STATE OF NEW YORK
________________________________________________________________________
9111
IN ASSEMBLY
January 21, 2020
___________
Introduced by M. of A. L. ROSENTHAL -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to providing reimburse-
ment for transportation to and from inpatient and outpatient diagnosis
and treatment of substance disorder
The People of the State of New York, represented in Senate and Assem-
bly, do enact as follows:
1 Section 1. Subparagraph (A) of paragraph 30 of subsection (i) of
2 section 3216 of the insurance law, as amended by section 5 of subpart A
3 of part BB of chapter 57 of the laws of 2019, is amended to read as
4 follows:
5 (A) Every policy that provides hospital, major medical or similar
6 comprehensive coverage shall provide inpatient coverage for the diagno-
7 sis and treatment of substance use disorder, including detoxification
8 and rehabilitation services, and shall provide reimbursement for trans-
9 portation to and from such inpatient diagnosis and treatment of
10 substance use disorder. Such inpatient coverage shall include unlimited
11 medically necessary treatment for substance use disorder treatment
12 services provided in residential settings. Further, such inpatient
13 coverage shall not apply financial requirements or treatment limita-
14 tions, including utilization review requirements, to inpatient substance
15 use disorder benefits that are more restrictive than the predominant
16 financial requirements and treatment limitations applied to substantial-
17 ly all medical and surgical benefits covered by the policy.
18 § 2. Subparagraph (A) of paragraph 31 of subsection (i) of section
19 3216 of the insurance law, as amended by section 6 of subpart A of part
20 BB of chapter 57 of the laws of 2019, is amended to read as follows:
21 (A) Every policy that provides medical, major medical or similar
22 comprehensive-type coverage shall provide outpatient coverage for the
23 diagnosis and treatment of substance use disorder, including detoxifica-
24 tion and rehabilitation services, and shall provide reimbursement for
25 transportation to and from such outpatient diagnosis and treatment of
26 substance use disorder. Such coverage shall not apply financial require-
27 ments or treatment limitations to outpatient substance use disorder
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD14557-01-9
A. 9111 2
1 benefits that are more restrictive than the predominant financial
2 requirements and treatment limitations applied to substantially all
3 medical and surgical benefits covered by the policy.
4 § 3. Subparagraph (A) of paragraph 6 of subsection (l) of section 3221
5 of the insurance law, as amended by section 15 of subpart A of part BB
6 of chapter 57 of the laws of 2019, is amended to read as follows:
7 (A) Every policy that provides hospital, major medical or similar
8 comprehensive coverage shall provide inpatient coverage for the diagno-
9 sis and treatment of substance use disorder, including detoxification
10 and rehabilitation services, and shall provide reimbursement for trans-
11 portation to and from such inpatient diagnosis and treatment of
12 substance use disorder. Such inpatient coverage shall include unlimited
13 medically necessary treatment for substance use disorder treatment
14 services provided in residential settings. Further, such inpatient
15 coverage shall not apply financial requirements or treatment limita-
16 tions, including utilization review requirements, to inpatient substance
17 use disorder benefits that are more restrictive than the predominant
18 financial requirements and treatment limitations applied to substantial-
19 ly all medical and surgical benefits covered by the policy.
20 § 4. Subparagraph (A) of paragraph 7 of subsection (l) of section 3221
21 of the insurance law, as amended by section 16 of subpart A of part BB
22 of chapter 57 of the laws of 2019, is amended to read as follows:
23 (A) Every policy that provides medical, major medical or similar
24 comprehensive-type coverage shall provide outpatient coverage for the
25 diagnosis and treatment of substance use disorder, including detoxifica-
26 tion and rehabilitation services, and shall provide reimbursement for
27 transportation to and from such outpatient diagnosis and treatment of
28 substance use disorder. Such coverage shall not apply financial
29 requirements or treatment limitations to outpatient substance use disor-
30 der benefits that are more restrictive than the predominant financial
31 requirements and treatment limitations applied to substantially all
32 medical and surgical benefits covered by the policy.
33 § 5. Paragraph 1 of subsection (k) of section 4303 of the insurance
34 law, as amended by section 26 of subpart A of part BB of chapter 57 of
35 the laws of 2019, is amended to read as follows:
36 (1) Every contract that provides hospital, major medical or similar
37 comprehensive coverage shall provide inpatient coverage for the diagno-
38 sis and treatment of substance use disorder, including detoxification
39 and rehabilitation services, and shall provide reimbursement for trans-
40 portation to and from such inpatient diagnosis and treatment of
41 substance use disorder. Such inpatient coverage shall include unlimited
42 medically necessary treatment for substance use disorder treatment
43 services provided in residential settings. Further, such inpatient
44 coverage shall not apply financial requirements or treatment limita-
45 tions, including utilization review requirements, to inpatient substance
46 use disorder benefits that are more restrictive than the predominant
47 financial requirements and treatment limitations applied to substantial-
48 ly all medical and surgical benefits covered by the contract.
49 § 6. Paragraph 1 of subsection (l) of section 4303 of the insurance
50 law, as amended by section 27 of subpart A of part BB of chapter 57 of
51 the laws of 2019, is amended to read as follows:
52 (1) Every contract that provides medical, major medical or similar
53 comprehensive-type coverage shall provide outpatient coverage for the
54 diagnosis and treatment of substance use disorder, including detoxifica-
55 tion and rehabilitation services, and shall provide reimbursement for
56 transportation to and from such outpatient diagnosis and treatment of
A. 9111 3
1 substance use disorder. Such coverage shall not apply financial
2 requirements or treatment limitations to outpatient substance use disor-
3 der benefits that are more restrictive than the predominant financial
4 requirements and treatment limitations applied to substantially all
5 medical and surgical benefits covered by the contract.
6 § 7. This act shall take effect on the ninetieth day after it shall
7 have become a law; provided, however, that if part BB of chapter 57 of
8 the laws of 2019 has not taken effect on or before such date then this
9 act shall take effect on the same date and in the same manner as such
10 part takes effect; and shall apply to all policies and contracts issued,
11 renewed, modified, altered or amended on or after such date.