Bill S7103-2013

Requires health insurance to cover drug and alcohol abuse and dependency treatment services

Requires health insurance to cover drug and alcohol abuse and dependency treatment services.

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  • Apr 28, 2014: REFERRED TO INSURANCE

Memo

BILL NUMBER:S7103

TITLE OF BILL: An act to amend the insurance law, in relation to requiring health insurance coverage for drug and alcohol abuse and dependency treatment services

PURPOSE OR GENERAL IDEA OF BILL: To expand the time frame in which insurance companies will provide coverage for rehabilitation of opioid users.

SUMMARY OF SPECIFIC PROVISIONS: Section 1 amends subdivision B of paragraph 30 of subsection (i) of section 3216 of the insurance law to require every policy delivered or issued for delivery in New York State increase the length of coverage for addiction rehabilitation to no less than 60 days of treatment. It specifies that coverage can only be terminated when the admitting or attending physician certifies that there is no further treatment necessary and the patient should be discharged. This allows for up to an additional 30 days of treatment, for a total of 90 days, if the admitting or attending physician deems it necessary.

It further provides that if the admitting or attending physician certifies that treatment beyond 90 days is necessary, his or her certification shall be sufficient for eligibility for coverage through Medicaid as administered through county social services departments. Costs associated with continued Medicaid coverage shall be borne by the state.

Section 2 amends subdivision B of paragraph 19 of subsection 1 of section 3221 of the insurance law. This section's language mirrors that of section 1, requiring that every group or blanket policy delivered or issued for delivery in New York State be subject to the same provisions.

Section 3 amends subdivision 2 of subsection (oo) of Section 4303 of insurance law. This section's language again mirrors that of section 1, to require that every contract issued by a hospital service company or health service corporation meet the same provisions.

Section 4 is the effective date.

JUSTIFICATION: As addiction to opioids, and particularly to heroin, continues to rise in New York State, it is imperative that this public health issue be addressed in a comprehensive way. Most of the treatment programs provided by private sector insurance in New York only allow for up to 30 days of treatment coverage - a duration that is grossly inadequate for effective treatment. The result is a tragic scenario that plays out far too often in New York: parents who have health insurance coverage for their children that will not meet the needs of treating heroin addiction are forced to "emancipate" their loved ones so they qualify for Medicaid.

While requiring private sector policies to cover of up to 90 days will not bring comply with these federal Medicaid standards, it significantly improves on existing coverage. In addition, the bill provides for a

smooth transition from private coverage to Medicaid after 90 days, and ensures that any additional cost will be borne by the State, rather than counties.

PRIOR LEGISLATIVE HISTORY: New Bill - 2014

FISCAL IMPLICATIONS: To be determined.

EFFECTIVE DATE: This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to policies and contracts issued, renewed, modified, altered, or amended on or after such date.


Text

STATE OF NEW YORK ________________________________________________________________________ 7103 IN SENATE April 28, 2014 ___________
Introduced by Sens. GIPSON, BRESLIN, DILAN, HOYLMAN, KRUEGER, PARKER, PERKINS, STAVISKY -- 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 health insurance coverage for drug and alcohol abuse and dependency treatment services 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 DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH PROVIDES MEDICAL, MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE SPECIFIC COVERAGE FOR DRUG AND ALCOHOL ABUSE AND DEPENDENCY TREATMENT SERVICES THAT ARE CERTIFIED AS NECESSARY BY A QUAL- IFIED HEALTH PROFESSIONAL, AS DEFINED IN THE REGULATIONS OF THE COMMIS- SIONER OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES. (B) THE ONLY PREREQUISITE FOR THE COVERAGE OF HOSPITAL OR NON-HOSPITAL BASED DETOXIFICATION, INCLUDING MEDICALLY MANAGED, MEDICALLY SUPERVISED AND MEDICALLY MONITORED WITHDRAWAL, OR INPATIENT OR INTENSIVE RESIDEN- TIAL REHABILITATION, OR INTENSIVE OR ROUTINE OUTPATIENT TREATMENT, SHALL BE THAT A COVERED PERSON BE CERTIFIED AND REFERRED BY A QUALIFIED HEALTH PROFESSIONAL. SUCH CERTIFICATION AND REFERRAL SHALL CONTROL BOTH THE NATURE AND DURATION OF COVERED TREATMENT; PROVIDED, HOWEVER, THAT THE DURATION OF SUCH COVERAGE SHALL NOT BE LESS THAN SIXTY DAYS AND MAY BE TERMINATED ONLY WHEN AND IF THE ADMITTING OR ATTENDING PHYSICIAN, OR A PHYSICIAN ASSISTANT OR NURSE PRACTITIONER ACTING UNDER THE SUPERVISION OF THE ADMITTING OR ATTENDING PHYSICIAN, PROVIDING DETOXIFICATION, REHA- BILITATION OR OUTPATIENT TREATMENT CERTIFIES THAT ADMISSION OF THE COVERED PERSON IS NOT NECESSARY AND EARLY DISCHARGE IS APPROPRIATE. THE DURATION OF SUCH COVERAGE SHALL BE EXTENDED BY AS MANY AS THIRTY ADDI- TIONAL INPATIENT DAYS OR SESSIONS IF THE ADMITTING OR ATTENDING PHYSI- CIAN, OR A PHYSICIAN ASSISTANT OR NURSE PRACTITIONER ACTING UNDER THE SUPERVISION OF THE ADMITTING OR ATTENDING PHYSICIAN, DEEMS SUCH ADDI- TIONAL DAYS OR SESSIONS ARE NECESSARY.
(C) IF THE ADMITTING OR ATTENDING PHYSICIAN CERTIFIES THAT TREATMENT BEYOND NINETY DAYS IS NECESSARY, SUCH CERTIFICATION SHALL BE SUFFICIENT FOR ELIGIBILITY FOR COVERAGE THROUGH MEDICAID AS ADMINISTERED THROUGH COUNTY SOCIAL SERVICES DEPARTMENTS, AND NO FURTHER CERTIFICATION SHALL BE REQUIRED BY SUCH DEPARTMENTS. (D) COSTS ASSOCIATED WITH CONTINUED MEDICAID COVERAGE SHALL NOT ACCRUE TO THE COUNTY AND SHALL BE ASSUMED BY THE STATE. (E) THE LOCATION OF COVERED TREATMENT PURSUANT TO THIS PARAGRAPH SHALL BE SUBJECT TO THE INSURER'S REQUIREMENTS RELATING TO THE USE OF PARTIC- IPATING PROVIDERS, INCLUDING THOSE PROVIDERS LOCATED OUTSIDE OF THE STATE. S 2. Subsection (1) of section 3221 of the insurance law is amended by adding a new paragraph 19 to read as follows: (19)(A) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH PROVIDES MEDICAL, MAJOR MEDICAL OR SIMILAR COMPRE- HENSIVE-TYPE COVERAGE SHALL INCLUDE SPECIFIC COVERAGE FOR DRUG AND ALCO- HOL ABUSE AND DEPENDENCY TREATMENT SERVICES THAT ARE CERTIFIED AS NECES- SARY BY A QUALIFIED HEALTH PROFESSIONAL, AS DEFINED IN THE REGULATIONS OF THE COMMISSIONER OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES. (B) THE ONLY PREREQUISITE FOR THE COVERAGE OF HOSPITAL OR NON-HOSPITAL BASED DETOXIFICATION, INCLUDING MEDICALLY MANAGED, MEDICALLY SUPERVISED AND MEDICALLY MONITORED WITHDRAWAL, OR INPATIENT OR INTENSIVE RESIDEN- TIAL REHABILITATION, OR INTENSIVE OR ROUTINE OUTPATIENT TREATMENT, SHALL BE THAT A COVERED PERSON BE CERTIFIED AND REFERRED BY A QUALIFIED HEALTH PROFESSIONAL. SUCH CERTIFICATION AND REFERRAL SHALL CONTROL BOTH THE NATURE AND DURATION OF COVERED TREATMENT; PROVIDED, HOWEVER, THAT THE DURATION OF SUCH COVERAGE SHALL NOT BE LESS THAN SIXTY DAYS, AND MAY BE TERMINATED ONLY WHEN AND IF THE ADMITTING OR ATTENDING PHYSICIAN, OR A PHYSICIAN ASSISTANT OR NURSE PRACTITIONER ACTING UNDER THE SUPERVISION OF THE ADMITTING OR ATTENDING PHYSICIAN, PROVIDING DETOXIFICATION, REHA- BILITATION OR OUTPATIENT TREATMENT CERTIFIES THAT ADMISSION OF THE COVERED PERSON IS NOT NECESSARY AND EARLY DISCHARGE IS APPROPRIATE. THE DURATION OF SUCH COVERAGE SHALL BE EXTENDED BY AS MANY AS THIRTY ADDI- TIONAL INPATIENT DAYS OR SESSIONS IF THE ADMITTING OR ATTENDING PHYSI- CIAN, OR A PHYSICIAN ASSISTANT OR NURSE PRACTITIONER ACTING UNDER THE SUPERVISION OF THE ADMITTING OR ATTENDING PHYSICIAN, DEEMS SUCH ADDI- TIONAL DAYS OR SESSIONS ARE NECESSARY. (C) IF THE ADMITTING OR ATTENDING PHYSICIAN CERTIFIES THAT TREATMENT BEYOND NINETY DAYS IS NECESSARY, SUCH CERTIFICATION SHALL BE SUFFICIENT FOR ELIGIBILITY FOR COVERAGE THROUGH MEDICAID AS ADMINISTERED THROUGH COUNTY SOCIAL SERVICES DEPARTMENTS, AND NO FURTHER CERTIFICATION SHALL BE REQUIRED BY SUCH DEPARTMENTS. (D) COSTS ASSOCIATED WITH CONTINUED MEDICAID COVERAGE SHALL NOT ACCRUE TO THE COUNTY AND SHALL BE ASSUMED BY THE STATE. (E) THE LOCATION OF COVERED TREATMENT PURSUANT TO THIS PARAGRAPH SHALL BE SUBJECT TO THE INSURER'S REQUIREMENTS RELATING TO THE USE OF PARTIC- IPATING PROVIDERS, INCLUDING THOSE PROVIDERS LOCATED OUTSIDE OF THE STATE. S 3. Section 4303 of the insurance law is amended by adding a new subsection (oo) to read as follows: (OO)(1) EVERY CONTRACT ISSUED BY A HOSPITAL SERVICE COMPANY OR HEALTH SERVICE CORPORATION WHICH PROVIDES MEDICAL, MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE SPECIFIC COVERAGE FOR DRUG AND ALCOHOL ABUSE AND DEPENDENCY TREATMENT SERVICES THAT ARE CERTIFIED AS NECESSARY BY A QUALIFIED HEALTH PROFESSIONAL, AS DEFINED IN THE REGU- LATIONS OF THE COMMISSIONER OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES.
(2) THE ONLY PREREQUISITE FOR THE COVERAGE OF HOSPITAL OR NON-HOSPITAL BASED DETOXIFICATION, INCLUDING MEDICALLY MANAGED, MEDICALLY SUPERVISED AND MEDICALLY MONITORED WITHDRAWAL, OR INPATIENT OR INTENSIVE RESIDEN- TIAL REHABILITATION, OR INTENSIVE OR ROUTINE OUTPATIENT TREATMENT, SHALL BE THAT A COVERED PERSON BE CERTIFIED AND REFERRED BY A QUALIFIED HEALTH PROFESSIONAL. SUCH CERTIFICATION AND REFERRAL SHALL CONTROL BOTH THE NATURE AND DURATION OF COVERED TREATMENT, PROVIDED, HOWEVER, THAT THE DURATION OF SUCH COVERAGE NOT BE LESS THAN SIXTY DAYS, AND MAY BE TERMI- NATED ONLY WHEN AND IF THE ADMITTING OR ATTENDING PHYSICIAN, OR A PHYSI- CIAN ASSISTANT OR NURSE PRACTITIONER ACTING UNDER THE SUPERVISION OF THE ADMITTING OR ATTENDING PHYSICIAN, PROVIDING DETOXIFICATION, REHABILI- TATION OR OUTPATIENT TREATMENT CERTIFIES THAT ADMISSION OF THE COVERED PERSON IS NOT NECESSARY AND EARLY DISCHARGE IS APPROPRIATE. THE DURATION OF SUCH COVERAGE SHALL BE EXTENDED BY AS MANY AS THIRTY ADDITIONAL INPA- TIENT DAYS OR SESSIONS IF THE ADMITTING OR ATTENDING PHYSICIAN, OR A PHYSICIAN ASSISTANT OR NURSE PRACTITIONER ACTING UNDER THE SUPERVISION OF THE ADMITTING OR ATTENDING PHYSICIAN, DEEMS SUCH ADDITIONAL DAYS OR SESSIONS ARE NECESSARY. (3) IF THE ADMITTING OR ATTENDING PHYSICIAN CERTIFIES THAT TREATMENT BEYOND NINETY DAYS IS NECESSARY, SUCH CERTIFICATION SHALL BE SUFFICIENT FOR ELIGIBILITY FOR COVERAGE THROUGH MEDICAID AS ADMINISTERED THROUGH COUNTY SOCIAL SERVICES DEPARTMENTS, AND NO FURTHER CERTIFICATION SHALL BE REQUIRED BY SUCH DEPARTMENTS. (4) COSTS ASSOCIATED WITH CONTINUED MEDICAID COVERAGE SHALL NOT ACCRUE TO THE COUNTY AND SHALL BE ASSUMED BY THE STATE. (5) THE LOCATION OF COVERED TREATMENT PURSUANT TO THIS SUBSECTION SHALL BE SUBJECT TO THE INSURER'S REQUIREMENTS RELATING TO THE USE OF PARTICIPATING PROVIDERS, INCLUDING THOSE PROVIDERS LOCATED OUTSIDE OF THE STATE. S 4. This act shall take effect on the first of January next succeed- ing the date on which it shall have become a law and shall apply to policies and contracts issued, renewed, modified, altered or amended on or after such date.

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