BILL NUMBER: S5565
SPONSOR: BAILEY
 
TITLE OF BILL:
An act to amend the insurance law and the social services law, in
relation to requiring health insurance policies and Medicaid to cover
patient navigation services
 
PURPOSE:
To define patient navigation services and eligible patients and estab-
lish a requirement for coverage of patient navigation services by
commercial insurance plans and Medicaid.
 
SUMMARY OF PROVISIONS:
Sections 1-3 of the bill define patient navigation services and eligible
patients, and amend sections 3216, 3221, and 4303 of the insurance law
to establish commercial insurance coverage for patient navigation
services.
Section 4 of the bill defines patient navigation services and eligible
patients, and amends section 365-a of the social services law to estab-
lish Medicaid coverage for patient navigation services.
 
JUSTIFICATION:
Patient navigation is individualized assistance that helps a patient
overcome health care system barriers from prevention and early detection
of disease to accessing quality health and psychosocial care. Patient
navigation is critical to ensure access and improve outcomes for
patients in need of screening and for treatment of serious, often life-
threatening conditions. For example, oncology patient navigation extends
across the full cancer continuum, beginning with screening and early
detection, and extending through diagnosis, treatment, survivorship, and
end-of-life. Access to patient navigation services can help cancer
patients and survivors get the care they need.
Patient navigation programs can help eliminate health disparities and
reduce costs across the care continuum by addressing the needs of people
who have been historically marginalized and excluded, as well as those
living in under-resourced communities. The navigators help increase
disease screening rates, help patients better understand and access
treatment options after diagnosis, and help ensure patients receive the
post-treatment care they need in survivorship. Patient navigation offers
tailored patient-centered care and the opportunity to prioritize unique
patient needs. Patient navigation also has a proven return on investment
and can help identify diagnosis at earlier stages when less invasive or
progressed and less costly treatment options are available to patients,
often resulting in better outcomes and reduced overall costs. Lastly, it
has been shown to increase patient retention and reduce provider admin-
istrative burdens, therefore reducing health care costs overall.
Despite the positive impact on patient outcomes and reducing health care
costs, patient navigation services are still absent or limited in many
programs and hospital settings due to a lack of clinical reimbursement.
Throughout the U.S., a patchwork of coverage exists, depending on where
patients live and the type of insurance coverage they have, and is not
continuous throughout the cancer care continuum.
Ensuring access to patient navigation services will only be achieved by
ensuring payment for patient navigation services is available across
both public and private payers.
The law will apply to all policies and contracts issued, renewed, or
otherwise amended on or after the effective date.
 
PRIOR LEGISLATIVE HISTORY:
New bill.
 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
To be determined.
 
EFFECTIVE DATE:
The first of January next succeeding the date it becomes a law, with an
immediate effective date for adding, amending, or repealing any rule or
regulation for purposes of implementation.

Statutes affected:
S5565: 4303 insurance law, 365-a social services law, 365-a(2) social services law