NY State Senate Bill 2019-S3760

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 08, 2020	referred to insurance
Feb 13, 2019	referred to insurance

2019-S3760 (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
2011-2012: S1121
2013-2014: S2841
2015-2016: S2791
2017-2018: S2679
2021-2022: S3302
2023-2024: S4695

2019-S3760 (ACTIVE) - Summary

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

2019-S3760 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S3760

SPONSOR: PARKER
 
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 proprie-
tors, 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 cover-
age 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 work-
ers whose employers do not provide health insurance may also purchase
comprehensive coverage directly through HNY.

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, produc-
tivity 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

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 impor-
tant concern for American children, affecting 10-12 individuals for
every 10,000 children.

Any or all, of these conditions can lead to excessive absences from
school, failure to thrive in the academic or home environment, and asso-
ciated physical ailments.

With new research and innovations, advanced treatment is readably avail-
able. In order to seek this treatment patients need coverage to diagnose
and treat themselves and their children.

That is why this legislation expands HNY's coverage to include coverage
for mental health services for eligible small employers, sole proprie-
tors, and uninsured working individuals.

 
LEGISLATIVE HISTORY:

2017-18:S2679- Referred to Insurance

2015-16:S.2791- Referred to Insurance

2013-14:S.2841- Referred to Insurance

2011-12:S.1121- Referred to Insurance

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.

2019-S3760 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3760
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                             February 13, 2019
                                ___________
 
 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:
   §  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.

                                                            LBD08530-01-9

 S. 3760                             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.
   § 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.
   § 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:
   § 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. 3760                             3
 
 coinsurance,  co-pays,  or  deductibles,  than  the in-network benefits,
 regardless of whether the contract is written under one license  or  two
 licenses.
   §  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.
   §  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. 3760                             4

 this section and this paragraph may be limited to not less  than  twenty
 visits in any contract year, plan year or calendar year.
   § 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.
   §  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.
   § 10. This act shall take effect immediately.

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Senate Bill S3760

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

2019-S3760 (ACTIVE) - Details

2019-S3760 (ACTIVE) - Summary

2019-S3760 (ACTIVE) - Sponsor Memo

2019-S3760 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S3760

Share this bill

Sponsored By

Kevin S. Parker

Archive: Last Bill Status - In Senate Committee Insurance Committee

2019-S3760 (ACTIVE) - Details

2019-S3760 (ACTIVE) - Summary

2019-S3760 (ACTIVE) - Sponsor Memo

2019-S3760 (ACTIVE) - Bill Text download pdf

Comments