BILL NUMBER: S499
SPONSOR: FERNANDEZ
 
TITLE OF BILL:
An act to amend the public health law, in relation to including mental
health services, substance use disorder treatment services and recovery
support services to network adequacy requirements; and directs the
superintendent of financial services and the commissioner of health to
review data and update regulations regarding health maintenance organ-
izations and network adequacy requirements
 
PURPOSE OR GENERAL IDEA OF BILL:
Enacts the "ensuring access to behavioral health act"
 
SUMMARY OF PROVISIONS:
Section 1: Provides this act may be cited as the " ensuring access to
behavioral health act"
Section 2: Amends Subdivision 3 of section 4401 of the public health law
to include mental health services, substance use disorder treatment
services, and recovery support services to the definition of "comprehen-
sive health services."
Section 3: Amends Subdivision 5 of section 4403 of the public health law
to include mental health services, substance use disorder treatment
services, and recovery support services ensuring that health maintenance
organizationS maintain a network of health care providers that adequate-
ly meet the patient's need. Including but not limited to ensuring that
there are a sufficient number of geographically accessible participating
providers, and there are opportunities to select from at least three
primary care providers pursuant to travel and distance-time standards
including access to providers in rural areas. Additionally, all opioid
treatment programs in all counties and the city of New York and all
authorized buprenorphine prescribers in all counties of the state and in
the city of New York must be covered.
Section 4: Requires the superintendent of financial services, in consul-
tation with the office of addiction services and supports and the office
of mental health review data gathered through the mental health and
substance use disorder parity compliance program for every insurer,
corporation, municipal cooperative health benefit plan, health mainte-
nance organization or student health plan. After such review and review
of the national best practices for network adequacy for behavioral
health, the superintendent of financial services shall update any regu-
lations or guidance regarding network adequacy for all mental health and
substance use disorder services.
Section 5: Requires the commissioner of health, in consultation with the
independent substance use disorder and mental health ombudsman, shall
review and update network adequacy requirements for mental health and
substance use disorder services covered by managed care plans as part of
the periodic reviews of plans network adequacy required by subdivision
11-a of section 4403-f of the public health law; including telephonic
and telehealth services.
Section 6: States the effective date.
 
JUSTIFICATION:
The CDC has reported an increase in opioid overdoses as well as an
increase in emergency room visits related to mental health. As the state
navigates through the increasing need for substance use disorder treat-
ment, recovery, and mental health services it is vital that we ensure
these services are easily accessible to those in need. Currently,
insurance companies with a network of providers are required to ensure
that the network is adequate to meet the health needs of the insured.
Including providing an appropriate choice of providers sufficient to
render the services covered under such policy or contract and capping
the distance the insured is required to travel to receive covered
services. This bill seeks to include mental health services, substance
use disorder treatment services, and recovery support services under the
definition of "comprehensive health services". This change would ensure
that insurance companies extend the network adequacy requirements
expanding access to behavioral health services.
 
PRIOR LEGISLATIVE HISTORY:
2023-24: S3524 / A4410
2022: S8058 / A9303
 
FISCAL IMPLICATIONS:
TBD
 
EFFECTIVE DATE:
This act shall take effect immediately

Statutes affected:
S499: 4401 public health law, 4401(3) public health law, 4403 public health law, 4403(5) public health law