New York S 1763: Relates to cost sharing fees for outpatient treatment at a substance use treatment program

Bill Text

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S01763 Summary:

BILL NOS01763A

&nbsp

SAME ASSAME AS A03148-A

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SPONSORFERNANDEZ

&nbsp

COSPNSRADDABBO, RYAN S

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MLTSPNSR

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Amd §§3216, 3221 & 4303, Ins L

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Provides that for a substance use disorder outpatient treatment episode of care by a provider licensed, certified or otherwise authorized by the office of addiction services and supports, an insured shall only be responsible for a cost sharing fee not to exceed two hundred fifty dollars.

Go to top S01763 Actions:

BILL NOS01763A

&nbsp

01/13/2025REFERRED TO INSURANCE

01/29/2025AMEND AND RECOMMIT TO INSURANCE

01/29/2025PRINT NUMBER 1763A

05/12/20251ST REPORT CAL.982

05/13/20252ND REPORT CAL.

05/14/2025ADVANCED TO THIRD READING 

05/29/2025PASSED SENATE

05/29/2025DELIVERED TO ASSEMBLY

05/29/2025referred to insurance

01/07/2026died in assembly

01/07/2026returned to senate

01/07/2026REFERRED TO INSURANCE

02/03/2026REPORTED AND COMMITTED TO FINANCE

06/04/2026COMMITTEE DISCHARGED AND COMMITTED TO RULES

06/04/2026ORDERED TO THIRD READING CAL.1791

06/04/2026PASSED SENATE

06/04/2026DELIVERED TO ASSEMBLY

06/05/2026referred to insurance

Go to topS01763 Committee&nbspVotes:

Go to topS01763 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topS01763 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 1763--A

 2025-2026 Regular Sessions

 IN SENATE

 January 13, 2025
 ___________

 Introduced by Sens. FERNANDEZ, ADDABBO, S. RYAN -- read twice and
 ordered printed, and when printed to be committed 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, in relation to certain cost sharing
 fees for outpatient treatment at a substance use treatment program

 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
 21 services and supports and appropriate to the age of the patient, to
 22 ensure that the outpatient treatment is medically necessary for the
 23 patient. Any utilization review of the treatment provided under this

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD03320-02-5

 S. 1763--A 2

 1 subparagraph may include a review of all services provided during such
 2 outpatient treatment, including all services provided during the first
 3 four weeks of continuous treatment, not to exceed twenty-eight visits,
 4 of such outpatient treatment. Provided, however, the insurer shall only
 5 deny coverage for any portion of the initial four weeks of continuous
 6 treatment, not to exceed twenty-eight visits, for outpatient treatment
 7 on the basis that such treatment was not medically necessary if such
 8 outpatient treatment was contrary to the evidence-based