Bill Text: NY S01235 | 2011-2012 | General Assembly | Introduced
Bill Title: Provides certain coverage for diagnosis and treatment of chemical abuse and chemical dependence.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2012-01-04 - REFERRED TO INSURANCE [S01235 Detail]
Download: New_York-2011-S01235-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 1235 2011-2012 Regular Sessions I N S E N A T E January 6, 2011 ___________ Introduced by Sen. DUANE -- 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 providing certain coverage for diagnosis and treatment of chemical abuse and chemical dependence THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Paragraph 6 of subsection (l) of section 3221 of the insur- 2 ance law, as amended by chapter 558 of the laws of 1999, is amended to 3 read as follows: 4 (6) (A) Every insurer delivering a group or school blanket policy or 5 issuing a group or school blanket policy for delivery, in this state, 6 which provides coverage for inpatient hospital care [must make available 7 and, if requested by the policyholder,] OR COVERAGE FOR PHYSICIAN 8 SERVICES SHALL provide AS PART OF SUCH POLICY BROAD-BASED coverage for 9 the diagnosis and treatment of chemical abuse and chemical dependence, 10 however defined in such policy, AT LEAST EQUAL TO THE COVERAGE PROVIDED 11 FOR OTHER HEALTH CONDITIONS, provided, however, that the term chemical 12 abuse shall mean and include alcohol and substance abuse and chemical 13 dependence shall mean and include alcoholism and substance dependence, 14 however defined in such policy. [Written notice of the availability of 15 such coverage shall be delivered to the policyholder prior to inception 16 of such group policy and annually thereafter, except that this notice 17 shall not be required where a policy covers two hundred or more employ- 18 ees or where the benefit structure was the subject of collective 19 bargaining affecting persons who are employed in more than one state.] 20 (B) Such coverage shall, WHERE THE POLICY PROVIDES COVERAGE FOR INPA- 21 TIENT HOSPITAL CARE, be at least equal to the following: 22 (i) with respect to benefits for detoxification as a consequence of 23 chemical dependence, inpatient benefits in a hospital or a detoxifica- EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01208-01-1 S. 1235 2 1 tion facility may not be limited to less than seven days of active 2 treatment in any CONTRACT YEAR, PLAN YEAR, OR calendar year; and 3 (ii) with respect to benefits for rehabilitation services, such bene- 4 fits may not be limited to less than thirty days of inpatient care in 5 any calendar year. 6 (C) Such coverage may be limited to facilities in New York state which 7 are certified by the office of alcoholism and substance abuse services 8 and, in other states, to those which are accredited by the joint commis- 9 sion on accreditation of hospitals as alcoholism, substance abuse or 10 chemical dependence treatment programs. 11 (D) Such coverage shall be [made available] PROVIDED at the inception 12 of all new policies and with respect to all other policies at any anni- 13 versary date of the policy [subject to evidence of insurability]. 14 (E) Such coverage may be subject to annual deductibles, CO-PAYS and 15 co-insurance as may be deemed appropriate by the superintendent and are 16 consistent with those imposed on other benefits [within a given] UNDER 17 THE policy. [Further, each insurer shall report to the superintendent 18 each year the number of contract holders to whom it has issued policies 19 for the inpatient treatment of chemical dependence, and the approximate 20 number of persons covered by such policies] IN THE EVENT THAT A POLICY 21 PROVIDES COVERAGE FOR BOTH INPATIENT HOSPITAL CARE AND PHYSICIAN 22 SERVICES, THE AGGREGATE OF THE BENEFITS FOR OUTPATIENT CARE OBTAINED 23 UNDER THIS PARAGRAPH MAY BE LIMITED TO NOT LESS THAN SIXTY VISITS IN ANY 24 CONTRACT YEAR, PLAN YEAR OR CALENDAR YEAR. 25 (F) Such coverage shall not replace, restrict or eliminate existing 26 coverage provided by the policy. 27 (G) THE SUPERINTENDENT SHALL DEVELOP AND IMPLEMENT A METHODOLOGY TO 28 FULLY COVER THE COST TO ANY GROUP PURCHASER WITH FIFTY OR FEWER EMPLOY- 29 EES THAT IS A POLICYHOLDER OF A POLICY THAT IS SUBJECT TO THE PROVISIONS 30 OF THIS SECTION FOR PROVIDING THE COVERAGE REQUIRED IN THIS PARAGRAPH 31 AND PARAGRAPH SEVEN OF THIS SUBSECTION. SUCH METHODOLOGY SHALL BE 32 FINANCED FROM FUNDS FROM THE GENERAL FUND THAT SHALL BE MADE AVAILABLE 33 TO THE SUPERINTENDENT FOR SUCH PURPOSE. 34 S 2. Paragraph 7 of subsection (1) of section 3221 of the insurance 35 law, as amended by chapter 565 of the laws of 2000, is amended to read 36 as follows: 37 (7) Every insurer delivering a group or school blanket policy or issu- 38 ing a group or school blanket policy for delivery in this state which 39 provides coverage for inpatient hospital care [must] OR COVERAGE FOR 40 PHYSICIAN SERVICES SHALL provide AS PART OF SUCH POLICY coverage for at 41 least sixty outpatient visits in any CONTRACT YEAR, PLAN YEAR OR calen- 42 dar year for the diagnosis and treatment of chemical dependence of which 43 up to twenty may be for family members, except that this provision shall 44 not apply to a policy which covers persons employed in more than one 45 state or the benefit structure of which was the subject of collective 46 bargaining affecting persons who are employed in more than one state. 47 Such coverage may be limited to facilities in New York state certified 48 by the office of alcoholism and substance abuse services or licensed by 49 such office as outpatient clinics or medically supervised ambulatory 50 substance abuse programs and, in other states, to those which are 51 accredited by the joint commission on accreditation of hospitals as 52 alcoholism or chemical dependence treatment programs. WHERE THE POLICY 53 PROVIDES COVERAGE FOR PHYSICIAN SERVICES, IT SHALL INCLUDE BENEFITS FOR 54 OUTPATIENT CARE PROVIDED BY A PSYCHIATRIST OR PSYCHOLOGIST LICENSED TO 55 PRACTICE IN THIS STATE, A LICENSED CLINICAL SOCIAL WORKER WHO MEETS THE 56 REQUIREMENTS OF SUBPARAGRAPH (D) OF PARAGRAPH FOUR OF THIS SUBSECTION, S. 1235 3 1 OR A PROFESSIONAL CORPORATION OR UNIVERSITY FACULTY PRACTICE CORPORATION 2 THEREOF. Such coverage may be subject to annual deductibles, CO-PAYS and 3 co-insurance as may be deemed appropriate by the superintendent and 4 [are] SHALL BE consistent with those imposed on other benefits [within a 5 given] UNDER THE policy. IN THE EVENT THAT A POLICY PROVIDES COVERAGE 6 FOR BOTH INPATIENT HOSPITAL CARE AND PHYSICIAN SERVICES, THE AGGREGATE 7 OF THE BENEFITS FOR OUTPATIENT CARE OBTAINED UNDER THIS PARAGRAPH MAY BE 8 LIMITED TO NOT LESS THAN SIXTY VISITS IN ANY CONTRACT YEAR, PLAN YEAR OR 9 CALENDAR YEAR. Such coverage shall not replace, restrict, or eliminate 10 existing coverage provided by the policy. Except as otherwise provided 11 in the applicable policy or contract, no insurer delivering a group or 12 school blanket policy or issuing a group or school blanket policy 13 providing coverage for alcoholism or substance abuse services pursuant 14 to this section shall deny coverage to a family member who identifies 15 [themself] HIMSELF OR HERSELF as a family member of a person suffering 16 from the disease of alcoholism, substance abuse or chemical dependency 17 and who seeks treatment as a family member who is otherwise covered by 18 the applicable policy or contract pursuant to this section. The coverage 19 required by this paragraph shall include treatment as a family member 20 pursuant to such family members' own policy or contract provided such 21 family member (i) does not exceed the allowable number of family visits 22 provided by the applicable policy or contract pursuant to this section, 23 and (ii) is otherwise entitled to coverage pursuant to this section and 24 such family members' applicable policy or contract. 25 S 3. Subsection (k) of section 4303 of the insurance law, as amended 26 by chapter 558 of the laws of 1999, is amended to read as follows: 27 (k) A hospital service corporation or a health service corporation 28 which provides group, group remittance or school blanket coverage for 29 inpatient hospital care [must make available and if requested by the 30 contract holder] SHALL provide AS PART OF ITS CONTRACT BROAD-BASED 31 coverage for the diagnosis and treatment of chemical abuse and chemical 32 dependence, however defined in such policy, AT LEAST EQUAL TO THE COVER- 33 AGE PROVIDED FOR OTHER HEALTH CONDITIONS, provided, however, that the 34 term chemical abuse shall mean and include alcohol and substance abuse 35 and chemical dependence shall mean and include alcoholism and substance 36 dependence, however defined in such policy, except that this provision 37 shall not apply to a policy which covers persons employed in more than 38 one state or the benefit structure of which was the subject of collec- 39 tive bargaining affecting persons who are employed in more than one 40 state. Such coverage shall be at least equal to the following: (1) with 41 respect to benefits for detoxification as a consequence of chemical 42 dependence, inpatient benefits for care in a hospital or detoxification 43 facility may not be limited to less than seven days of active treatment 44 in any CONTRACT YEAR, PLAN YEAR OR calendar year; and (2) with respect 45 to benefits for inpatient rehabilitation services, such benefits may not 46 be limited to less than thirty days of inpatient rehabilitation in a 47 hospital based or free standing chemical dependence facility in any 48 CONTRACT YEAR, PLAN YEAR OR calendar year. Such coverage may be limited 49 to facilities in New York state which are certified by the office of 50 alcoholism and substance abuse services and, in other states, to those 51 which are accredited by the joint commission on accreditation of hospi- 52 tals as alcoholism, substance abuse, or chemical dependence treatment 53 programs. Such coverage [shall be made available at the inception of all 54 new policies and with respect to policies issued before the effective 55 date of this subsection at the first annual anniversary date thereafter, 56 without evidence of insurability and at any subsequent annual anniver- S. 1235 4 1 sary date subject to evidence of insurability] MAY BE PROVIDED ON A 2 CONTRACT YEAR, PLAN YEAR OR CALENDAR YEAR BASIS AND SHALL BE CONSISTENT 3 WITH THE PROVISIONS OF OTHER BENEFITS UNDER THE CONTRACT. Such coverage 4 may be subject to annual deductibles, CO-PAYS and co-insurance as may be 5 deemed appropriate by the superintendent and are consistent with those 6 imposed on other benefits [within a given policy. Further, each hospital 7 service corporation or health service corporation shall report to the 8 superintendent each year the number of contract holders to whom it has 9 issued policies for the inpatient treatment of chemical dependence, and 10 the approximate number of persons covered by such policies] UNDER THE 11 CONTRACT. Such coverage shall not replace, restrict or eliminate exist- 12 ing coverage provided by the policy. [Written notice of the availability 13 of such coverage shall be delivered to the group remitting agent or 14 group contract holder prior to inception of such contract and annually 15 thereafter, except that this notice shall not be required where a policy 16 covers two hundred or more employees or where the benefit structure was 17 the subject of collective bargaining affecting persons who are employed 18 in more than one state] THE SUPERINTENDENT SHALL DEVELOP AND IMPLEMENT A 19 METHODOLOGY TO FULLY COVER THE COST TO ANY GROUP REMITTANCE GROUP OR 20 GROUP CONTRACT HOLDER WITH FIFTY OR FEWER EMPLOYEES WHO IS A GROUP 21 REMITTANCE GROUP OR GROUP CONTRACT HOLDER OF A POLICY THAT IS SUBJECT TO 22 THE PROVISIONS OF THIS SECTION FOR PROVIDING THE COVERAGE REQUIRED IN 23 THIS SUBSECTION AND SUBSECTION (L) OF THIS SECTION. SUCH METHODOLOGY 24 SHALL BE FINANCED FROM FUNDS FROM THE GENERAL FUND THAT SHALL BE MADE 25 AVAILABLE TO THE SUPERINTENDENT FOR SUCH PURPOSE. 26 S 4. Subsection (l) of section 4303 of the insurance law, as amended 27 by chapter 565 of the laws of 2000, is amended to read as follows: 28 (l) A hospital service corporation or a health service corporation 29 which provides group, group remittance or school blanket coverage for 30 inpatient hospital care [must] SHALL provide AS PART OF ITS CONTRACT 31 coverage for at least sixty outpatient visits in any CONTRACT YEAR, PLAN 32 YEAR OR calendar year for the diagnosis and treatment of chemical 33 dependence of which up to twenty may be for family members, except that 34 this provision shall not apply to a contract issued pursuant to section 35 four thousand three hundred five of this article which covers persons 36 employed in more than one state or the benefit structure of which was 37 the subject of collective bargaining affecting persons who are employed 38 in more than one state. Such coverage may be limited to facilities in 39 New York state certified by the office of alcoholism and substance abuse 40 services or licensed by such office as outpatient clinics or medically 41 supervised ambulatory substance abuse programs and, in other states, to 42 those which are accredited by the joint commission on accreditation of 43 hospitals as alcoholism or chemical dependence substance abuse treatment 44 programs. SUCH COVERAGE MAY BE PROVIDED ON A CONTRACT YEAR, PLAN YEAR 45 OR CALENDAR YEAR BASIS AND SHALL BE CONSISTENT WITH THE PROVISION OF 46 OTHER BENEFITS UNDER THE CONTRACT. Such coverage may be subject to annu- 47 al deductibles, CO-PAYS and co-insurance as may be deemed appropriate by 48 the superintendent and are consistent with those imposed on other bene- 49 fits [within a given policy] UNDER THE CONTRACT. Such coverage shall 50 not replace, restrict or eliminate existing coverage provided by the 51 policy. Except as otherwise provided in the applicable policy or 52 contract, no hospital service corporation or health service corporation 53 providing coverage for alcoholism or substance abuse services pursuant 54 to this section shall deny coverage to a family member who identifies 55 [themself] HIMSELF OR HERSELF as a family member of a person suffering 56 from the disease of alcoholism, substance abuse or chemical dependency S. 1235 5 1 and who seeks treatment as a family member who is otherwise covered by 2 the applicable policy or contract pursuant to this section. The coverage 3 required by this subsection shall include treatment as a family member 4 pursuant to such family members' own policy or contract provided such 5 family member (i) does not exceed the allowable number of family visits 6 provided by the applicable policy or contract pursuant to this section, 7 and (ii) is otherwise entitled to coverage pursuant to this section and 8 such family members' applicable policy or contract. 9 S 5. The superintendent of insurance shall monitor the implementation 10 of the coverage required pursuant to paragraphs 6 and 7 of subsection 11 (l) of section 3221, and subsections (k) and (l) of section 4303 of the 12 insurance law, and take such action as may be necessary, to ensure that 13 insurers' contracts or policies do not contain unreasonable definitions 14 of chemical abuse, alcohol and substance abuse, chemical dependence, 15 alcoholism and substance dependence in their contracts or policies. In 16 determining whether such definitions may be unreasonable, the super- 17 intendent of insurance shall ensure that any exclusions and limitations 18 on covered benefits are consistent with benefits provided to public 19 officers and employees pursuant to article 11 of the civil service law. 20 S 6. This act shall take effect on the first of January next succeed- 21 ing the date on which it shall have become a law; and the provisions of 22 this act shall apply to policies and contracts issued, renewed, modi- 23 fied, altered or amended on or after such effective date.