BILL NUMBER: S8466
SPONSOR: BRESLIN
 
TITLE OF BILL:
An act to amend the insurance law and the public health law, in relation
to setting a minimum reimbursement rate for ambulatory behavioral health
services
 
PURPOSE OR GENERAL IDEA OF BILL:
To provide minimum reimbursement rates for New York ambulatory behav-
ioral health providers.
 
SUMMARY:
Section 1. The insurance law is amended by adding a new subparagraph
(K). that every policy which provides medical, major medical, or similar
comprehensive type coverage shall reimburse ambulatory behavioral health
services provided to its insureds at a minimum, at a rate equivalent to
the payments established for such services under the ambulatory patient
group (APG) rate-setting methodology utilized by the Department of
Health, Office of Mental Health or offices of addiction services.
Section 2 amends the insurance law adding a new subparagraph (K) that
every insurer will provide to its insureds, at a minimum, ambulatory
behavioral health services at a rate equivalent to the payments estab-
lished for such services under the ambulatory patient group (APG) rate
utilized by the department of health, mental health or offices of
addiction services.
Section 3 amends the insurance law by adding anew paragraph 12 that sets
minimum payments for ambulatory behavioral health services as outlined
in sections 1 and 2, for medical expense indemnity corporations, hospi-
tals, service corporations or health service corporations.
 
DIFFERENCE BETWEEN ORIGINAL AND AMENDED VERSION (IF APPLICABLE):
 
JUSTIFICATION:
New York state sets Medicaid payment rates to behavioral health care
providers, but providers have to negotiate rates with commercial insur-
ers. As a result, commercial insurers pay on average 50% less than Medi-
caid pays. This ongoing financial shortfall means providers are unable
to hire and retain staff and accept new patients.
New Yorkers seeking ambulatory behavioral health are finding few to no
providers available in their area, and those that are accepting new
patients have extensive waiting lists. Waiting lists for parents of
children seeking appointments for a child can number in the hundreds.
Behavioral health is increasingly difficult for New Yorkers to obtain,
at a time when demand for services has been steadily climbing. This
legislation sets as a minimum payment for commercial insurers at the
State established Medicaid payment rate, so that providers can continue
to operate and seek to hire additional behavioral health staff to meet
the demand for services.
 
PRIOR LEGISLATIVE HISTORY:
This is a new bill
 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
to be determined
 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall become
law.

Statutes affected:
S8466: 3216 insurance law, 3216(i) insurance law, 3221 insurance law, 3221(l) insurance law, 4303 insurance law, 4303(g) insurance law, 4403 public health law