BILL NUMBER:S7071                REVISED 5/21/14

TITLE OF BILL:  An act to amend the insurance law, in relation to
requiring health insurance coverage of inpatient treatment of opioid
addiction

PURPOSE: Requires health insurance policies to provide coverage of
both inpatient and outpatient opioid addiction treatment services.

SUMMARY OF PROVISIONS:

Section One - amends Section 3216 of the insurance law by adding a new
paragraph 30 to state that every policy delivered or issued in New
York state that provides major medical or similar comprehensive type
coverage will include coverage for both inpatient and outpatient
opioid addiction services that are provided by a qualified health
professional, as defined in the regulations of the commissioner of
alcoholism and substance abuse.

Section One - states the only prerequisite for the coverage of
hospital or non-hospital based opioid addiction services, including
medically managed, medically supervised and medically monitored
withdrawal, or inpatient or intensive residential rehabilitation, or
intensive or routine outpatient treatment will be that a covered
person be certified and referred by a qualified health professional.
Such certification and referral will control both the nature and
              

duration of covered treatment; provided, however, that such coverage
will be terminated when the admitting or attending physician, or a
physician assistant or nurse practitioner acting under the supervision
of a physician, providing opioid addiction services, rehabilitation or
outpatient treatment certifies that admission of the covered person is
not necessary, early discharge is appropriate or additional inpatient
days or sessions are necessary.

Section Two - amends Section 3221 of the insurance law by adding a new
paragraph 19 to state that every group or blanket policy delivered or
issued for delivery in this state that provides major medical or
similar comprehensive type coverage will include coverage for both
inpatient and outpatient opioid addiction services that are provided
by a qualified health professional, as defined in the regulations of
the commissioner of alcoholism and substance abuse services.

Section Two - states the only prerequisite for the coverage of
hospital or non-hospital based opioid addiction services, including
medically managed, medically supervised and medically monitored
withdrawal, or inpatient or intensive residential rehabilitation, or
intensive or routine outpatient treatment will be that a covered
person be certified and referred by a qualified health professional.
Such certification and referral will control both the nature and
duration of covered treatment; provided, however, that such coverage
will be terminated when the admitting or attending physician, or a
physician assistant or nurse practitioner acting under the supervision
of a physician, providing opioid addiction services, rehabilitation or
outpatient treatment certifies that admission of the covered person is
not necessary, early discharge is appropriate or additional inpatient
days or sessions are necessary.


Section Three - amends Section 4303 of the insurance law by adding a
new subsection (oo) to state every contract issued by a hospital
service company or health service corporation which provides major
medical or similar comprehensive type coverage will include coverage
for both impatient and outpatient opioid addiction services that are
provided by a qualified health professional, as defined in the
regulations of the commissioner of alcoholism and substance abuse
services.

Section Three - states the only prerequisite for the coverage of
hospital or non-hospital based opioid addiction services, including
medically managed, medically supervised and medically monitored
withdrawal, or inpatient or intensive residential rehabilitation, or
intensive or routine outpatient treatment will be that a covered
person be certified and referred by a qualified health professional.
Such certification and referral will control both the nature and
duration of covered treatment; provided, however, that such coverage
will be terminated when the admitting or attending physician, or a
physician assistant or nurse practitioner acting under the supervision
of a physician, providing opioid addiction services, rehabilitation or
outpatient treatment certifies that admission of the covered person is
not necessary, early discharge is appropriate or additional inpatient
days or sessions are necessary.

Section Four - this act will take effect on the thirtieth day after it
has become law.

JUSTIFICATION: Heroin use is on the rise throughout New York State -
an alarming trend that transcends regions, race, gender and economic
status. The New York State legislature cannot turn a blind eye to this
deadly epidemic, and it is time to be proactive and develop a
comprehensive solution.

To combat this scourge, we need to join together and discover new
preventative measures, while expanding and improving the treatment
options for those suffering from opioid addiction. When an individual
suffering from an opioid addiction makes the decision to get help,
there is a window to provide them with the care and assistance they
need to have a successful recovery.

In certain cases, a qualified health care professional will require an
individual to be admitted as an inpatient to be able to get the proper
help they need to fight an opioid addiction. This legislation would
successfully enable a request to be made by a qualified health care
professional and require health insurance coverage of an individual
requiring inpatient services, to receive the medical assistance for
proper treatment of an opioid addiction before it is too late.

Often times insurance companies require an individual to try
outpatient treatment before they can be admitted as an inpatient.
That requirement by insurance companies shortens the little window
time the individual has to get better and defeat their addiction. By
requiring inpatient treatment immediately, that gap of wasted time
spent receiving outpatient treatment is eliminated. Getting an
individual in the care of a professional as soon as possible is vital
to the defeat of the addiction.


LEGISLATIVE HISTORY: New Legislation.

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: This act shall take effect on the thirtieth day after
it shall have become a law.