Senate Bill S7288

2023-2024 Legislative Session

Relates to cost sharing fees for treatment of substance use disorder

download bill text pdf

Sponsored By

Current Bill Status - In Assembly 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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Votes

Bill Amendments

co-Sponsors

2023-S7288 - Details

Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L

2023-S7288 - Summary

Provides that for treatment of substance use disorder, an insured shall only be responsible for annual deductibles and coinsurance and that the total amount that an insured shall be required to pay out-of-pocket is capped out at an amount not to exceed five hundred dollars for an episode of care.

2023-S7288 - Sponsor Memo

2023-S7288 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7288
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               May 19, 2023
                                ___________
 
 Introduced by Sen. FERNANDEZ -- 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 prohibiting copayments
   for outpatient treatment at a substance use treatment program
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (E) 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  and  a  new
 subparagraph (J) is added to read as follows:
   (E) This subparagraph shall apply to facilities in this state that are
 licensed, certified or otherwise authorized by the office of [alcoholism
 and  substance  abuse] ADDICTION services AND SUPPORTS for the provision
 of  outpatient,  intensive  outpatient,  outpatient  rehabilitation  and
 opioid  treatment  that  are  participating  in  the  insurer's provider
 network. Coverage provided under this paragraph shall not be subject  to
 preauthorization.  Coverage  provided  under this paragraph shall not be
 subject to concurrent review for the  first  four  weeks  of  continuous
 treatment,  not  to  exceed  twenty-eight  visits, provided the facility
 notifies the insurer of both the start  of  treatment  and  the  initial
 treatment  plan  within  two  business  days. The facility shall perform
 clinical assessment of the patient at  each  visit,  including  periodic
 consultation  with the insurer at or just prior to the fourteenth day of
 treatment to ensure that the facility is using  the  evidence-based  and
 peer  reviewed  clinical  review  tool  utilized by the insurer which is
 designated by the office of [alcoholism and substance  abuse]  ADDICTION
 services  AND  SUPPORTS  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
 subparagraph may include a review of all services provided  during  such
 outpatient  treatment,  including all services provided during the first
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11569-01-3
              

co-Sponsors

2023-S7288A - Details

Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L

2023-S7288A - Summary

Provides that for treatment of substance use disorder, an insured shall only be responsible for annual deductibles and coinsurance and that the total amount that an insured shall be required to pay out-of-pocket is capped out at an amount not to exceed five hundred dollars for an episode of care.

2023-S7288A - Sponsor Memo

2023-S7288A - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7288--A
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               May 19, 2023
                                ___________
 
 Introduced  by  Sens. FERNANDEZ, KENNEDY, RYAN -- read twice and ordered
   printed, and when printed to be committed to the Committee  on  Insur-
   ance  --  recommitted to the Committee on Insurance in accordance with
   Senate Rule 6, sec. 8 -- committee discharged, bill  amended,  ordered
   reprinted as amended and recommitted to said committee

 AN  ACT  to amend the insurance law, in relation to certain cost sharing
   fees for outpatient treatment at a substance use treatment program
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subparagraph  (E)  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 and a new
 subparagraph (J) is added to read as follows:
   (E) This subparagraph shall apply to facilities in this state that are
 licensed, certified or otherwise authorized by the office of [alcoholism
 and substance abuse] ADDICTION services AND SUPPORTS for  the  provision
 of  outpatient,  intensive  outpatient,  outpatient  rehabilitation  and
 opioid treatment  that  are  participating  in  the  insurer's  provider
 network.  Coverage provided under this paragraph shall not be subject to
 preauthorization. Coverage provided under this paragraph  shall  not  be
 subject  to  concurrent  review  for  the first four weeks of continuous
 treatment, not to exceed  twenty-eight  visits,  provided  the  facility
 notifies  the  insurer  of  both  the start of treatment and the initial
 treatment plan within two business  days.  The  facility  shall  perform
 clinical  assessment  of  the  patient at each visit, including periodic
 consultation with the insurer at or just prior to the fourteenth day  of
 treatment  to  ensure  that the facility is using the evidence-based and
 peer reviewed clinical review tool utilized  by  the  insurer  which  is
 designated  by  the office of [alcoholism and substance abuse] ADDICTION
 services AND SUPPORTS and appropriate to the  age  of  the  patient,  to
 ensure  that  the  outpatient  treatment  is medically necessary for the
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11569-03-4
              

co-Sponsors

2023-S7288B (ACTIVE) - Details

Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L

2023-S7288B (ACTIVE) - Summary

Provides that for treatment of substance use disorder, an insured shall only be responsible for annual deductibles and coinsurance and that the total amount that an insured shall be required to pay out-of-pocket is capped out at an amount not to exceed five hundred dollars for an episode of care.

2023-S7288B (ACTIVE) - Sponsor Memo

2023-S7288B (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7288--B
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               May 19, 2023
                                ___________
 
 Introduced  by  Sens. FERNANDEZ, ADDABBO, RYAN -- read twice and ordered
   printed, and when printed to be committed to the Committee  on  Insur-
   ance  --  recommitted to the Committee on Insurance in accordance with
   Senate Rule 6, sec. 8 -- committee discharged, bill  amended,  ordered
   reprinted  as  amended  and recommitted to said committee -- committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee
 
 AN ACT to amend the insurance law, in relation to certain  cost  sharing
   fees for treatment of substance use disorder
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (E) 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  and  a  new
 subparagraph (K) is added to read as follows:
   (E) This subparagraph shall apply to facilities in this state that are
 licensed, certified or otherwise authorized by the office of [alcoholism
 and  substance  abuse] ADDICTION services AND SUPPORTS for the provision
 of  outpatient,  intensive  outpatient,  outpatient  rehabilitation  and
 opioid  treatment  that  are  participating  in  the  insurer's provider
 network. Coverage provided under this paragraph shall not be subject  to
 preauthorization.  Coverage  provided  under this paragraph shall not be
 subject to concurrent review for the  first  four  weeks  of  continuous
 treatment,  not  to  exceed  twenty-eight  visits, provided the facility
 notifies the insurer of both the start  of  treatment  and  the  initial
 treatment  plan  within  two  business  days. The facility shall perform
 clinical assessment of the patient at  each  visit,  including  periodic
 consultation  with the insurer at or just prior to the fourteenth day of
 treatment to ensure that the facility is using  the  evidence-based  and
 peer  reviewed  clinical  review  tool  utilized by the insurer which is
 designated by the office of [alcoholism and substance  abuse]  ADDICTION
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11569-05-4
              

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