BILL NUMBER: S6897A
SPONSOR: BAILEY
 
TITLE OF BILL:
An act to amend the insurance law, in relation to requiring rates paid
for rehabilitation and opioid treatment be pursuant to certain fee sche-
dules published by the office of addiction services and supports
 
PURPOSE OR GENERAL IDEA OF BILL:
The legislation would require the Office of Addiction Services and
Supports and the Office of Mental Health to publish a fee schedule for
commercial health plans to pay claims related to coverage enacted in
Part AA of Chapter 57 of the Laws of 2024.
 
SUMMARY OF MAIN PROVISIONS:
Section 1 amends subparagraph (J) of paragraph 31 of subsection (i) of
section 3216 of the insurance law, as added by Chapter 57 of the laws of
2024, to require the Office of Addiction Services and Supports to
publish a fee schedule for services covered by this subparagraph.
Section 2 amends subparagraph (K) of paragraph 35 of subsection (i) of
section 3216 of the insurance law, as added by Chapter 57 of the laws of
2024, to require the Office of Mental Health to publish a fee schedule
for services covered by this subparagraph.
Section 3 amends subparagraph (K) of paragraph (5) of subsection (1) of
section 3221 of the insurance law, as added by Chapter 57 of the laws of
2024, to require the Office of Mental Health to publish a fee schedule
for services covered by this subparagraph.
Section 4 amends subparagraph (J) of paragraph 7 of subsection (1) of
section 3221 of the insurance law, as added by Chapter 57 of the laws of
2024, to require the Office of Addiction Services and Supports to
publish a fee schedule for services covered by this subparagraph.
Section 5 amends paragraph 12 of subsection (a) of section 4303 of the
insurance law, as added by Chapter 57 of the laws of 2024, to require
the Office of Mental Health to publish a fee schedule for services
covered by this subparagraph.
Section 6 amends paragraph 10 of subsection (1) of section 4303 of the
insurance law, as added by Chapter 57 of the laws of 2024, to require
the Office of Addiction Services and Supports to publish a fee schedule
for services covered by this subparagraph.
 
JUSTIFICATION:
Part AA of Chapter 57 of the laws of 2024 required New York State-regu-
lated insurers to reimburse providers licensed by the Office of Mental
Health (OMH) and the Office of Addiction Services and Supports (OASAS)
at or above the Medicaid rate for outpatient behavioral health services.
Health plans have worked closely with the Department of Financial
Services (DFS) and OMH to implement these requirements before the effec-
tive date of 1/1/25. Requiring the agencies to publish fee schedules
with specific rates tied to specific services would greatly reduce
administrative burden and confusion for providers and health plans. It
is not unreasonable for the state to provide a fee schedule for these
services to ensure accuracy in payment related to the 2024 requirement.
If OMH needs additional resources to develop the fee schedule, the $1
million included in the FY26 Executive budget for oversight of plan
compliance of the rate mandate would be better allocated to this proc-
ess.
 
PRIOR LEGISLATIVE HISTORY:
New bill.
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
Immediately, with provisions.

Statutes affected:
S6897: 3216 insurance law, 3216(i) insurance law, 3221 insurance law, 3221(l) insurance law, 4303 insurance law, 4303(g) insurance law, 4303(l) insurance law
S6897A: 3216 insurance law, 3216(i) insurance law, 3221 insurance law, 3221(l) insurance law, 4303 insurance law, 4303(g) insurance law, 4303(l) insurance law