BILL NUMBER: S5263
SPONSOR: ASHBY
 
TITLE OF BILL:
An act to amend the insurance law, in relation to providing that cover-
age for outpatient diagnosis and treatment of substance use disorder
shall not be subject to preauthorization
 
PURPOSE::
To make it easier for people to access treatment for substance use by
removing the need for preauthorization of insurance.
 
SUMMARY OF PROVISIONS::
Sections 1,2 and 3 of this bill amend insurance law, by stating that
coverage for outpatient diagnosis and treatment of substance use disor-
der provided by policies providing medical coverage shall not be subject
to preauthorization.
Section 4 provides the effective date.
 
JUSTIFICATION::
The aim of this bill is to work towards removing one of the many exist-
ing barriers to substance use treatment: the need to seek prior authori-
zation from their insurance before starting treatment. This would allow
people to avoid any delays in the initiation of care. Getting people
into treatment is a critical moment, and every minute saves patients
from continued substance use, medical complications, overdose and death.
In 2016, the Senate's Task Force on Heroin and Opioid Addiction released
a report with recommendations. Many of the recommendations were adopted
that year, including provisions which made it easier of people to access
treatment, by among other things, requiring health plan coverage, with-
out preauthorization, of in-network inpatient treatment by OASAS certi-
fied providers. The state also adopted legislation to prohibit -for the
first 14 days of treatment- concurrent utilization review.
This legislation builds upon those reforms, by prohibiting preauthori-
zation for outpatient treatment of substance use disorder, making it
easier to access treatment and maintain sobriety.
 
LEGISLATIVE HISTORY::
2023-24 - S.4842-referredtoinsurance
2021-22 - S.1915:ReferredtoInsurance
2019-20 - S.333:ReferredtoInsurance
2018 - S.8046: Referred to Insurance
 
FISCAL IMPLICATIONS::
To be determined, provided savings should accrue as those ready for
recovery can access outpatient care quicker and avoid the costly conse-
quences of returning to abusing substances.
 
EFFECTIVE DATE::
This act shall take effect immediately, and shall apply to policies and
contracts issued, renewed, modified, altered or amended on or after such
date.

Statutes affected:
S5263: 3216 insurance law, 3216(i) insurance law, 3221 insurance law, 3221(l) insurance law, 4303 insurance law, 4303(l) insurance law