Requires a rate enhancement for reimbursement of individual psychotherapy services provided by a mental health counselor, a clinical social worker, or a psychologist where such services are provided in an outpatient substance use disorder clinic.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A8734
SPONSOR: Steck TITLE OF BILL:
An act to amend the mental hygiene law, in relation to establishing the
individual counseling for integrated care rate enhancement act
PURPOSE:
Extends an existing rate enhancement for group counseling so that it
applies to individual counseling provided by certain licensed practi-
tioners authorized to diagnosis and develop assessment-based treatment
plans to expand access to integrated care provided by clinics licensed
under Article 32 of the MHL
SUMMARY OF PROVISIONS:
Section 1. Names the individual counseling rated enhancement for inte-
grated care act
Section 2. adds a new section 19.18-d to establish a rate enhancement
for reimbursement of individual psychotherapy when the service is
provided by certain licensed mental health practitioners at outpatient
substance use disorder clinics licensed under Article 32 of this chap-
ter.
Section 3. provides for the effective date.
JUSTIFICATION:
There are critical barriers to accessing integrated health care and
treatment when individuals are suffering from both a mental illness and
substance use disorder. There is a need to ensure that programs and
services providing addiction and mental health services are encouraged
to hire enough qualified staff who are licensed to diagnose and treat
those presenting with co-occurring disorders. Currently, outpatient
substance use disorder clinics licensed by the Office of Addiction
Services and Supports can receive an enhanced rate for group therapy
when provided by a licensed mental health practitioner who is licensed
to diagnose and develop assessment-based treatment plans. Yet the indi-
vidual therapy rates are not enhanced and are based on services provided
by certified, but not licensed staff.
To ensure that individuals are properly diagnosed and provided with a
treatment plan to address their mental health and substance use disorder
needs without having to be admitted for care at 2 separate clinics, the
appropriate staff need to be integrated into substance use disorder
treatment settings. Diagnosis and treatment plans can only be provided
by certain practitioners licensed under Art 153, Art 154 or Art 163 of
State Education Law. Yet the rate paid at Art 32 outpatient clinics is
based upon the outdated assumption that the counseling will be provided
by a Credentialed Alcoholism and Substance Abuse Counselor (CASAC. While
this certification allows professionals to work in jobs related to
addiction counseling, it does not allow for diagnosing, providing
psychotherapy or developing assessment-based treatment plans.
If access to integrated mental health and substance use services is to
be expanded, rates that cover the cost of employing master's level
licensed mental health practitioners must become common place at outpa-
tient substance use disorder clinics licensed by OASAS. Authorizing an
enhanced rate for certain services can encourage the delivery of inte-
grated care.
This bill incentivizes having appropriate licensed practitioners at
OASAS outpatient clinics. The bill will ensure those with co-occurring
disorders do not need to seek treatment in separate locations. The bill
is necessary because:
1)OASAS individual counseling is assumed to be provided by CASACs not
Master's level professionals and the rate is therefor too low to support
hiring the Master's level professionals.
2)To routinely treat patients with a dual diagnosis, the individual
therapists who can diagnose and develop treatment plans are Masters
level licensed mental health counselors, licensed marriage and family
therapists, licensed psychotherapists, and licensed clinical social
workers
3)When a licensed therapist provides the individual service, the rate
enhancement would be added to cover the cost of the professional provid-
ing the service
4)Assessment based treatment plans can only be developed by certain
licensed practitioners and adding group therapy to a treatment plan
without an initial diagnostic individual session, it is not best prac-
tice.
LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS:
The bill would be budget neutral to Medicaid spending, because most
patients would be receiving the services by going to two separate
locations for care. The effectiveness and (an OMH-licensed clinic for
their diagnostic and psychotherapy mental health care and an OASAS-li-
censed clinic for their substance use disorder counseling).
EFFECTIVE DATE:
Immediately.
STATE OF NEW YORK
________________________________________________________________________
8734
2025-2026 Regular Sessions
IN ASSEMBLY
June 2, 2025
___________
Introduced by M. of A. STECK -- read once and referred to the Committee
on Alcoholism and Drug Abuse
AN ACT to amend the mental hygiene law, in relation to establishing the
individual counseling for integrated care rate enhancement act
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. This act shall be known and may be cited as the "individual
2 counseling rate enhancement act".
3 § 2. The mental hygiene law is amended by adding a new section 19.18-d
4 to read as follows:
5 § 19.18-d Individual counseling rate enhancement.
6 1. The office shall establish a rate enhancement for reimbursement of
7 individual psychotherapy services provided to individuals by a mental
8 health counselor licensed pursuant to article one hundred sixty-three of
9 the education law or a clinical social worker licensed pursuant to arti-
10 cle one hundred fifty-four of the education law or a psychologist
11 licensed pursuant to article one hundred fifty-three of the education
12 law where such services are provided in outpatient substance use disor-
13 der clinics licensed pursuant to article thirty-two of this chapter.
14 Such rate shall be no less than the rate established by the office for
15 individual counseling in effect on April first, two thousand twenty-five
16 plus a service rate of 50%.
17 2. The office shall promulgate regulations to implement the rate
18 enhancement set forth under this section. In developing such rates the
19 office, in consultation with the department of health, shall, if neces-
20 sary, pursue federal Medicaid participation and reimbursement. Within
21 thirty-six months of the establishment of the enhanced rate, the office
22 shall evaluate and report whether the access to integrated mental health
23 and addiction recovery services increased. The office shall transmit
24 such report to the governor, the temporary president of the senate, the
25 speaker of the assembly, the minority leader of the senate and the
26 minority leader of the assembly.
27 § 3. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13259-01-5
