Bill Text: NY S01121 | 2011-2012 | General Assembly | Introduced
Bill Title: Requires coverage under the healthy New York program for mental illness.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2012-01-04 - REFERRED TO INSURANCE [S01121 Detail]
Download: New_York-2011-S01121-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 1121 2011-2012 Regular Sessions I N S E N A T E January 5, 2011 ___________ Introduced by Sen. PARKER -- 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 coverage under the Healthy New York program for mental illness THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. The opening paragraph of subparagraph (A) of paragraph 5 of 2 subsection (l) of section 3221 of the insurance law, as amended by chap- 3 ter 502 of the laws of 2007, is amended to read as follows: 4 Every insurer delivering a group or school blanket policy OR A GROUP 5 OR INDIVIDUAL POLICY PURSUANT TO SECTION FOUR THOUSAND THREE HUNDRED 6 TWENTY-SIX OF THIS CHAPTER or issuing a group or school blanket policy 7 OR A GROUP OR INDIVIDUAL POLICY PURSUANT TO SECTION FOUR THOUSAND THREE 8 HUNDRED TWENTY-SIX OF THIS CHAPTER for delivery, in this state, which 9 provides coverage for inpatient hospital care or coverage for physician 10 services shall provide as part of such policy broad-based coverage for 11 the diagnosis and treatment of mental, nervous or emotional disorders or 12 ailments, however defined in such policy, at least equal to the coverage 13 provided for other health conditions and: 14 S 2. Item (i) of subparagraph (B) of paragraph 5 of subsection (l) of 15 section 3221 of the insurance law, as amended by chapter 502 of the laws 16 of 2007, is amended to read as follows: 17 (i) Every insurer delivering a group or school blanket policy OR A 18 GROUP OR INDIVIDUAL POLICY PURSUANT TO SECTION FOUR THOUSAND THREE 19 HUNDRED TWENTY-SIX OF THIS CHAPTER or issuing a group or school blanket 20 policy OR A GROUP OR INDIVIDUAL POLICY PURSUANT TO SECTION FOUR THOUSAND 21 THREE HUNDRED TWENTY-SIX OF THIS CHAPTER for delivery, in this state, 22 which provides coverage for inpatient hospital care or coverage for 23 physician services, shall provide comparable coverage for adults and 24 children with biologically based mental illness. Such group policies 25 issued or delivered in this state shall also provide such comparable EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02185-01-1 S. 1121 2 1 coverage for children with serious emotional disturbances. Such coverage 2 shall be provided under the terms and conditions otherwise applicable 3 under the policy, including network limitations or variations, exclu- 4 sions, co-pays, coinsurance, deductibles or other specific cost sharing 5 mechanisms. Provided further, where a policy provides both in-network 6 and out-of-network benefits, the out-of-network benefits may have 7 different coinsurance, co-pays, or deductibles, than the in-network 8 benefits, regardless of whether the policy is written under one license 9 or two licenses. 10 S 3. Subparagraph (D) of paragraph 5 of subsection (l) of section 3221 11 of the insurance law, as amended by chapter 502 of the laws of 2007, 12 item (ii) as amended by section 1 of part A of chapter 503 of the laws 13 of 2009, is amended to read as follows: 14 (D) [(i) The provisions of subparagraph (B) of this paragraph shall 15 not apply to any group purchaser with fifty or fewer employees that is a 16 policyholder of a policy that is subject to the provisions of this 17 section; provided however that an insurer must make available, and if 18 requested by such group purchaser, provide the coverage as specified in 19 subparagraph (B) of this paragraph. Written notice of the availability 20 of the coverage shall be delivered to the policyholder prior to incep- 21 tion of the group policy and annually thereafter. 22 (ii)] The superintendent shall develop and implement a methodology to 23 cover the cost to any [such] INDIVIDUAL PURCHASER OR group purchaser 24 WITH FIFTY OR FEWER EMPLOYEES THAT IS A POLICYHOLDER OF A POLICY THAT IS 25 SUBJECT TO THE PROVISIONS OF THIS SECTION for providing the coverage 26 required in subparagraph (A) of this paragraph. Such methodology shall 27 be financed from moneys appropriated from the General Fund that shall be 28 made available to the superintendent for such purposes, to the extent of 29 funds available. 30 S 4. The opening paragraph of paragraph 1 of subsection (g) of section 31 4303 of the insurance law, as amended by chapter 502 of the laws of 32 2007, is amended to read as follows: 33 A hospital service corporation or a health service corporation, which 34 provides group, group remittance or school blanket coverage OR GROUP OR 35 INDIVIDUAL COVERAGE PURSUANT TO SECTION FOUR THOUSAND THREE HUNDRED 36 TWENTY-SIX OF THIS ARTICLE for inpatient hospital care, shall provide as 37 part of its contract broad-based coverage for the diagnosis and treat- 38 ment of mental, nervous or emotional disorders or ailments, however 39 defined in such contract, at least equal to the coverage provided for 40 other health conditions and shall include: 41 S 5. Subparagraph (A) of paragraph 2 of subsection (g) of section 4303 42 of the insurance law, as amended by chapter 502 of the laws of 2007, is 43 amended to read as follows: 44 (A) A hospital service corporation or a health service corporation, 45 which provides group, group remittance or school blanket coverage OR 46 GROUP OR INDIVIDUAL COVERAGE PURSUANT TO SECTION FOUR THOUSAND THREE 47 HUNDRED TWENTY-SIX OF THIS ARTICLE for inpatient hospital care, shall 48 provide comparable coverage for adults and children with biologically 49 based mental illness. Such hospital service corporation or health 50 service corporation shall also provide such comparable coverage for 51 children with serious emotional disturbances. Such coverage shall be 52 provided under the terms and conditions otherwise applicable under the 53 contract, including network limitations or variations, exclusions, 54 co-pays, coinsurance, deductibles or other specific cost sharing mech- 55 anisms. Provided further, where a contract provides both in-network and 56 out-of-network benefits, the out-of-network benefits may have different S. 1121 3 1 coinsurance, co-pays, or deductibles, than the in-network benefits, 2 regardless of whether the contract is written under one license or two 3 licenses. 4 S 6. Paragraph 4 of subsection (g) of section 4303 of the insurance 5 law, as amended by chapter 502 of the laws of 2007, subparagraph (B) as 6 amended by section 2 of part A of chapter 503 of the laws of 2009, is 7 amended to read as follows: 8 (4) [(A) The provisions of paragraph two of this subsection shall not 9 apply to any group remittance group or group contract holder with fifty 10 or fewer employees who is a group remittance group or group contract 11 holder of a policy that is subject to the provisions of this section; 12 provided however that a hospital service corporation or health service 13 corporation must make available, and if requested by such group remit- 14 ting agent or group contract holder, provide the coverage as specified 15 in paragraph two of this subsection. Written notice of the availability 16 of such coverage shall be delivered to the remitting agent or group 17 contract holder prior to inception of such contract and annually there- 18 after. 19 (B)] The superintendent shall develop and implement a methodology to 20 cover the cost to any [such] INDIVIDUAL CONTRACT HOLDER OR group 21 contract holder WITH FIFTY OR FEWER EMPLOYEES THAT IS A GROUP REMITTANCE 22 GROUP OR GROUP CONTRACT HOLDER OF A POLICY THAT IS SUBJECT TO THE 23 PROVISIONS OF THIS SECTION for providing the coverage required in para- 24 graph one of this subsection. Such methodology shall be financed from 25 moneys appropriated from the General Fund that shall be made available 26 to the superintendent for such purposes, to the extent of funds avail- 27 able. 28 S 7. Paragraph 1 of subsection (h) of section 4303 of the insurance 29 law, as amended by chapter 502 of the laws of 2007, is amended to read 30 as follows: 31 (1) A medical expense indemnity corporation or a health service corpo- 32 ration, which provides group, group remittance or school blanket cover- 33 age OR GROUP OR INDIVIDUAL COVERAGE PURSUANT TO SECTION FOUR THOUSAND 34 THREE HUNDRED TWENTY-SIX OF THIS ARTICLE for physician services, shall 35 provide as part of its contract broad-based coverage for the diagnosis 36 and treatment of mental, nervous or emotional disorders or ailments, 37 however defined in such contract, at least equal to the coverage 38 provided for other health conditions and shall include: benefits for 39 outpatient care provided by a psychiatrist or psychologist licensed to 40 practice in this state, a licensed clinical social worker who meets the 41 requirements of subsection (n) of this section, or a professional corpo- 42 ration or university faculty practice corporation thereof, which bene- 43 fits may be limited to not less than twenty visits in any contract year, 44 plan year or calendar year. Such coverage may be provided on a contract 45 year, plan year or calendar year basis and shall be consistent with the 46 provision of other benefits under the contract. Such coverage may be 47 subject to annual deductibles, co-pays and coinsurance as may be deemed 48 appropriate by the superintendent and shall be consistent with those 49 imposed on other benefits under the contract. In the event the group 50 remittance group or contract holder is provided coverage provided under 51 this paragraph and under subparagraph (B) of paragraph one of subsection 52 (g) of this section from the same health service corporation, or under a 53 contract which is jointly underwritten by two health service corpo- 54 rations or by a health service corporation and a medical expense indem- 55 nity corporation, the aggregate of the benefits for out-patient care 56 obtained under subparagraph (B) of paragraph one of subsection (g) of S. 1121 4 1 this section and this paragraph may be limited to not less than twenty 2 visits in any contract year, plan year or calendar year. 3 S 8. Subparagraph (A) of paragraph 2 of subsection (h) of section 4303 4 of the insurance law, as amended by chapter 502 of the laws of 2007, is 5 amended to read as follows: 6 (A) A medical expense indemnity corporation or a health service corpo- 7 ration, which provides group, group remittance or school blanket cover- 8 age OR GROUP OR INDIVIDUAL COVERAGE PURSUANT TO SECTION FOUR THOUSAND 9 THREE HUNDRED TWENTY-SIX OF THIS ARTICLE for physician services, shall 10 provide comparable coverage for adults and children with biologically 11 based mental illness. Such medical expense indemnity corporation or 12 health service corporation shall also provide such comparable coverage 13 for children with serious emotional disturbances. Such coverage shall be 14 provided under the terms and conditions otherwise applicable under the 15 contract, including network limitations or variations, exclusions, 16 co-pays, coinsurance, deductibles or other specific cost sharing mech- 17 anisms. Provided further, where a contract provides both in-network and 18 out-of-network benefits, the out-of-network benefits may have different 19 coinsurance, co-pays, or deductibles, than the in-network benefits, 20 regardless of whether the contract is written under one license or two 21 licenses. 22 S 9. Paragraph 4 of subsection (h) of section 4303 of the insurance 23 law, as amended by chapter 502 of the laws of 2007, subparagraph (B) as 24 amended by section 3 of part A of chapter 503 of the laws of 2009, is 25 amended to read as follows: 26 (4) [(A) The provisions of paragraph two of this subsection shall not 27 apply to any group remittance group or group contract holder with fifty 28 or fewer employees who is a group remittance group or group contract 29 holder of a contract that is subject to the provisions of this section; 30 provided, however, that a hospital service corporation or health service 31 corporation must make available, and if requested by such group remit- 32 ting agent or group contract holder, provide the coverage as specified 33 in paragraph two of this subsection. Written notice of the availability 34 of the coverage shall be delivered to the group remitting agent or group 35 contract holder prior to inception of such contract and annually there- 36 after. 37 (B)] The superintendent shall develop and implement a methodology to 38 cover the cost to any [such] group remittance group and INDIVIDUAL 39 CONTRACT HOLDER OR group contract holder WITH FIFTY OR FEWER EMPLOYEES 40 THAT IS A GROUP REMITTANCE GROUP OR GROUP CONTRACT HOLDER OF A POLICY 41 THAT IS SUBJECT TO THE PROVISIONS OF THIS SECTION for providing the 42 coverage required in paragraph one of this subsection. Such methodology 43 shall be financed from moneys appropriated from the General Fund that 44 shall be made available to the superintendent for such purposes, to the 45 extent of funds available. 46 S 10. This act shall take effect immediately.