New York S 4867: Expands the Doctors Across New York program to include dentists

Bill Text

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S04867 Summary:

BILL NOS04867A

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SAME ASSAME AS A07522-A

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SPONSORFAHY

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COSPNSRFERNANDEZ, JACKSON, ROLISON, WEBB

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MLTSPNSR

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Amd §§3216, 3221 & 4303, Ins L

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Prohibits the application of fail-first or step therapy protocols to coverage for the diagnosis and treatment of serious mental health conditions; defines serious mental health condition.

Go to top S04867 Actions:

BILL NOS04867A

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02/13/2025REFERRED TO INSURANCE

03/24/20251ST REPORT CAL.583

03/25/20252ND REPORT CAL.

03/26/2025ADVANCED TO THIRD READING 

05/07/2025AMENDED ON THIRD READING 4867A

06/13/2025COMMITTED TO RULES

01/07/2026REFERRED TO INSURANCE

04/20/20261ST REPORT CAL.700

04/21/20262ND REPORT CAL.

04/22/2026ADVANCED TO THIRD READING 

05/07/2026PASSED SENATE

05/07/2026DELIVERED TO ASSEMBLY

05/07/2026referred to insurance

Go to topS04867 Committee&nbspVotes:

Go to topS04867 Floor&nbspVotes:

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

Go to topS04867 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 4867--A
 Cal. No. 583

 2025-2026 Regular Sessions

 IN SENATE

 February 13, 2025
 ___________

 Introduced by Sens. FAHY, JACKSON, WEBB -- read twice and ordered print-
 ed, and when printed to be committed to the Committee on Insurance --
 reported favorably from said committee, ordered to first and second
 report, ordered to a third reading, amended and ordered reprinted,
 retaining its place in the order of third reading

 AN ACT to amend the insurance law, in relation to prohibiting the appli-
 cation of fail-first or step therapy protocols to coverage for the
 diagnosis and treatment of serious mental health conditions

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

 1 Section 1. Item (ii) of subparagraph (A) and subparagraphs (C) and (E)
 2 of paragraph 35 of subsection (i) of section 3216 of the insurance law,
 3 item (ii) of subparagraph (A) as amended by chapter 62 of the laws of
 4 2023 and subparagraphs (C) and (E) as added by section 8 of subpart A of
 5 part BB of chapter 57 of the laws of 2019, are amended to read as
 6 follows:
 7 (ii) where the policy provides coverage for physician services, such
 8 policy shall include benefits for outpatient care provided by a psychia-
 9 trist or psychologist licensed to practice in this state, a licensed
 10 clinical social worker within the lawful scope of [his or her] their
 11 practice, who is licensed pursuant to article one hundred fifty-four of
 12 the education law, a mental health counselor, marriage and family thera-
 13 pist, or psychoanalyst licensed pursuant to article one hundred sixty-
 14 three of the education law, a nurse practitioner licensed to practice in
 15 this state, or a professional corporation or university faculty practice
 16 corporation thereof, including outpatient drug coverage. Nothing herein
 17 shall be construed to modify or expand the scope of practice of a mental
 18 health counselor, marriage and family therapist, or psychoanalyst
 19 licensed pursuant to article one hundred sixty-three of the education
 20 law. Further, nothing herein shall be construed to create a new mandated
 21 health benefit.

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD09475-02-5

 S. 4867--A 2

 1 (C) Coverage under this paragraph shall not apply financial require-
 2 ments or treatment limitations to mental health benefits, including
 3 outpatient drug coverage, that are more restrictive than the predominant
 4 financial requirements and treatment limitations applied to substantial-
 5 ly all medical and surgical benefits covered by the policy. Coverage
 6 under this paragraph, including drug coverage, shall not apply any of
 7 the following to a drug or drugs prescribed for a serious mental health
 8 condition:
 9 (i) a fail-first or step therapy protocol, as defined by section four
 10 thousand nine hundred of this chapter; or
 11 (ii) a prior authorization requirement, as established pursuant to
 12 subsection (h) of section four thousand nine hundred three of this chap-
 13 ter.
 14 (E) For purposes of this paragraph:
 15 (i) "financial requirement" means deductible, copayments