May 29, 2024

As always, the NYS Council continues to share information with our members regarding legislation of interest.
The last bill in the chart (below) is intended to ease the burden of cost share expenses an insured must pay for substance use disorder treatment when utilizing their commercial health insurance.  The bill was recently amended.  I pasted the recently amended text below the chart so you can see what changed.  I do not see a ‘same as’ version of this bill in the Assembly – yet.

**Also, we just spotted a bill that has been around for a number of years that recently picked up an Assembly sponsor so now there is a ‘same as’ bill in both houses.  The legislation would amend not-for-profit corporation law to include that non- profits licensed under OPWDD, DOH or OMH with 25 or more employees receiving $1 million or 75% or more of its gross funding through government to be subject to NYS Open Meetings Law.  The bill is:  S2451/A10458.    PLEASE SEND ME A NOTE AND LET ME KNOW IF YOU SUPPORT OR OPPOSE THIS LEGISLATION.

Here’s the legislation copy:

Introduced  by  Sen.  COMRIE -- read twice and ordered printed, and when
          printed to be committed to the Committee on Corporations,  Authorities
          and Commissions
 
        AN  ACT  to  amend  the  not-for-profit  corporation law, in relation to
          making certain not-for-profit corporations subject to the  freedom  of
          information and open meetings laws
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. The not-for-profit corporation law is amended by  adding  a
     2  new section 116 to read as follows:
     3  § 116. Access to records.
     4    (a)  Any not-for-profit corporation as defined in subparagraph five of
     5  paragraph (a) of section one hundred two of this article,  with  twenty-
     6  five  or  more full time equivalent employees, which receives either one
     7  million dollars or more in government funding, or  seventy-five  percent
     8  or  more  of its gross revenues through government funding, and which is
     9  licensed by the office of people with developmental disabilities, office
    10  of mental health, or department of health as  an  approved  provider  of
    11  services,  shall  be subject to the provisions of articles six and seven
    12  of the public officers law; provided, however, that  the  provisions  of
    13  this section shall not apply to patient records as defined in the Health
    14  Insurance Portability and Accountability Act of 1996.
    15    (b)  Any  records  identified  by  the New York state police as secure
    16  documents requiring the non-disclosure for security purposes  shall  not
    17  be subject to the provisions of paragraph (a) of this section.
    18    §  2.  This  act shall take effect on the thirtieth day after it shall
    19  have become a law.

—

THE FOLLOWING BILL(S) WERE AMENDED. WE WILL KEEP YOU UPDATED. Click Here to Find Bill Text and Memo

(red ink = omitted; green ink is new language)

STATE OF NEW YORK
        ________________________________________________________________________

                                         7288--B

                               2023-2024 Regular Sessions

                    IN SENATE

                                      May 19, 2023
                                       ___________

        Introduced  by  Sens. FERNANDEZ, ADDABBO, RYAN -- read twice and ordered
          printed, and when printed to be committed to the Committee  on  Insur-
          ance  --  recommitted to the Committee on Insurance in accordance with
          Senate Rule 6, sec. 8 -- committee discharged, bill  amended,  ordered
          reprinted  as  amended  and recommitted to said committee -- committee
          discharged, bill amended, ordered reprinted as amended and recommitted
          to said committee

        AN ACT to amend the insurance law, in relation to certain  cost  sharing
          fees for treatment of substance use disorder

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Subparagraph (E) of  paragraph  31  of  subsection  (i)  of
     2  section  3216 of the insurance law, as amended by section 6 of subpart A
     3  of part BB of chapter 57 of the laws of  2019,  is  amended  and  a  new
     4  subparagraph (K) is added to read as follows:
     5    (E) This subparagraph shall apply to facilities in this state that are
     6  licensed, certified or otherwise authorized by the office of [alcoholism
     7  and  substance  abuse] addiction services and supports for the provision
     8  of  outpatient,  intensive  outpatient,  outpatient  rehabilitation  and
     9  opioid  treatment  that  are  participating  in  the  insurer's provider
    10  network. Coverage provided under this paragraph shall not be subject  to
    11  preauthorization.  Coverage  provided  under this paragraph shall not be
    12  subject to concurrent review for the  first  four  weeks  of  continuous
    13  treatment,  not  to  exceed  twenty-eight  visits, provided the facility
    14  notifies the insurer of both the start  of  treatment  and  the  initial
    15  treatment  plan  within  two  business  days. The facility shall perform
    16  clinical assessment of the patient at  each  visit,  including  periodic
    17  consultation  with the insurer at or just prior to the fourteenth day of
    18  treatment to ensure that the facility is using  the  evidence-based  and
    19  peer  reviewed  clinical  review  tool  utilized by the insurer which is
    20  designated by the office of [alcoholism and substance  abuse]  addiction

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11569-05-4
        S. 7288--B                          2

     1  services  and  supports  and  appropriate  to the age of the patient, to
     2  ensure that the outpatient treatment  is  medically  necessary  for  the
     3  patient.  Any  utilization  review  of the treatment provided under this
     4  subparagraph  may  include a review of all services provided during such
     5  outpatient treatment, including all services provided during  the  first
     6  four  weeks  of continuous treatment, not to exceed twenty-eight visits,
     7  of such outpatient treatment. Provided, however, the insurer shall  only
     8  deny  coverage  for  any portion of the initial four weeks of continuous
     9  treatment, not to exceed twenty-eight visits, for  outpatient  treatment
    10  on  the  basis  that  such treatment was not medically necessary if such
    11  outpatient  treatment  was  contrary  to  the  evidence-based  and  peer
    12  reviewed  clinical  review  tool utilized by the insurer which is desig-
    13  nated by the  office  of  [alcoholism  and  substance  abuse]  addiction
    14  services and supports. An insured shall only have financial responsibil-
    15  ities  as  set  out  in subparagraph (K) of this paragraph and shall not
    16  have any financial obligation to the facility for  any  treatment  under
    17  this  subparagraph  other than any copayment, coinsurance, or deductible
    18  otherwise required under the policy.
    19    (K) (i) Such coverage may be subject to annual deductibles and coinsu-
    20  rance as may be deemed appropriate by  the  superintendent  and  as  are
    21  consistent  with  those  established  for  other benefits within a given
    22  policy; provided however, the total amount that an insured  is  required
    23  to  pay out-of-pocket for such services shall be capped at an amount not
    24  to exceed five hundred dollars for an episode of care, regardless of the
    25  insured's deductible, copayment, coinsurance or any  other  cost-sharing
    26  requirement. If under federal law, application of this requirement would
    27  result  in  health  savings account ineligibility under 26 USC 223, this
    28  requirement shall apply for health savings account-qualified high deduc-
    29  tible health plans with respect to the deductible of such a  plan  after
    30  the insured has satisfied the minimum deductible under 26 USC 223.
    31    (ii) An episode of care shall include up to sixty visits with the same
    32  treatment provider.
    33    §  2.  Subparagraphs (C-1) and (E) of paragraph 7 of subsection (l) of
    34  section 3221 of the  insurance  law,  subparagraph  (C-1)  as  added  by
    35  section 16 and subparagraph (E) as amended by section 17 of subpart A of
    36  part BB of chapter 57 of the laws of 2019, are amended and a new subpar-
    37  agraph (K) is added to read as follows:
    38    (C-1) A large group policy that provides coverage under this paragraph
    39  shall  not  impose  [copayments or] coinsurance for outpatient substance
    40  use disorder  services  that  exceeds  the  [copayment  or]  coinsurance
    41  imposed  for a primary care office visit. [Provided that no greater than
    42  one such copayment may be imposed for all services provided in a  single
    43  day  by  a  facility  licensed, certified or otherwise authorized by the
    44  office of alcoholism and substance abuse services to provide  outpatient
    45  substance  use  disorder  services]  A  large group policy that provides
    46  coverage under this paragraph shall not impose copayments for outpatient
    47  substance use disorder services.
    48    (E) This subparagraph shall apply to facilities in this state that are
    49  licensed, certified or otherwise authorized by the office of [alcoholism
    50  and substance abuse] addiction services and supports for  the  provision
    51  of  outpatient,  intensive  outpatient,  outpatient  rehabilitation  and
    52  opioid treatment  that  are  participating  in  the  insurer's  provider
    53  network.  Coverage provided under this paragraph shall not be subject to
    54  preauthorization. Coverage provided under this paragraph  shall  not  be
    55  subject  to  concurrent  review  for  the first four weeks of continuous
    56  treatment, not to exceed  twenty-eight  visits,  provided  the  facility
        S. 7288--B                          3

     1  notifies  the  insurer  of  both  the start of treatment and the initial
     2  treatment plan within two business  days.  The  facility  shall  perform
     3  clinical  assessment  of  the  patient at each visit, including periodic
     4  consultation  with the insurer at or just prior to the fourteenth day of
     5  treatment to ensure that the facility is using  the  evidence-based  and
     6  peer  reviewed  clinical  review  tool  utilized by the insurer which is
     7  designated by the office of [alcoholism and substance  abuse]  addiction
     8  services  and  supports  and  appropriate  to the age of the patient, to
     9  ensure that the outpatient treatment  is  medically  necessary  for  the
    10  patient.  Any  utilization  review  of the treatment provided under this
    11  subparagraph may include a review of all services provided  during  such
    12  outpatient  treatment,  including all services provided during the first
    13  four weeks of continuous treatment, not to exceed  twenty-eight  visits,
    14  of  such outpatient treatment. Provided, however, the insurer shall only
    15  deny coverage for any portion of the initial four  weeks  of  continuous
    16  treatment,  not  to exceed twenty-eight visits, for outpatient treatment
    17  on the basis that such treatment was not  medically  necessary  if  such
    18  outpatient  treatment  was  contrary  to  the  evidence-based  and  peer
    19  reviewed clinical review tool utilized by the insurer  which  is  desig-
    20  nated  by  the  office  of  [alcoholism  and  substance abuse] addiction
    21  services and supports. An insured shall only have financial responsibil-
    22  ities as set out in subparagraph (K) of this  paragraph  and  shall  not
    23  have  any  financial  obligation to the facility for any treatment under
    24  this subparagraph other than any copayment, coinsurance,  or  deductible
    25  otherwise required under the policy.
    26    (K) (i) Such coverage may be subject to annual deductibles and coinsu-
    27  rance  as  may  be  deemed  appropriate by the superintendent and as are
    28  consistent with those established for  other  benefits  within  a  given
    29  policy;  provided  however, the total amount that an insured is required
    30  to pay out-of-pocket for such services shall be capped at an amount  not
    31  to  exceed five hundred dollars for an episode of care regardless of the
    32  insured's deductible, copayment, coinsurance or any  other  cost-sharing
    33  requirement. If under federal law, application of this requirement would
    34  result  in  health  savings account ineligibility under 26 USC 223, this
    35  requirement shall apply for health savings account-qualified high deduc-
    36  tible health plans with respect to the deductible of such a  plan  after
    37  the insured has satisfied the minimum deductible under 26 USC 223.
    38    (ii) An episode of care shall include up to sixty visits with the same
    39  treatment provider.
    40    §  3.  Paragraphs  3-a  and 5 of subsection (l) of section 4303 of the
    41  insurance law, paragraph 3-a as added by section 27 and paragraph  5  as
    42  amended  by section 28 of subpart A of part BB of chapter 57 of the laws
    43  of 2019, are amended and a new paragraph 11 is added to read as follows:
    44    (3-a) A  contract  that  provides  large  group  coverage  under  this
    45  subsection  shall  not impose [copayments or] coinsurance for outpatient
    46  substance use disorder services that exceed the [copayment  or]  coinsu-
    47  rance imposed for a primary care office visit. [Provided that no greater
    48  than  one  such  copayment may be imposed for all services provided in a
    49  single day by a facility licensed, certified or otherwise authorized  by
    50  the  office of alcoholism and substance abuse services to provide outpa-
    51  tient substance  use  disorder  services]  A  large  group  policy  that
    52  provides  coverage  under this paragraph shall not impose copayments for
    53  outpatient substance use disorder services.
    54    (5) This paragraph shall apply to facilities in this  state  that  are
    55  licensed, certified or otherwise authorized by the office of [alcoholism
    56  and  substance  abuse] addiction services and supports for the provision
        S. 7288--B                          4

     1  of  outpatient,  intensive  outpatient,  outpatient  rehabilitation  and
     2  opioid  treatment  that  are participating in the corporation's provider
     3  network. Coverage provided under this subsection shall not be subject to
     4  preauthorization.  Coverage  provided under this subsection shall not be
     5  subject to concurrent review for the  first  four  weeks  of  continuous
     6  treatment,  not  to  exceed  twenty-eight  visits, provided the facility
     7  notifies the corporation of both the start of treatment and the  initial
     8  treatment  plan  within  two  business  days. The facility shall perform
     9  clinical assessment of the patient at  each  visit,  including  periodic
    10  consultation with the corporation at or just prior to the fourteenth day
    11  of treatment to ensure that the facility is using the evidence-based and
    12  peer  reviewed clinical review tool utilized by the corporation which is
    13  designated by the office of [alcoholism and substance  abuse]  addiction
    14  services  and  supports  and  appropriate  to the age of the patient, to
    15  ensure that the outpatient treatment  is  medically  necessary  for  the
    16  patient.  Any  utilization  review  of the treatment provided under this
    17  paragraph may include a review of  all  services  provided  during  such
    18  outpatient  treatment,  including all services provided during the first
    19  four weeks of continuous treatment, not to exceed  twenty-eight  visits,
    20  of  such outpatient treatment.  Provided, however, the corporation shall
    21  only deny coverage for any portion of the initial four weeks of  contin-
    22  uous treatment, not to exceed twenty-eight visits, for outpatient treat-
    23  ment  on  the  basis  that such treatment was not medically necessary if
    24  such outpatient treatment was contrary to the  evidence-based  and  peer
    25  reviewed  clinical  review  tool  utilized  by  the corporation which is
    26  designated by the office of [alcoholism and substance  abuse]  addiction
    27  services  and supports. A subscriber shall only have financial responsi-
    28  bilities as set out in paragraph eleven of this subsection and shall not
    29  have any financial obligation to the facility for  any  treatment  under
    30  this  paragraph  other  than  any  copayment, coinsurance, or deductible
    31  otherwise required under the contract.
    32    (11) (A) Such coverage may be subject to annual deductibles and  coin-
    33  surance  as  may  be deemed appropriate by the superintendent and as are
    34  consistent with those established for  other  benefits  within  a  given
    35  contract; provided however, the total amount that an insured is required
    36  to  pay out-of-pocket for such services shall be capped at an amount not
    37  to exceed five hundred dollars for an episode of care regardless of  the
    38  insured's  deductible,  copayment, coinsurance or any other cost-sharing
    39  requirement. If under federal law, application of this requirement would
    40  result in health savings account ineligibility under 26  USC  223,  this
    41  requirement shall apply for health savings account-qualified high deduc-
    42  tible  health  plans with respect to the deductible of such a plan after
    43  the insured has satisfied the minimum deductible under 26 USC 223.
    44    (B) An episode of care shall include up to sixty visits with the  same
    45  treatment provider.
    46    §  4. This act shall take effect on the first of January next succeed-
    47  ing the date on which it shall have become a  law  and  shall  apply  to
    48  policies  and contracts issued, renewed, modified, altered or amended on
    49  and after such date.