NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A8839
SPONSOR: Gunther TITLE OF BILL:
An act to amend the insurance law and the public health law, in relation
to setting a minimum reimbursement rate for ambulatory behavioral health
services
PURPOSE OR GENERAL IDEA OF BILL:
To provide minimum reimbursement rates for New York ambulatory behav-
ioral health providers.
SUMMARY:
Section 1. The insurance law is amended by adding a new subparagraph
(K). that every policy which provides medical, major medical, or similar
comprehensive type coverage shall reimburse ambulatory behavioral health
services provided to its insureds at a minimum, at a rate equivalent to
the payments established for such services under the ambulatory patient
group (APG) rate-setting methodology utilized by the Department of
Health, Office of Mental Health or offices of addiction services.
Section 2 amends the insurance law adding a new subparagraph (K) that
every insurer will provide to its insureds, at a minimum, ambulatory
behavioral health services at a rate equivalent to the payments estab-
lished for such services under the ambulatory patient group (APG) rate
utilized by the department of health, mental health or offices of
addiction services.
Section 3 amends the insurance law by adding a new paragraph 12 that
sets minimum payments for ambulatory behavioral health services as
outlined in sections 1 and 2, for medical expense indemnity corpo-
rations, hospitals, service corporations or health service corporations.
DIFFERENCE BETWEEN ORIGINAL AND AMENDED VERSION (IF APPLICABLE):
JUSTIFICATION:
New York state sets Medicaid payment rates to behavioral health care
providers, but providers have to negotiate rates with commercial insur-
ers. As a result, commercial insurers pay on average 50% less than Medi-
caid pays. This ongoing financial shortfall means providers are unable
to hire and retain staff and accept new patients.
New Yorkers seeking ambulatory behavioral health are finding few to no
providers available in their area, and those that are accepting new
patients have extensive waiting lists. Waiting lists for parents of
children seeking appointments for a child can number in the hundreds.
Behavioral health is increasingly difficult for New Yorkers to obtain,
at a time when demand for services has been steadily climbing. This
legislation sets as a minimum payment for commercial insurers at the
State established Medicaid payment rate, so that providers can continue
to operate and seek to hire additional behavioral health staff to meet
the demand for services.
PRIOR LEGISLATIVE HISTORY:
This is a new bill
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
to be determined
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall become
law.
STATE OF NEW YORK
________________________________________________________________________
8839
IN ASSEMBLY
January 18, 2024
___________
Introduced by M. of A. GUNTHER -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law and the public health law, in relation
to setting a minimum reimbursement rate for ambulatory behavioral
health services
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 35 of subsection (i) of section 3216 of the
2 insurance law is amended by adding a new subparagraph (K) to read as
3 follows:
4 (K) Every policy which provides medical, major medical, or similar
5 comprehensive-type coverage shall reimburse in network, participating
6 providers licensed pursuant to article twenty-eight of the public health
7 law or article thirty-one or thirty-two of the mental hygiene law for
8 ambulatory behavioral health services provided to its insureds, at a
9 minimum, at a rate equivalent to the payments established for such
10 services under the ambulatory patient group (APG) rate-setting methodol-
11 ogy at the time of service, utilized by the department of health or by
12 the office of mental health or offices of addiction services and
13 supports for rate-setting purposes for ambulatory behavioral health
14 services provided to enrollees in the medical assistance program under
15 title eleven of article five of the social services law. Insurers and in
16 network, participating providers may negotiate different rates and meth-
17 ods of payments, however insurers shall pay no less than the equivalent
18 of rates that would be paid for ambulatory behavioral health services
19 pursuant to the medical assistance program under title eleven of article
20 five of the social services law.
21 § 2. Paragraph 5 of subsection (l) of section 3221 of the insurance
22 law is amended by adding a new subparagraph (K) to read as follows:
23 (K) Every insurer delivering a group or blanket policy or issuing a
24 group or blanket policy for delivery in this state that provides cover-
25 age for hospital, major medical, or similar comprehensive-type
26 coverage shall reimburse in network, participating providers licensed
27 pursuant to article twenty-eight of the public health law or article
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13904-01-3
A. 8839 2
1 thirty-one or thirty-two of the mental hygiene law for ambulatory behav-
2 ioral health services provided to its insureds, at a minimum, at a rate
3 equivalent to the payments established for such services under the ambu-
4 latory patient group (APG) rate-setting methodology at the time of
5 service, utilized by the department of health or by the office of mental
6 health or offices of addiction services and supports for rate-setting
7 purposes for ambulatory behavioral health services provided to enrollees
8 in the medical assistance program under title eleven of article five of
9 the social services law. Insurers and in network, participating provid-
10 ers may negotiate different rates and methods of payments, however
11 insurers shall pay no less than the equivalent of rates that would be
12 paid for ambulatory behavioral health services pursuant to the medical
13 assistance program under title eleven of article five of the social
14 services law.
15 § 3. Subsection (g) of section 4303 of the insurance law is amended by
16 adding a new paragraph 12 to read as follows:
17 (12) A medical expense indemnity corporation, a hospital service
18 corporation or a health service corporation that provides coverage for
19 medical, major medical, or similar comprehensive-type coverage shall
20 reimburse in network, participating providers licensed pursuant to arti-
21 cle twenty-eight of the public health law or article thirty-one or thir-
22 ty-two of the mental hygiene law for ambulatory behavioral health
23 services provided to its insureds, at a minimum, at a rate equivalent to
24 the payments established for such services under the ambulatory patient
25 group (APG) rate-setting methodology at the time of service, utilized by
26 the department of health or by the office of mental health or offices of
27 addiction services and supports for rate-setting purposes for ambulatory
28 behavioral health services provided to enrollees in the medical assist-
29 ance program under title eleven of article five of the social services
30 law. Insurers and in network, participating providers may negotiate
31 different rates and methods of payments, however insurers shall pay no
32 less than the equivalent of rates that would be paid for ambulatory
33 behavioral health services pursuant to the medical assistance program
34 under title eleven of article five of the social services law.
35 § 4. Section 4403 of the public health law is amended by adding a new
36 subdivision 10 to read as follows:
37 10. A health maintenance organization shall reimburse in network,
38 participating providers licensed pursuant to article twenty-eight of
39 this chapter or article thirty-one or thirty-two of the mental hygiene
40 law for ambulatory behavioral health services provided to its enrollees,
41 at a minimum, at a rate equivalent to the payments established for such
42 services under the ambulatory patient group (APG) rate-setting methodol-
43 ogy at the time of service, utilized by the department or by the office
44 of mental health or offices of addiction services and supports for rate-
45 setting purposes for ambulatory behavioral health services provided to
46 enrollees in the medical assistance program under title eleven of arti-
47 cle five of the social services law. Organizations and in network,
48 participating providers may negotiate different rates and methods of
49 payments, however organizations shall pay no less than the equivalent of
50 rates that would be paid for ambulatory behavioral health services
51 pursuant to the medical assistance program under title eleven of article
52 five of the social services law.
53 § 5. This act shall take effect September 1, 2024 and shall apply to
54 all policies and contracts issued, renewed, modified, altered or amended
55 on or after such date.
