S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    902
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 6, 2021
                                ___________
 
 Introduced by M. of A. JONES, GUNTHER, ABINANTI, MONTESANO, WALSH, DICK-
   ENS, BYRNE -- Multi-Sponsored by -- M. of A. COOK, THIELE -- read once
   and referred 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 5 of subpart A
 of part BB of chapter 57 of the laws of 2019,  is  amended  to  read  as
 follows:
   (A)  Every  policy  that  provides  hospital, major medical or similar
 comprehensive coverage shall provide inpatient coverage for the  diagno-
 sis  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 neces-
 sary treatment for substance use disorder treatment services provided in
 residential settings. Further, such inpatient coverage shall  not  apply
 financial  requirements  or treatment limitations, 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.
   §  2.  Subparagraph  (A)  of paragraph 31 of subsection (i) of section
 3216 of the insurance law, as amended by section 6 of subpart A of  part
 BB of chapter 57 of the laws of 2019, is amended to read as follows:
   (A)  Every  policy  that  provides  medical,  major medical or similar
 comprehensive-type coverage shall provide outpatient  coverage  for  the
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

                       [ ] is old law to be omitted.
                                                            LBD05509-01-1

 A. 902                              2
 
 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.
   § 3. Subparagraph (A) of paragraph 6 of subsection (l) of section 3221
 of  the  insurance law, as amended by section 15 of subpart A of part BB
 of chapter 57 of the laws of 2019, is amended to read as follows:
   (A) Every policy that provides  hospital,  major  medical  or  similar
 comprehensive  coverage shall provide inpatient coverage for the diagno-
 sis 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  neces-
 sary treatment for substance use disorder treatment services provided in
 residential  settings.  Further, such inpatient coverage shall not apply
 financial requirements or treatment limitations,  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.
   § 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221
 of the insurance law, as amended by section 16 of subpart A of  part  BB
 of chapter 57 of the laws of 2019, is amended to read as follows:
   (A)  Every  policy  that  provides  medical,  major medical or similar
 comprehensive-type coverage shall 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.
   §  5.  Paragraph  1 of subsection (k) of section 4303 of the insurance
 law, as amended by section 26 of subpart A of part BB of chapter  57  of
 the laws of 2019, is amended to read as follows:
   (1)  Every  contract  that provides hospital, major medical or similar
 comprehensive coverage shall provide inpatient coverage for the  diagno-
 sis  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 neces-
 sary treatment for substance use disorder treatment services provided in
 residential settings. Further, such inpatient coverage shall  not  apply
 financial  requirements  or treatment limitations, 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.
   §  6.  Paragraph  1 of subsection (l) of section 4303 of the insurance
 law, as amended by section 27 of subpart A of part BB of chapter  57  of
 the laws of 2019, is amended to read as follows:
   (1)  Every  contract  that  provides medical, major medical or similar
 comprehensive-type coverage shall 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-

 A. 902                              3
 
 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.
   § 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
 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.