S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7038
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 18, 2025
                                ___________
 
 Introduced by M. of A. WEPRIN -- read once and referred to the Committee
   on Insurance
 
 AN  ACT  to amend the insurance law, in relation to requiring rates paid
   for rehabilitation and opioid treatment be  pursuant  to  certain  fee
   schedules published by the office of addiction services and supports

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subparagraph (J) of  paragraph  31  of  subsection  (i)  of
 section  3216  of the insurance law, as added by section 1 of part AA of
 chapter 57 of the laws of 2024, is amended to read as follows:
   (J) This subparagraph shall apply to facilities in this state that are
 licensed, certified, or otherwise authorized by the office of  addiction
 services  and supports for the provision of outpatient, intensive outpa-
 tient, outpatient rehabilitation and opioid treatment that  are  partic-
 ipating  in  the  insurer's  provider network. Reimbursement for covered
 outpatient treatment provided by such facilities shall be at rates nego-
 tiated between the insurer and the participating facility, provided that
 such rates are not less than the rates  that  would  be  paid  for  such
 treatment  pursuant to the medical assistance program under title eleven
 of article five of the social services law. For  the  purposes  of  this
 subparagraph,  the  rates that would be paid for such treatment pursuant
 to the medical assistance program under title eleven of article five  of
 the  social  services law SHALL BE SET FORTH IN A PUBLISHED FEE SCHEDULE
 SETTING FORTH THE SPECIFIC FEE FOR EACH INDIVIDUAL  SERVICE  COVERED  BY
 THIS  SUBPARAGRAPH  BY THE OFFICE OF ADDICTION SERVICES AND SUPPORTS AND
 shall be the rates with an effective date of April first of the  preced-
 ing  year,  which  shall  be  established  prior to October first of the
 preceding calendar year. Prior to the submission of premium rate filings
 and applications, the superintendent shall provide insurers  with  guid-
 ance  on  factors  to consider in calculating the impact of rate changes
 for the purposes of submitting premium rate filings and applications  to
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11143-01-5
              

 A. 7038                             2
 
 the  superintendent  for  the subsequent policy year. To the extent that
 the rates with an effective date of April first differ  from  the  esti-
 mated  rates  incorporated  in  premium  rate  filings and applications,
 insurers may account for such differences in future premium rate filings
 and applications submitted to the superintendent for approval.
   §  2.  Subparagraph  (K)  of paragraph 35 of subsection (i) of section
 3216 of the insurance law, as added by section 2 of part AA  of  chapter
 57 of the laws of 2024, is amended to read as follows:
   (K)  This subparagraph shall apply to outpatient treatment provided in
 a facility issued an operating certificate by the commissioner of mental
 health pursuant to the provisions of article thirty-one  of  the  mental
 hygiene  law,  or in a facility operated by the office of mental health,
 or in a crisis stabilization center licensed pursuant to  section  36.01
 of  the  mental  hygiene  law,  that  is  participating in the insurer's
 provider  network.  Reimbursement  for  covered   outpatient   treatment
 provided  by  such  a  facility shall be at rates negotiated between the
 insurer and the participating facility, provided that such rates are not
 less than the rates that would be paid for such  treatment  pursuant  to
 the medical assistance program under title eleven of article five of the
 social  services  law.  For the purposes of this subparagraph, the rates
 that would be paid for such treatment pursuant to the medical assistance
 program under title eleven of article five of the  social  services  law
 SHALL BE SET FORTH IN A PUBLISHED FEE SCHEDULE SETTING FORTH THE SPECIF-
 IC  FEE  FOR EACH INDIVIDUAL SERVICE COVERED BY THIS SUBPARAGRAPH BY THE
 OFFICE OF MENTAL HEALTH AND shall be the rates with an effective date of
 April first of the preceding year, which shall be established  prior  to
 October first of the preceding calendar year. Prior to the submission of
 premium  rate filings and applications, the superintendent shall provide
 insurers with guidance on factors to consider in calculating the  impact
 of  rate changes for the purposes of submitting premium rate filings and
 applications to the superintendent for the subsequent  policy  year.  To
 the  extent  that the rates with an effective date of April first differ
 from the estimated rates incorporated in premium rate filings and appli-
 cations, insurers may account for such  differences  in  future  premium
 rate  filings  and  applications  submitted  to  the  superintendent for
 approval.
   § 3. Subparagraph (K) of paragraph 5 of subsection (l) of section 3221
 of the insurance law, as added by section 3 of part AA of chapter 57  of
 the laws of 2024, is amended to read as follows:
   (K)  This subparagraph shall apply to outpatient treatment provided in
 a facility issued an operating certificate by the commissioner of mental
 health pursuant to the provisions of article thirty-one  of  the  mental
 hygiene  law,  or in a facility operated by the office of mental health,
 or in a crisis stabilization center licensed pursuant to  section  36.01
 of  the  mental  hygiene  law,  that  is  participating in the insurer's
 provider  network.  Reimbursement  for  covered   outpatient   treatment
 provided  by  such  a  facility shall be at rates negotiated between the
 insurer and the participating facility, provided that such rates are not
 less than the rates that would be paid for such  treatment  pursuant  to
 the medical assistance program under title eleven of article five of the
 social  services  law.  For the purposes of this subparagraph, the rates
 that would be paid for such treatment pursuant to the medical assistance
 program under title eleven of article five of the  social  services  law
 SHALL BE SET FORTH IN A PUBLISHED FEE SCHEDULE SETTING FORTH THE SPECIF-
 IC  FEE  FOR EACH INDIVIDUAL SERVICE COVERED BY THIS SUBPARAGRAPH BY THE
 OFFICE OF MENTAL HEALTH AND shall be the rates with an effective date of
 A. 7038                             3
 
 April first of the preceding year, which shall be established  prior  to
 October first of the preceding calendar year. Prior to the submission of
 premium  rate filings and applications, the superintendent shall provide
 insurers  with guidance on factors to consider in calculating the impact
 of rate changes for the purposes of submitting premium rate filings  and
 applications  to  the  superintendent for the subsequent policy year. To
 the extent that the rates with an effective date of April  first  differ
 from the estimated rates incorporated in premium rate filings and appli-
 cations,  insurers  may  account  for such differences in future premium
 rate filings  and  applications  submitted  to  the  superintendent  for
 approval.
   § 4. Subparagraph (J) of paragraph 7 of subsection (l) of section 3221
 of  the insurance law, as added by section 4 of part AA of chapter 57 of
 the laws of 2024, is amended to read as follows:
   (J) This subparagraph shall apply to facilities in this state that are
 licensed, certified, or otherwise authorized by the office of  addiction
 services  and supports for the provision of outpatient, intensive outpa-
 tient, outpatient rehabilitation and opioid treatment that  are  partic-
 ipating  in  the  insurer's  provider network. Reimbursement for covered
 outpatient treatment provided by such facilities shall be at rates nego-
 tiated between the insurer and the participating facility, provided that
 such rates are not less than the rates  that  would  be  paid  for  such
 treatment  pursuant to the medical assistance program under title eleven
 of article five of the social services law. For  the  purposes  of  this
 subparagraph,  the  rates that would be paid for such treatment pursuant
 to the medical assistance program under title eleven of article five  of
 the  social  services law SHALL BE SET FORTH IN A PUBLISHED FEE SCHEDULE
 SETTING FORTH THE SPECIFIC FEE FOR EACH INDIVIDUAL  SERVICE  COVERED  BY
 THIS  SUBPARAGRAPH  BY THE OFFICE OF ADDICTION SERVICES AND SUPPORTS AND
 shall be the rates with an effective date of April first of the  preced-
 ing  year,  which  shall  be  established  prior to October first of the
 preceding calendar year. Prior to the submission of premium rate filings
 and applications, the superintendent shall provide insurers  with  guid-
 ance  on  factors  to consider in calculating the impact of rate changes
 for the purposes of submitting premium rate filings and applications  to
 the  superintendent  for  the subsequent policy year. To the extent that
 the rates with an effective date of April first differ  from  the  esti-
 mated  rates  incorporated  in  premium  rate  filings and applications,
 insurers may account for such differences in future premium rate filings
 and applications submitted to the superintendent for approval.
   § 5. Paragraph 12 of subsection (g) of section 4303 of  the  insurance
 law, as added by section 5 of part AA of chapter 57 of the laws of 2024,
 is amended to read as follows:
   (12)  This paragraph shall apply to outpatient treatment provided in a
 facility issued an operating certificate by the commissioner  of  mental
 health  pursuant  to  the provisions of article thirty-one of the mental
 hygiene law, or in a facility operated by the office of  mental  health,
 or  in  a crisis stabilization center licensed pursuant to section 36.01
 of the mental hygiene law, that is participating  in  the  corporation's
 provider   network.   Reimbursement  for  covered  outpatient  treatment
 provided by such facility shall  be  at  rates  negotiated  between  the
 corporation and the participating facility, provided that such rates are
 not  less  than the rates that would be paid for such treatment pursuant
 to the medical assistance program under title eleven of article five  of
 the  social  services law. For the purposes of this paragraph, the rates
 that would be paid for such treatment pursuant to the medical assistance
 A. 7038                             4
 
 program under title eleven of article five of the  social  services  law
 SHALL BE SET FORTH IN A PUBLISHED FEE SCHEDULE SETTING FORTH THE SPECIF-
 IC  FEE  FOR  EACH  INDIVIDUAL  SERVICE COVERED BY THIS PARAGRAPH BY THE
 OFFICE OF MENTAL HEALTH AND shall be the rates with an effective date of
 April  first  of the preceding year, which shall be established prior to
 October first of the preceding calendar year. Prior to the submission of
 premium rate filings and applications, the superintendent shall  provide
 corporations  with  guidance  on  factors to consider in calculating the
 impact of rate changes for  the  purposes  of  submitting  premium  rate
 filings and applications to the superintendent for the subsequent policy
 year. To the extent that the rates with an effective date of April first
 differ from the estimated rates incorporated in premium rate filings and
 applications,  corporations  may  account for such differences in future
 premium rate filings and applications submitted  to  the  superintendent
 for approval.
   §  6.  Paragraph 10 of subsection (l) of section 4303 of the insurance
 law, as added by section 6 of part AA of chapter 57 of the laws of 2024,
 is amended to read as follows:
   (10) This paragraph shall apply to facilities in this state  that  are
 licensed,  certified, or otherwise authorized by the office of addiction
 services and supports for the provision of outpatient, intensive  outpa-
 tient,  outpatient  rehabilitation and opioid treatment that are partic-
 ipating in the corporation's provider network. Reimbursement for covered
 outpatient treatment provided by such facilities shall be at rates nego-
 tiated between the corporation and the participating facility,  provided
 that  such rates are not less than the rates that would be paid for such
 treatment pursuant to the medical assistance program under title  eleven
 of  article  five  of  the social services law. For the purposes of this
 paragraph, the rates that would be paid for such treatment  pursuant  to
 the medical assistance program under title eleven of article five of the
 social  services  law  SHALL  BE  SET  FORTH IN A PUBLISHED FEE SCHEDULE
 SETTING FORTH THE SPECIFIC FEE FOR EACH INDIVIDUAL  SERVICE  COVERED  BY
 THIS  PARAGRAPH  BY  THE  OFFICE  OF ADDICTION SERVICES AND SUPPORTS AND
 shall be the rates with an effective date of April first of the  preced-
 ing  year,  which  shall  be  established  prior to October first of the
 preceding calendar year. Prior to the submission of premium rate filings
 and applications, the superintendent  shall  provide  corporations  with
 guidance on factors to consider in calculating the impact of rate chang-
 es  for the purposes of submitting premium rate filings and applications
 to the superintendent for the subsequent policy year. To the extent that
 the rates with an effective date of April first differ  from  the  esti-
 mated  rates  incorporated  in  premium  rate  filings and applications,
 corporations may account for such differences  in  future  premium  rate
 filings and applications submitted to the superintendent for approval.
   §  7.  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.