NY State Senate Bill 2025-S5114

Senate Bill S5114

2025-2026 Legislative Session

Requires insurance coverage for child and family treatment and support services and children's home and community based services

download bill text pdf

Current 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
Feb 19, 2025	referred to insurance

2025-S5114 (ACTIVE) - Details

See Assembly Version of this Bill:: A5389
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L

2025-S5114 (ACTIVE) - Summary

Requires all policies that provide coverage for inpatient hospital care to include benefits for child and family treatment and support services and children's home and community based services.

2025-S5114 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S5114

SPONSOR: HINCHEY
 
TITLE OF BILL:

An act to amend the insurance law, in relation to requiring insurance
coverage for child and family treatment and support services and chil-
dren's home and community based services

 
PURPOSE:

This bill ensures that health insurers are providing certain coverages
for outpatient children's behavioral health services.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends section 3216 of the insurance law by adding child and
family treatment and support services and children's home and communi-
ty-based services to the list of covered outpatient services.

Section 2 amends section 3221 of the insurance law by adding child and
family treatment and support services and children's home and communi-

ty-based services to the list of covered outpatient services.

Section 3 amends section 4303 of the insurance law by adding child and
family treatment and support services and children's home and communi-
ty-based services to the list of covered outpatient services.

Section 4 sets forth an effective date of January 1, 2026.

 
JUSTIFICATION:

New York's Medicaid Plan offers robust behavioral health services for
children and families. Child and Family Treatment and Support Services
(CFTSS) and Children's Home and Community Based Services (HCBS) are two
critical treatment options for children experiencing a behavioral health
issue. CFTSS and HCBS are unique in that they meet young people and
families where they are - in their homes and in their communities. They
provide treatment and supports for the youth, and more importantly,
offer modalities that serve the family and caregiving unit. The services
reach people earlier on in the service continuum, providing treatments
up front, often leading to better outcomes, avoiding crisis visits to
hospitals and emergency rooms, and ultimately saving money for the
patient, state, and healthcare system.

CFTSS and HCBS services are readily available in the state's Medicaid
Plan, and more recently were added to the Child Health Plus Plan (CHP)
in 2022.

This is of course a great benefit to those with Medicaid and CHP cover-
age, and there is signifiCant'deMand for these Services that is, greatly
Outpacing systeM capacity. : Sadly, commercial health plans,
intlUding'eMployer sponsOred and individual health plans, thatMAny
NewYorkerS:find theii coverage thrOughi are not
proViding'similatCoverage, ThiS leaves many faMilies and caregivers
without access to these'critical community-based services simply because
Of the health benefits card in their pocket Indeed, it has created two-
tiered system for access to care that has perpetUated, Mental health
disparities in a time of crisis where treatment is desperately needed.
To ensure broad access to CFTSS and HCBS services, this bill would clar-
ify that commercial health insurance policies are required to cover
these two services: This action would more closely align commercial
behavioral health' benefits with those 'of Medicaid. It would further
ensure that health plans are in compliance with federal mental health
parity coverage requirements. This legislation is intended to comport
with the coverage outlined in New York's Essential Health Benefits Pack-
age (Benchmark Plan) and is not intended to create a new mandated health
benefit.

 
FISCAL IMPLICATIONS:

 
EFFECTIVE DATE:
This act shall take effect on January 1, 2026.

2025-S5114 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5114
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 19, 2025
                                ___________
 
 Introduced  by  Sen. HINCHEY -- 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  insurance
   coverage for child and family treatment and support services and chil-
   dren's home and community based services

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Item (i) of subparagraph (A) of paragraph 35 of  subsection
 (i)  of  section  3216  of the insurance law, as amended by section 1 of
 subpart A of part II of chapter 57 of the laws of 2023,  is  amended  to
 read as follows:
   (i)  where  the  policy provides coverage for inpatient hospital care,
 such policy shall include benefits for: inpatient care in a hospital  as
 defined  by  subdivision  ten of section 1.03 of the mental hygiene law;
 sub-acute care in a residential facility licensed  or  operated  by  the
 office  of  mental health; outpatient care provided by 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 by
 a facility operated by the office  of  mental  health;  outpatient  care
 provided  by  a crisis stabilization center licensed pursuant to section
 36.01 of the mental hygiene law; outpatient care provided  by  a  mobile
 crisis intervention services provider licensed, certified, or designated
 by  the  office of mental health or the office of addiction services and
 supports; outpatient and inpatient care for critical  time  intervention
 services  and outpatient care for assertive community treatment services
 provided by facilities issued an operating certificate  by  the  commis-
 sioner of mental health pursuant to the provisions of article thirty-one
 of the mental hygiene law, beginning no later than thirty days following
 discharge  from a hospital as defined by subdivision ten of section 1.03
 of the mental hygiene law or the  emergency  department  of  a  hospital
 licensed  pursuant  to  article  twenty-eight  of the public health law;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07845-01-5

 S. 5114                             2
 
 CHILD AND FAMILY TREATMENT AND SUPPORT  SERVICES;  CHILDREN'S  HOME  AND
 COMMUNITY  BASED  SERVICES;  or,  for  care provided in other states, to
 similarly licensed or  certified  hospitals,  facilities,  or  licensed,
 certified or designated providers; and
   §  2. Item (i) of subparagraph (A) of paragraph 5 of subsection (l) of
 section 3221 of the insurance law, as amended by section 5 of subpart  A
 of  part  II  of  chapter  57 of the laws of 2023, is amended to read as
 follows:
   (i) where the policy provides coverage for  inpatient  hospital  care,
 benefits for: inpatient care in a hospital as defined by subdivision ten
 of  section 1.03 of the mental hygiene law; sub-acute care in a residen-
 tial facility licensed or operated  by  the  office  of  mental  health;
 outpatient  care  provided by a facility issued an operating certificate
 by the commissioner of mental health pursuant to the provisions of arti-
 cle thirty-one of the mental hygiene law, or by a facility  operated  by
 the  office  of  mental  health;  outpatient  care  provided by a crisis
 stabilization center licensed pursuant to section 36.01  of  the  mental
 hygiene  law;  outpatient  care provided by a mobile crisis intervention
 services provider licensed, certified, or designated by  the  office  of
 mental  health  or the office of addiction services and supports; outpa-
 tient and inpatient care for critical  time  intervention  services  and
 outpatient  care  for assertive community treatment services provided by
 facilities issued an operating certificate by the commissioner of mental
 health pursuant to the provisions of article thirty-one  of  the  mental
 hygiene  law,  beginning  no  later than thirty days following discharge
 from a hospital as defined by subdivision ten of  section  1.03  of  the
 mental  hygiene  law  or the emergency department of a hospital licensed
 pursuant to article twenty-eight of the public  health  law;  CHILD  AND
 FAMILY  TREATMENT  AND  SUPPORT  SERVICES; CHILDREN'S HOME AND COMMUNITY
 BASED SERVICES; or, for care provided  in  other  states,  to  similarly
 licensed  or  certified hospitals, facilities, or licensed, certified or
 designated providers; and
   § 3. Paragraph 1 of subsection (g) of section 4303  of  the  insurance
 law,  as  amended  by section 9 of subpart A of part II of chapter 57 of
 the laws of 2023, is amended to read as follows:
   (1) where the contract provides coverage for inpatient hospital  care,
 benefits  for:  in-patient  care in a hospital as defined by subdivision
 ten of section 1.03 of the mental hygiene law; sub-acute care in a resi-
 dential facility licensed or operated by the office  of  mental  health;
 outpatient  care  provided by a facility issued an operating certificate
 by the commissioner of mental health pursuant to the provisions of arti-
 cle thirty-one of the mental hygiene law or by a  facility  operated  by
 the  office  of  mental  health;  outpatient  care  provided by a crisis
 stabilization center licensed pursuant to section 36.01  of  the  mental
 hygiene  law;  outpatient  care provided by a mobile crisis intervention
 services provider licensed, certified, or designated by  the  office  of
 mental  health  or the office of addiction services and supports; outpa-
 tient and inpatient care for critical  time  intervention  services  and
 outpatient  care  for assertive community treatment services provided by
 facilities issued an operating certificate by the commissioner of mental
 health pursuant to the provisions of article thirty-one  of  the  mental
 hygiene  law,  beginning  no  later than thirty days following discharge
 from a hospital as defined by subdivision ten of  section  1.03  of  the
 mental  hygiene  law  or the emergency department of a hospital licensed
 pursuant to article twenty-eight of the public  health  law;  CHILD  AND
 FAMILY  TREATMENT  AND  SUPPORT  SERVICES; CHILDREN'S HOME AND COMMUNITY
 S. 5114                             3
 
 BASED SERVICES; or for care  provided  in  other  states,  to  similarly
 licensed  or  certified hospitals, facilities, or licensed, certified or
 designated providers; and
   §  4.  This  act  shall take effect January 1, 2026 and shall apply to
 policies and contracts issued, renewed, amended, modified or altered  on
 or after such date; provided, however, that:
   (a)  if section 1 of subpart A of part II of chapter 57 of the laws of
 2023 shall not have taken effect on or before such  date,  then  section
 one  of  this  act  shall  take  effect on the same date and in the same
 manner as such section of such subpart of such part of such  chapter  of
 the laws of 2023, takes effect;
   (b)  if section 5 of subpart A of part II of chapter 57 of the laws of
 2023 shall not have taken effect on or before such  date,  then  section
 two  of  this  act  shall  take  effect on the same date and in the same
 manner as such section of such subpart of such part of such  chapter  of
 the laws of 2023, takes effect; and
   (c)  if section 9 of subpart A of part II of chapter 57 of the laws of
 2023 shall not have taken effect on or before such  date,  then  section
 three  of  this  act  shall take effect on the same date and in the same
 manner as such section of such subpart of such part of such  chapter  of
 the laws of 2023, takes effect.

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