UNDER THIS PARAGRAPH FOR DETOXIFICATION, SHALL
 BE AT A MINIMUM, SEVEN DAYS. REHABILITATION  SERVICES  SHALL  BE,  AT  A
 MINIMUM, THIRTY DAYS.
   §  5.  Paragraph  3 of subsection (k) of section 4303 of the insurance
 law is renumbered paragraph 5 and a new paragraph 3 is added to read  as
 follows:
   (3)  COVERAGE  PROVIDED UNDER THIS PARAGRAPH FOR DETOXIFICATION, SHALL
 BE AT A MINIMUM, SEVEN DAYS. REHABILITATION  SERVICES  SHALL  BE,  AT  A
 MINIMUM, THIRTY DAYS.
   §  6.  Paragraphs  3, 4 and 5 of subsection (l) of section 4303 of the
 insurance law, paragraphs 3 and 4 as amended by chapter 41 of  the  laws
 of  2014  and paragraph 5 as added by section 5 of part MM of chapter 57
 of the laws of 2018, are amended to read as follows:
   (3) COVERAGE PROVIDED UNDER THIS PARAGRAPH FOR  DETOXIFICATION,  SHALL
 BE  AT  A  MINIMUM,  SEVEN  DAYS. REHABILITATION SERVICES SHALL BE, AT A
 MINIMUM, THIRTY DAYS.
   (4) Coverage provided under this subsection may be subject  to  annual
 deductibles and co-insurance as deemed appropriate by the superintendent
 and  that  are  consistent with those imposed on other benefits within a
 given contract.
   [(4)] (5) A contract providing coverage  for  substance  use  disorder
 services  pursuant  to this subsection shall provide up to twenty outpa-
 tient visits per contract or calendar year to an individual who  identi-
 fies  him  or  herself  as  a  family  member of a person suffering from
 substance use disorder and who seeks treatment as a family member who is
 otherwise  covered  by  the  applicable  contract   pursuant   to   this
 subsection.  The  coverage  required  by  this  subsection shall include
 treatment as a family  member  pursuant  to  such  family  member's  own
 contract provided such family member:
   (A)  does not exceed the allowable number of family visits provided by
 the applicable contract pursuant to this subsection; and
   (B) is otherwise entitled to coverage pursuant to this subsection  and
 such family member's applicable contract.
   [(5)]  (6)  This  paragraph  shall  apply  to facilities in this state
 certified by the office of alcoholism and substance abuse  services  for
 the  provision of outpatient, intensive outpatient, outpatient rehabili-
 tation and opioid treatment that are participating in the  corporation's
 provider  network.  Coverage provided under this subsection shall not be
 subject to preauthorization. Coverage  provided  under  this  subsection
 shall  not  be  subject  to concurrent review for the first two weeks of
 continuous treatment, not to exceed fourteen visits, provided the facil-
 ity notifies the corporation of both the  start  of  treatment  and  the
 initial  treatment  plan  within  forty-eight  hours. The facility shall
 perform clinical assessment of the patient at each visit, including  the
 periodic  consultation  with the corporation to ensure that the facility
 is using the evidence-based  and  peer  reviewed  clinical  review  tool
 utilized  by  the corporation which is designated by the office of alco-
 holism and substance abuse services and appropriate to the  age  of  the
 patient,  to ensure that the outpatient treatment is medically necessary
 for the patient. Any utilization review of the treatment provided  under
 this paragraph may include a review of all services provided during such
 outpatient  treatment,  including all services provided during the first
 two weeks of continuous treatment, not to  exceed  fourteen  visits,  of
 such outpatient treatment. Provided, however, the corporation shall only
 deny  coverage  for  any  portion of the initial two weeks of continuous
 treatment, not to exceed fourteen visits, for  outpatient  treatment  on

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 the basis that such treatment was not medically necessary if such outpa-
 tient  treatment  was  contrary  to the evidence-based and peer reviewed
 clinical review tool utilized by the corporation which is designated  by
 the  office  of  alcoholism  and  substance abuse services. A subscriber
 shall not have any financial obligation to the facility for  any  treat-
 ment  under  this  paragraph  other  than any copayment, coinsurance, or
 deductible otherwise required under the contract.
   § 7. This act shall take effect on the thirtieth day  after  it  shall
 have become a law.