Assembly Bill A9943B

2013-2014 Legislative Session

Relates to insurance coverage for diagnosis and treatment of substance use disorder benefits

download bill text pdf

Sponsored By

Archive: Last Bill Status - In Assembly 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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Bill Amendments

2013-A9943 - Details

See Senate Version of this Bill:
S7882
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221, 4303, 4902, 4903 & 4904, Ins L; amd §§4902, 4903 & 4904, Pub Health L

2013-A9943 - Summary

Relates to insurance coverage for diagnosis and treatment of substance use disorder benefits; creates a workgroup to study and make recommendations on improving access to and the availability of chemical dependency or substance use disorder treatment services.

2013-A9943 - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  9943

                          I N  A S S E M B L Y

                              June 2, 2014
                               ___________

Introduced  by  COMMITTEE ON RULES -- (at request of M. of A. Cusick) --
  read once and referred to the Committee on Insurance

AN ACT to amend the insurance law, in relation to insurance coverage for
  substance abuse disorder

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  The insurance law is amended by adding a new section 3242
to read as follows:
  S 3242. COVERAGE FOR SUBSTANCE ABUSE DISORDER. (A) (1) WHEN CONDUCTING
MEDICAL MANAGEMENT OR UTILIZATION REVIEW  FOR  PURPOSES  OF  DETERMINING
HEALTH  CARE  COVERAGE FOR SUBSTANCE ABUSE DISORDER, A HEALTH PLAN SHALL
USE A HEALTH CARE PROVIDER  WHO  SPECIALIZES  IN  BEHAVIORAL  HEALTH  OR
SUBSTANCE  ABUSE DISORDER TREATMENT TO SUPERVISE AND OVERSEE THE MEDICAL
MANAGEMENT DECISIONS RELATING TO SUBSTANCE ABUSE TREATMENT.
  (2) A HEALTH PLAN SHALL ONLY UTILIZE CLINICAL  REVIEW  CRITERIA  WHICH
ARE BASED ON THE AMERICAN SOCIETY OF ADDICTION MEDICINE'S PATIENT PLACE-
MENT  CRITERIA,  OR  ANY  OTHER  NATIONALLY DEVELOPED, PEER REVIEWED AND
WIDELY ACCEPTED CARE CRITERIA OR COMPENDIA WHICH ARE DEEMED  APPROPRIATE
BY  THE  OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, IN CONSULTA-
TION WITH THE COMMISSIONER OF HEALTH AND THE SUPERINTENDENT.
  (3) THE TREATING HEALTHCARE PROVIDER, WHO SHALL BE A QUALIFIED  HEALTH
PROFESSIONAL  AS  DEFINED  IN  REGULATIONS  ESTABLISHED BY THE OFFICE OF
ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, SHALL, TO THE EXTENT  POSSIBLE,
ALSO  UTILIZE  CLINICAL  REVIEW CRITERIA WHICH ARE BASED ON THE AMERICAN
SOCIETY OF ADDICTION MEDICINE'S PATIENT PLACEMENT CRITERIA, OR ANY OTHER
NATIONALLY DEVELOPED, PEER REVIEWED AND WIDELY ACCEPTED CARE CRITERIA OR
COMPENDIA WHICH ARE DEEMED APPROPRIATE BY THE OFFICE OF  ALCOHOLISM  AND
SUBSTANCE  ABUSE  SERVICES,  IN  CONSULTATION  WITH  THE COMMISSIONER OF
HEALTH AND THE SUPERINTENDENT, WHEN MAKING RECOMMENDATIONS  RELATING  TO
SUBSTANCE ABUSE TREATMENT ON BEHALF OF AN INSURED.
  (4)  THE  TREATING  HEALTHCARE  PROVIDER SHALL SUBMIT ALL REQUESTS FOR
PRIOR AUTHORIZATIONS AND ALL APPEALS TO AN INSURED'S HEALTH  PLAN  IN  A
TIMELY FASHION.
  (5)  WHERE AN INSURED'S TREATING HEALTHCARE PROVIDER DETERMINES THAT A
DELAY IN PROVIDING CARE OR  TREATMENT  RELATING  TO  A  SUBSTANCE  ABUSE
DISORDER  WOULD  POSE  A  SERIOUS  THREAT TO THE HEALTH OR SAFETY OF THE
INSURED, ALL INTERNAL AND EXTERNAL APPEALS OF UTILIZATION REVIEW  DETER-
              

co-Sponsors

2013-A9943A - Details

See Senate Version of this Bill:
S7882
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221, 4303, 4902, 4903 & 4904, Ins L; amd §§4902, 4903 & 4904, Pub Health L

2013-A9943A - Summary

Relates to insurance coverage for diagnosis and treatment of substance use disorder benefits; creates a workgroup to study and make recommendations on improving access to and the availability of chemical dependency or substance use disorder treatment services.

2013-A9943A - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 9943--A

                          I N  A S S E M B L Y

                              June 2, 2014
                               ___________

Introduced  by  COMMITTEE ON RULES -- (at request of M. of A. Cusick) --
  read once and referred to the  Committee  on  Insurance  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN ACT to amend the insurance law and the public health law, in relation
  to  requiring  health  insurance coverage for substance abuse disorder
  treatment services and creating a workgroup to study and  make  recom-
  mendations

  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  the  insurance  law  is
amended by adding a new paragraph 30 to read as follows:
  (30)  (A) EVERY POLICY THAT PROVIDES MEDICAL, MAJOR-MEDICAL OR SIMILAR
COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE SPECIFIC COVERAGE FOR DRUG AND
ALCOHOL ABUSE AND DEPENDENCY TREATMENT SERVICES PURSUANT TO THE  FEDERAL
PAUL  WELLSTONE  AND  PETE  DOMENICI  MENTAL HEALTH PARITY AND ADDICTION
EQUITY ACT OF 2008, AND APPLICABLE STATE STATUTES WHICH REQUIRES  PARITY
BETWEEN   MENTAL   HEALTH   OR   SUBSTANCE  USE  DISORDER  BENEFITS  AND
MEDICAL/SURGICAL BENEFITS WITH RESPECT  TO  FINANCIAL  REQUIREMENTS  AND
TREATMENT.
  (B) DETERMINATION OF COVERAGE FOR SUBSTANCE ABUSE OR DEPENDENCY TREAT-
MENT  SERVICES  BY A HEALTH PLAN SHALL BE MADE THROUGH A MEDICAL MANAGE-
MENT REVIEW PROCESS WHICH:
  (I) UTILIZES A HEALTH CARE  PROVIDER  WHO  SPECIALIZES  IN  BEHAVIORAL
HEALTH AND WHO HAS EXPERIENCE IN THE DELIVERY OF SUBSTANCE ABUSE COURSES
OF  TREATMENT  TO SUPERVISE AND OVERSEE THE MEDICAL MANAGEMENT DECISIONS
RELATING TO SUBSTANCE ABUSE TREATMENT; AND
  (II) UTILIZES ONLY CLINICAL REVIEW  CRITERIA  CONTAINED  IN  THE  MOST
RECENT  EDITION  OF THE AMERICAN SOCIETY OF ADDICTION MEDICINE'S PATIENT
PLACEMENT CRITERIA OR OTHER RECOGNIZED AND  PEER  REVIEWED  CRITERIA  OR
COMPENDIA  DEEMED APPROPRIATE AND APPROVED FOR SUCH USE BY THE OFFICE OF
ALCOHOLISM AND SUBSTANCE ABUSE SERVICES IN CONSULTATION WITH THE COMMIS-
SIONER OF HEALTH AND THE SUPERINTENDENT. ANY ADDITIONAL  CRITERIA  SHALL
BE SUBJECT TO THE APPROVAL OF THE COMMISSIONER OF THE OFFICE OF ALCOHOL-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
              

co-Sponsors

2013-A9943B (ACTIVE) - Details

See Senate Version of this Bill:
S7882
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221, 4303, 4902, 4903 & 4904, Ins L; amd §§4902, 4903 & 4904, Pub Health L

2013-A9943B (ACTIVE) - Summary

Relates to insurance coverage for diagnosis and treatment of substance use disorder benefits; creates a workgroup to study and make recommendations on improving access to and the availability of chemical dependency or substance use disorder treatment services.

2013-A9943B (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 9943--B

                          I N  A S S E M B L Y

                              June 2, 2014
                               ___________

Introduced  by  COMMITTEE  ON  RULES  -- (at request of M. of A. Cusick,
  Weisenberg,  Ortiz,  Gunther,  Skoufis,  Rosenthal,  Titone,   Mosley,
  Peoples-Stokes,  Galef,  Barrett, Gottfried, Fahy, Braunstein, Camara,
  Cook, Hooper, Magee, O'Donnell, Rivera, Saladino, Sweeney, Thiele)  --
  read  once  and  referred  to  the Committee on Insurance -- committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee -- again reported from said  committee  with  amend-
  ments, ordered reprinted as amended and recommitted to said committee

AN ACT to amend the insurance law and the public health law, in relation
  to  requiring health insurance coverage for diagnosis and treatment of
  substance use disorder treatment services and creating a workgroup  to
  study and make recommendations

  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  the  insurance  law  is
amended by adding a new paragraph 30 to read as follows:
  (30)  (A) EVERY POLICY THAT PROVIDES MEDICAL, MAJOR-MEDICAL OR SIMILAR
COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE  COVERAGE  FOR  DIAGNOSIS  AND
TREATMENT  OF  SUBSTANCE  USE  DISORDER BENEFITS PURSUANT TO THE FEDERAL
PAUL WELLSTONE AND PETE DOMENICI  MENTAL  HEALTH  PARITY  AND  ADDICTION
EQUITY  ACT  OF  2008, AS AMENDED, OR OTHER APPLICABLE FEDERAL AND STATE
STATUTES AND RULES AND REGULATIONS  PROMULGATED  THERETO  WHICH  REQUIRE
PARITY  BETWEEN  MENTAL  HEALTH  OR  SUBSTANCE USE DISORDER BENEFITS AND
MEDICAL/SURGICAL BENEFITS WITH RESPECT  TO  FINANCIAL  REQUIREMENTS  AND
TREATMENT  OR  WHICH  REQUIRE  COVERAGE  OF  SUCH  TREATMENT,  WHICHEVER
PROVIDES A BENEFIT THAT IS MORE  ADVANTAGEOUS  TO  THE  POLICYHOLDER  AS
DETERMINED BY THE SUPERINTENDENT. SUCH COVERAGE SHALL INCLUDE BOTH INPA-
TIENT  AND  OUTPATIENT TREATMENT, INCLUDING DETOXIFICATION AND REHABILI-
TATION SERVICES.
  (B) IN THE EVENT OF AN ADVERSE DETERMINATION FOR SUBSTANCE USE  DISOR-
DER TREATMENT SERVICES, THE HEALTH PLAN SHALL CONTINUE TO PROVIDE COVER-
AGE  AND REIMBURSE FOR ALL SUCH SERVICES UNTIL THE INSURED HAS EXHAUSTED
ALL APPEALS, BOTH INTERNAL  AND  EXTERNAL,  OR  OTHERWISE  NOTIFIES  THE
HEALTH  PLAN  IN  WRITING THAT HE OR SHE HAS DECIDED TO NOT MOVE FORWARD

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
              

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