NY State Senate Bill 2025-S5565

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 25, 2025	referred to insurance

co-Sponsors

2025-S5565 (ACTIVE) - Details

See Assembly Version of this Bill:: A6586
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L; amd §365-a, Soc Serv L

2025-S5565 (ACTIVE) - Summary

Requires health insurance policies and Medicaid to cover patient navigation services.

2025-S5565 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S5565

SPONSOR: BAILEY
 
TITLE OF BILL:

An act to amend the insurance law and the social services law, in
relation to requiring health insurance policies and Medicaid to cover
patient navigation services

 
PURPOSE:

To define patient navigation services and eligible patients and estab-
lish a requirement for coverage of patient navigation services by
commercial insurance plans and Medicaid.

 
SUMMARY OF PROVISIONS:

Sections 1-3 of the bill define patient navigation services and eligible
patients, and amend sections 3216, 3221, and 4303 of the insurance law
to establish commercial insurance coverage for patient navigation
services.

Section 4 of the bill defines patient navigation services and eligible
patients, and amends section 365-a of the social services law to estab-
lish Medicaid coverage for patient navigation services.

 
JUSTIFICATION:

Patient navigation is individualized assistance that helps a patient
overcome health care system barriers from prevention and early detection
of disease to accessing quality health and psychosocial care. Patient
navigation is critical to ensure access and improve outcomes for
patients in need of screening and for treatment of serious, often life-
threatening conditions. For example, oncology patient navigation extends
across the full cancer continuum, beginning with screening and early
detection, and extending through diagnosis, treatment, survivorship, and
end-of-life. Access to patient navigation services can help cancer
patients and survivors get the care they need.

Patient navigation programs can help eliminate health disparities and
reduce costs across the care continuum by addressing the needs of people
who have been historically marginalized and excluded, as well as those
living in under-resourced communities. The navigators help increase
disease screening rates, help patients better understand and access
treatment options after diagnosis, and help ensure patients receive the
post-treatment care they need in survivorship. Patient navigation offers
tailored patient-centered care and the opportunity to prioritize unique
patient needs. Patient navigation also has a proven return on investment
and can help identify diagnosis at earlier stages when less invasive or
progressed and less costly treatment options are available to patients,
often resulting in better outcomes and reduced overall costs. Lastly, it
has been shown to increase patient retention and reduce provider admin-
istrative burdens, therefore reducing health care costs overall.

Despite the positive impact on patient outcomes and reducing health care
costs, patient navigation services are still absent or limited in many
programs and hospital settings due to a lack of clinical reimbursement.
Throughout the U.S., a patchwork of coverage exists, depending on where

patients live and the type of insurance coverage they have, and is not
continuous throughout the cancer care continuum.

Ensuring access to patient navigation services will only be achieved by
ensuring payment for patient navigation services is available across
both public and private payers.

The law will apply to all policies and contracts issued, renewed, or
otherwise amended on or after the effective date.

 
PRIOR LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

To be determined.

 
EFFECTIVE DATE:
The first of January next succeeding the date it becomes a law, with an
immediate effective date for adding, amending, or repealing any rule or
regulation for purposes of implementation.

2025-S5565 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5565
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 25, 2025
                                ___________
 
 Introduced  by  Sen.  BAILEY -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance  law  and  the  social  services  law,  in
   relation  to requiring health insurance policies and Medicaid to cover
   patient navigation services

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. Subsection (i) of section 3216 of insurance law is amended
 by adding a new paragraph 40 to read as follows:
   (40) (A) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR  SIMI-
 LAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE FOR PATIENT NAVI-
 GATION SERVICES TO IMPROVE ACCESS TO CARE FOR INDIVIDUALS WHO ARE ELIGI-
 BLE  FOR  SCREENING,  FOLLOW-UP  OR  TREATMENT SERVICES. ELIGIBILITY FOR
 PATIENT NAVIGATION SERVICES COVERAGE INCLUDES INDIVIDUALS WITH A SERIOUS
 CONDITION THAT IS EXPECTED TO LAST AT LEAST THREE MONTHS AND PLACES  THE
 INDIVIDUAL AT HIGH RISK FOR ONE OR MORE OF THE FOLLOWING:
   (I) HOSPITALIZATION;
   (II) NURSING HOME PLACEMENT;
   (III) A SUDDEN WORSENING OF PREEXISTING SYMPTOMS;
   (IV) PHYSICAL OR MENTAL DECLINE; OR
   (V) DEATH.
   (B) PATIENT NAVIGATION SERVICES SHALL INCLUDE, BUT NOT BE LIMITED TO:
   (I)  SCREENING  FOR NONCLINICAL AND SOCIAL NEEDS THAT DO NOT REQUIRE A
 LICENSED HEALTHCARE PROVIDER TO COMPLETE;
   (II) REFERRALS  AND  FOLLOW-UP  TO  CONNECT  INDIVIDUALS  TO  SERVICES
 INCLUDING,  BUT NOT LIMITED TO TRANSPORTATION, EMPLOYMENT, JOB TRAINING,
 FOOD  INSECURITY,  CHILDCARE,  HOUSING,  LANGUAGE  OR  HEALTH   LITERACY
 SUPPORT;
   (III)  HELP  WITH  ENROLLMENT  OR MAINTAINING ENROLLMENT IN GOVERNMENT
 PROGRAMS OR OTHER ASSISTANCE PROGRAMS;

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD08151-01-5
 S. 5565                             2

 
   (IV) ARRANGING FOR AND ACCOMPANIMENT TO IN-PERSON AND VIRTUAL  HEALTH-
 CARE VISITS; OR
   (V) OTHER PREVENTION, SCREENING AND TREATMENT HEALTH EDUCATION, HEALTH
 NAVIGATION, HEALTH ADVOCACY, OR INDIVIDUAL SUPPORTS INCLUDING TRANSITION
 OF CARE SUPPORTS.
   (C) REIMBURSEMENT SHALL BE PROVIDED TO INDIVIDUALS WHO ARE TRAINED AND
 HAVE  COMPLETED  A  NATIONAL PATIENT NAVIGATION CERTIFICATION OR CREDEN-
 TIALING PROGRAM, OR OTHER CERTIFICATION OR TRAINING PROGRAM APPROVED  BY
 THE  DEPARTMENT  OF HEALTH. APPROVED INDIVIDUALS SHALL BE EMPLOYED BY OR
 IN CONSULTATION WITH FACILITIES CERTIFIED UNDER ARTICLE TWENTY-EIGHT  OF
 THE PUBLIC HEALTH LAW, DIAGNOSTIC AND TREATMENT CENTERS, FEDERALLY QUAL-
 IFIED  HEALTH  CENTERS, CLINICS, PHYSICIANS OR OTHER LICENSED HEALTHCARE
 PROVIDERS, TO PROVIDE PATIENT NAVIGATION SERVICES.  INDIVIDUALS  AUTHOR-
 IZED TO PROVIDE PATIENT NAVIGATION SERVICES SHALL DO SO UNDER THE GENER-
 AL  SUPERVISION  OF  A  LICENSED  PHYSICIAN OR OTHER LICENSED HEALTHCARE
 PROVIDER.
   § 2. Subsection (l) of section 3221 of insurance  law  is  amended  by
 adding a new paragraph 23 to read as follows:
   (23) (A) EVERY INSURER DELIVERING A GROUP OR BLANKET POLICY OR ISSUING
 A  GROUP  OR  BLANKET  POLICY  FOR  DELIVERY IN THIS STATE THAT PROVIDES
 COVERAGE FOR MEDICAL, MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVER-
 AGE SHALL PROVIDE COVERAGE FOR PATIENT NAVIGATION  SERVICES  TO  IMPROVE
 ACCESS TO CARE FOR INDIVIDUALS WHO ARE ELIGIBLE FOR SCREENING, FOLLOW-UP
 OR  TREATMENT  SERVICES.    ELIGIBILITY  FOR PATIENT NAVIGATION SERVICES
 COVERAGE INCLUDES INDIVIDUALS WITH A SERIOUS CONDITION THAT IS  EXPECTED
 TO LAST AT LEAST THREE MONTHS AND PLACES THE INDIVIDUAL AT HIGH RISK FOR
 ONE OR MORE OF THE FOLLOWING:
   (I) HOSPITALIZATION;
   (II) NURSING HOME PLACEMENT;
   (III) A SUDDEN WORSENING OF PREEXISTING SYMPTOMS;
   (IV) PHYSICAL OR MENTAL DECLINE; OR
   (V) DEATH.
   (B) PATIENT NAVIGATION SERVICES SHALL INCLUDE BUT NOT BE LIMITED TO:
   (I)  SCREENING  FOR NONCLINICAL AND SOCIAL NEEDS THAT DO NOT REQUIRE A
 LICENSED HEALTHCARE PROVIDER TO COMPLETE;
   (II) REFERRALS  AND  FOLLOW-UP  TO  CONNECT  INDIVIDUALS  TO  SERVICES
 INCLUDING,  BUT NOT LIMITED TO TRANSPORTATION, EMPLOYMENT, JOB TRAINING,
 FOOD  INSECURITY,  CHILDCARE,  HOUSING,  LANGUAGE  OR  HEALTH   LITERACY
 SUPPORT;
   (III)  HELP  WITH  ENROLLMENT  OR MAINTAINING ENROLLMENT IN GOVERNMENT
 PROGRAMS OR OTHER ASSISTANCE PROGRAMS;
   (IV) ARRANGING FOR AND ACCOMPANIMENT TO IN-PERSON AND VIRTUAL  HEALTH-
 CARE VISITS; OR
   (V) OTHER PREVENTION, SCREENING AND TREATMENT HEALTH EDUCATION, HEALTH
 NAVIGATION, HEALTH ADVOCACY, OR INDIVIDUAL SUPPORTS INCLUDING TRANSITION
 OF CARE SUPPORTS.
   (C) REIMBURSEMENT SHALL BE PROVIDED TO INDIVIDUALS WHO ARE TRAINED AND
 HAVE  COMPLETED  A  NATIONAL PATIENT NAVIGATION CERTIFICATION OR CREDEN-
 TIALING PROGRAM, OR OTHER CERTIFICATION OR TRAINING PROGRAM APPROVED  BY
 THE  DEPARTMENT  OF HEALTH. APPROVED INDIVIDUALS SHALL BE EMPLOYED BY OR
 IN CONSULTATION WITH FACILITIES CERTIFIED UNDER ARTICLE TWENTY-EIGHT  OF
 THE PUBLIC HEALTH LAW, DIAGNOSTIC AND TREATMENT CENTERS, FEDERALLY QUAL-
 IFIED  HEALTH  CENTERS, CLINICS, PHYSICIANS OR OTHER LICENSED HEALTHCARE
 PROVIDERS, TO PROVIDE PATIENT NAVIGATION SERVICES.  INDIVIDUALS  AUTHOR-
 IZED TO PROVIDE PATIENT NAVIGATION SERVICES SHALL DO SO UNDER THE GENER-
 S. 5565                             3
 
 AL  SUPERVISION  OF  A  LICENSED  PHYSICIAN OR OTHER LICENSED HEALTHCARE
 PROVIDER.
   §  3.  Section  4303  of  the insurance law is amended by adding a new
 subsection (ww) to read as follows:
   (WW) (1) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR  SIMI-
 LAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE FOR PATIENT NAVI-
 GATION SERVICES TO IMPROVE ACCESS TO CARE FOR INDIVIDUALS WHO ARE ELIGI-
 BLE  FOR  SCREENING,  FOLLOW-UP  OR  TREATMENT SERVICES. ELIGIBILITY FOR
 PATIENT NAVIGATION SERVICES COVERAGE INCLUDES INDIVIDUALS WITH A SERIOUS
 CONDITION THAT IS EXPECTED TO LAST AT LEAST THREE MONTHS AND PLACES  THE
 INDIVIDUAL AT HIGH RISK FOR ONE OR MORE OF THE FOLLOWING:
   (A) HOSPITALIZATION;
   (B) NURSING HOME PLACEMENT;
   (C) A SUDDEN WORSENING OF PREEXISTING SYMPTOMS;
   (D) PHYSICAL OR MENTAL DECLINE; OR
   (E) DEATH.
   (2) PATIENT NAVIGATION SERVICES SHALL INCLUDE BUT NOT BE LIMITED TO:
   (A)  SCREENING  FOR NONCLINICAL AND SOCIAL NEEDS THAT DO NOT REQUIRE A
 LICENSED HEALTHCARE PROVIDER TO COMPLETE;
   (B) REFERRALS AND FOLLOW-UP TO CONNECT INDIVIDUALS TO SERVICES INCLUD-
 ING, BUT NOT LIMITED TO TRANSPORTATION, EMPLOYMENT, JOB  TRAINING,  FOOD
 INSECURITY, CHILDCARE, HOUSING, LANGUAGE OR HEALTH LITERACY SUPPORT;
   (C)  HELP  WITH  ENROLLMENT  OR  MAINTAINING  ENROLLMENT IN GOVERNMENT
 PROGRAMS OR OTHER ASSISTANCE PROGRAMS;
   (D) ARRANGING FOR AND ACCOMPANIMENT TO IN-PERSON AND  VIRTUAL  HEALTH-
 CARE VISITS; OR
   (E) OTHER PREVENTION, SCREENING AND TREATMENT HEALTH EDUCATION, HEALTH
 NAVIGATION, HEALTH ADVOCACY, OR INDIVIDUAL SUPPORTS INCLUDING TRANSITION
 OF CARE SUPPORTS.
   (3) REIMBURSEMENT SHALL BE PROVIDED TO INDIVIDUALS WHO ARE TRAINED AND
 HAVE  COMPLETED  A  NATIONAL PATIENT NAVIGATION CERTIFICATION OR CREDEN-
 TIALING PROGRAM, OR OTHER CERTIFICATION OR TRAINING PROGRAM APPROVED  BY
 THE  DEPARTMENT  OF HEALTH. APPROVED INDIVIDUALS SHALL BE EMPLOYED BY OR
 IN CONSULTATION WITH FACILITIES CERTIFIED UNDER ARTICLE TWENTY-EIGHT  OF
 THE PUBLIC HEALTH LAW, DIAGNOSTIC AND TREATMENT CENTERS, FEDERALLY QUAL-
 IFIED  HEALTH  CENTERS, CLINICS, PHYSICIANS OR OTHER LICENSED HEALTHCARE
 PROVIDERS, TO PROVIDE PATIENT NAVIGATION SERVICES.  INDIVIDUALS  AUTHOR-
 IZED TO PROVIDE PATIENT NAVIGATION SERVICES SHALL DO SO UNDER THE GENER-
 AL  SUPERVISION  OF  A  LICENSED  PHYSICIAN OR OTHER LICENSED HEALTHCARE
 PROVIDER.
   § 4. Subdivision 2 of section 365-a of  the  social  services  law  is
 amended by adding a new paragraph (nn) to read as follows:
   (NN)  (I)  PATIENT  NAVIGATION  SERVICES TO IMPROVE ACCESS TO CARE FOR
 INDIVIDUALS WHO ARE  ELIGIBLE  FOR  SCREENING,  FOLLOW-UP  OR  TREATMENT
 SERVICES.  ELIGIBILITY FOR PATIENT NAVIGATION SERVICES COVERAGE INCLUDES
 INDIVIDUALS WITH A SERIOUS CONDITION THAT IS EXPECTED TO LAST  AT  LEAST
 THREE  MONTHS  AND PLACES THE INDIVIDUAL AT HIGH RISK FOR ONE OR MORE OF
 THE FOLLOWING:
   (A) HOSPITALIZATION;
   (B) NURSING HOME PLACEMENT;
   (C) A SUDDEN WORSENING OF PREEXISTING SYMPTOMS;
   (D) PHYSICAL OR MENTAL DECLINE; OR
   (E) DEATH.
   (II) PATIENT NAVIGATION SERVICES SHALL INCLUDE BUT NOT BE LIMITED TO:
   (A) SCREENING FOR NONCLINICAL AND SOCIAL NEEDS THAT DO NOT  REQUIRE  A
 LICENSED HEALTHCARE PROVIDER TO COMPLETE;
 S. 5565                             4
 
   (B) REFERRALS AND FOLLOW-UP TO CONNECT INDIVIDUALS TO SERVICES INCLUD-
 ING,  BUT  NOT LIMITED TO TRANSPORTATION, EMPLOYMENT, JOB TRAINING, FOOD
 INSECURITY, CHILDCARE, HOUSING, LANGUAGE OR HEALTH LITERACY SUPPORT;
   (C)  HELP  WITH  ENROLLMENT  OR  MAINTAINING  ENROLLMENT IN GOVERNMENT
 PROGRAMS OR OTHER ASSISTANCE PROGRAMS;
   (D) ARRANGING FOR AND ACCOMPANIMENT TO IN-PERSON AND  VIRTUAL  HEALTH-
 CARE VISITS; OR
   (E) OTHER PREVENTION, SCREENING AND TREATMENT HEALTH EDUCATION, HEALTH
 NAVIGATION, HEALTH ADVOCACY, OR INDIVIDUAL SUPPORTS INCLUDING TRANSITION
 OF CARE SUPPORTS.
   (III)  REIMBURSEMENT  SHALL BE PROVIDED TO INDIVIDUALS WHO ARE TRAINED
 AND HAVE  COMPLETED  A  NATIONAL  PATIENT  NAVIGATION  CERTIFICATION  OR
 CREDENTIALING  PROGRAM,  OR  OTHER  CERTIFICATION  OR  TRAINING  PROGRAM
 APPROVED BY THE DEPARTMENT OF  HEALTH.  APPROVED  INDIVIDUALS  SHALL  BE
 EMPLOYED  BY  OR IN CONSULTATION WITH FACILITIES CERTIFIED UNDER ARTICLE
 TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, DIAGNOSTIC AND TREATMENT CENTERS,
 FEDERALLY  QUALIFIED  HEALTH  CENTERS,  CLINICS,  PHYSICIANS  OR   OTHER
 LICENSED  HEALTHCARE  PROVIDERS, TO PROVIDE PATIENT NAVIGATION SERVICES.
 INDIVIDUALS AUTHORIZED TO PROVIDE PATIENT NAVIGATION SERVICES  SHALL  DO
 SO  UNDER  THE  GENERAL  SUPERVISION  OF  A  LICENSED PHYSICIAN OR OTHER
 LICENSED HEALTHCARE PROVIDER.
   § 5. This act shall take effect on the first of January next  succeed-
 ing  the date on which it shall have become a law and shall apply to all
 policies and contracts issued, renewed, modified, altered or amended  on
 or  after  such  date.  Effective  immediately,  the addition, amendment
 and/or repeal of any rule or regulation necessary for the implementation
 of this act on  its  effective  date  are  authorized  to  be  made  and
 completed on or before such effective date.

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Senate Bill S5565

Sponsored By

Current Bill Status - In Senate Committee Insurance Committee

co-Sponsors

2025-S5565 (ACTIVE) - Details

2025-S5565 (ACTIVE) - Summary

2025-S5565 (ACTIVE) - Sponsor Memo

2025-S5565 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S5565

Share this bill

Sponsored By

Jamaal T. Bailey

Current Bill Status - In Senate Committee Insurance Committee

co-Sponsors

Joseph P. Addabbo Jr.

2025-S5565 (ACTIVE) - Details

2025-S5565 (ACTIVE) - Summary

2025-S5565 (ACTIVE) - Sponsor Memo

2025-S5565 (ACTIVE) - Bill Text download pdf

Comments