S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8839
 
                           I N  A S S E M B L Y
 
                             January 18, 2024
                                ___________
 
 Introduced  by M. of A. GUNTHER -- read once and referred to the Commit-
   tee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to setting a minimum  reimbursement  rate  for  ambulatory  behavioral
   health services
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Paragraph 35 of subsection  (i)  of  section  3216  of  the
 insurance  law  is  amended  by adding a new subparagraph (K) to read as
 follows:
   (K) EVERY  POLICY  WHICH  PROVIDES MEDICAL, MAJOR MEDICAL, OR  SIMILAR
 COMPREHENSIVE-TYPE  COVERAGE  SHALL  REIMBURSE IN NETWORK, PARTICIPATING
 PROVIDERS LICENSED PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH
 LAW OR ARTICLE THIRTY-ONE OR THIRTY-TWO OF THE MENTAL  HYGIENE  LAW  FOR
 AMBULATORY  BEHAVIORAL  HEALTH  SERVICES  PROVIDED TO ITS INSUREDS, AT A
 MINIMUM, AT A RATE EQUIVALENT  TO  THE  PAYMENTS  ESTABLISHED  FOR  SUCH
 SERVICES UNDER THE AMBULATORY PATIENT GROUP (APG) RATE-SETTING METHODOL-
 OGY  AT  THE TIME OF SERVICE, UTILIZED BY THE DEPARTMENT OF HEALTH OR BY
 THE OFFICE OF  MENTAL  HEALTH  OR  OFFICES  OF  ADDICTION  SERVICES  AND
 SUPPORTS  FOR  RATE-SETTING  PURPOSES  FOR  AMBULATORY BEHAVIORAL HEALTH
 SERVICES PROVIDED TO ENROLLEES IN THE MEDICAL ASSISTANCE  PROGRAM  UNDER
 TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW. INSURERS AND IN
 NETWORK, PARTICIPATING PROVIDERS MAY NEGOTIATE DIFFERENT RATES AND METH-
 ODS  OF PAYMENTS, HOWEVER INSURERS SHALL PAY NO LESS THAN THE EQUIVALENT
 OF RATES THAT WOULD BE PAID FOR AMBULATORY  BEHAVIORAL  HEALTH  SERVICES
 PURSUANT TO THE MEDICAL ASSISTANCE PROGRAM UNDER TITLE ELEVEN OF ARTICLE
 FIVE OF THE SOCIAL SERVICES LAW.
   §  2.  Paragraph  5 of subsection (l) of section 3221 of the insurance
 law is amended by adding a new subparagraph (K) to read as follows:
   (K) EVERY INSURER DELIVERING A GROUP OR BLANKET POLICY  OR  ISSUING  A
 GROUP  OR BLANKET POLICY FOR DELIVERY IN THIS STATE THAT PROVIDES COVER-
 AGE FOR HOSPITAL,   MAJOR   MEDICAL,   OR   SIMILAR   COMPREHENSIVE-TYPE
 COVERAGE  SHALL   REIMBURSE IN NETWORK, PARTICIPATING PROVIDERS LICENSED
 PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC  HEALTH  LAW  OR  ARTICLE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD13904-01-3
 A. 8839                             2
 
 THIRTY-ONE OR THIRTY-TWO OF THE MENTAL HYGIENE LAW FOR AMBULATORY BEHAV-
 IORAL  HEALTH SERVICES PROVIDED TO ITS INSUREDS, AT A MINIMUM, AT A RATE
 EQUIVALENT TO THE PAYMENTS ESTABLISHED FOR SUCH SERVICES UNDER THE AMBU-
 LATORY  PATIENT  GROUP  (APG)  RATE-SETTING  METHODOLOGY  AT THE TIME OF
 SERVICE, UTILIZED BY THE DEPARTMENT OF HEALTH OR BY THE OFFICE OF MENTAL
 HEALTH OR OFFICES OF ADDICTION SERVICES AND  SUPPORTS  FOR  RATE-SETTING
 PURPOSES FOR AMBULATORY BEHAVIORAL HEALTH SERVICES PROVIDED TO ENROLLEES
 IN  THE MEDICAL ASSISTANCE PROGRAM UNDER TITLE ELEVEN OF ARTICLE FIVE OF
 THE SOCIAL SERVICES LAW. INSURERS AND IN NETWORK, PARTICIPATING  PROVID-
 ERS  MAY  NEGOTIATE  DIFFERENT  RATES  AND  METHODS OF PAYMENTS, HOWEVER
 INSURERS SHALL PAY NO LESS THAN THE EQUIVALENT OF RATES  THAT  WOULD  BE
 PAID  FOR  AMBULATORY BEHAVIORAL HEALTH SERVICES PURSUANT TO THE MEDICAL
 ASSISTANCE PROGRAM UNDER TITLE ELEVEN OF  ARTICLE  FIVE  OF  THE  SOCIAL
 SERVICES LAW.
   § 3. Subsection (g) of section 4303 of the insurance law is amended by
 adding a new paragraph 12 to read as follows:
   (12)  A  MEDICAL  EXPENSE  INDEMNITY CORPORATION, A HOSPITAL   SERVICE
 CORPORATION  OR  A HEALTH SERVICE CORPORATION THAT PROVIDES COVERAGE FOR
 MEDICAL, MAJOR MEDICAL, OR  SIMILAR COMPREHENSIVE-TYPE   COVERAGE  SHALL
 REIMBURSE IN NETWORK, PARTICIPATING PROVIDERS LICENSED PURSUANT TO ARTI-
 CLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW OR ARTICLE THIRTY-ONE OR THIR-
 TY-TWO  OF  THE  MENTAL  HYGIENE  LAW  FOR  AMBULATORY BEHAVIORAL HEALTH
 SERVICES PROVIDED TO ITS INSUREDS, AT A MINIMUM, AT A RATE EQUIVALENT TO
 THE PAYMENTS ESTABLISHED FOR SUCH SERVICES UNDER THE AMBULATORY  PATIENT
 GROUP (APG) RATE-SETTING METHODOLOGY AT THE TIME OF SERVICE, UTILIZED BY
 THE DEPARTMENT OF HEALTH OR BY THE OFFICE OF MENTAL HEALTH OR OFFICES OF
 ADDICTION SERVICES AND SUPPORTS FOR RATE-SETTING PURPOSES FOR AMBULATORY
 BEHAVIORAL  HEALTH SERVICES PROVIDED TO ENROLLEES IN THE MEDICAL ASSIST-
 ANCE PROGRAM UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE  SOCIAL  SERVICES
 LAW.  INSURERS  AND  IN  NETWORK,  PARTICIPATING PROVIDERS MAY NEGOTIATE
 DIFFERENT RATES AND METHODS OF PAYMENTS, HOWEVER INSURERS SHALL  PAY  NO
 LESS  THAN  THE  EQUIVALENT  OF  RATES THAT WOULD BE PAID FOR AMBULATORY
 BEHAVIORAL HEALTH SERVICES PURSUANT TO THE  MEDICAL  ASSISTANCE  PROGRAM
 UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW.
   §  4. Section 4403 of the public health law is amended by adding a new
 subdivision 10 to read as follows:
   10. A HEALTH MAINTENANCE  ORGANIZATION  SHALL  REIMBURSE  IN  NETWORK,
 PARTICIPATING  PROVIDERS  LICENSED  PURSUANT  TO ARTICLE TWENTY-EIGHT OF
 THIS CHAPTER OR ARTICLE THIRTY-ONE OR THIRTY-TWO OF THE  MENTAL  HYGIENE
 LAW FOR AMBULATORY BEHAVIORAL HEALTH SERVICES PROVIDED TO ITS ENROLLEES,
 AT  A MINIMUM, AT A RATE EQUIVALENT TO THE PAYMENTS ESTABLISHED FOR SUCH
 SERVICES UNDER THE AMBULATORY PATIENT GROUP (APG) RATE-SETTING METHODOL-
 OGY AT THE TIME OF SERVICE, UTILIZED BY THE DEPARTMENT OR BY THE  OFFICE
 OF MENTAL HEALTH OR OFFICES OF ADDICTION SERVICES AND SUPPORTS FOR RATE-
 SETTING  PURPOSES  FOR AMBULATORY BEHAVIORAL HEALTH SERVICES PROVIDED TO
 ENROLLEES IN THE MEDICAL ASSISTANCE PROGRAM UNDER TITLE ELEVEN OF  ARTI-
 CLE  FIVE  OF  THE  SOCIAL  SERVICES  LAW. ORGANIZATIONS AND IN NETWORK,
 PARTICIPATING PROVIDERS MAY NEGOTIATE DIFFERENT  RATES  AND  METHODS  OF
 PAYMENTS, HOWEVER ORGANIZATIONS SHALL PAY NO LESS THAN THE EQUIVALENT OF
 RATES  THAT  WOULD  BE  PAID  FOR  AMBULATORY BEHAVIORAL HEALTH SERVICES
 PURSUANT TO THE MEDICAL ASSISTANCE PROGRAM UNDER TITLE ELEVEN OF ARTICLE
 FIVE OF THE SOCIAL SERVICES LAW.
   § 5. This act shall take effect September 1, 2024 and shall  apply  to
 all policies and contracts issued, renewed, modified, altered or amended
 on or after such date.