Shown verbatim: the complete text as captured from the official source posted by the New York State Senate, fetched 2026-08-11. Nothing is edited or removed. Where this bill amends existing law, language marked for deletion in the official source appears here in brackets. The official bill page.
S T A T E O F N E W Y O R K
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7038--A
Cal. No. 96
2025-2026 Regular Sessions
I N A S S E M B L Y
March 18, 2025
___________
Introduced by M. of A. WEPRIN, SANTABARBARA -- read once and referred to
the Committee on Insurance -- reported from committee, advanced to a
third reading, amended and ordered reprinted, retaining its place on
the order of third reading
AN ACT to amend the insurance law, in relation to requiring rates paid
for rehabilitation and opioid treatment be pursuant to certain fee
schedules published by the office of addiction services and supports
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subparagraph (J) of paragraph 31 of subsection (i) of
section 3216 of the insurance law, as added by section 1 of part AA of
chapter 57 of the laws of 2024, is amended to read as follows:
(J) This subparagraph shall apply to facilities in this state that are
licensed, certified, or otherwise authorized by the office of addiction
services and supports for the provision of outpatient, intensive outpa-
tient, outpatient rehabilitation and opioid treatment that are partic-
ipating in the insurer's provider network. Reimbursement for covered
outpatient treatment provided by such facilities shall be at rates nego-
tiated between the insurer and the participating facility, provided that
such rates are not less than the rates that would be paid for such
treatment pursuant to the medical assistance program under title eleven
of article five of the social services law. For the purposes of this
subparagraph, the rates that would be paid for such treatment pursuant
to the medical assistance program under title eleven of article five of
the social services law SHALL BE SET FORTH IN A FEE SCHEDULE SETTING
FORTH THE SPECIFIC FEE FOR EACH INDIVIDUAL SERVICE COVERED BY THIS
SUBPARAGRAPH PUBLISHED BY THE OFFICE OF ADDICTION SERVICES AND SUPPORTS
BY NOVEMBER FIRST OF THE PRECEDING CALENDAR YEAR AND shall be the rates
with an effective date of April first of the preceding year, which shall
be established prior to October first of the preceding calendar year.
Prior to the submission of premium rate filings and applications, the
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11143-02-5
A. 7038--A 2
superintendent shall provide insurers with guidance on factors to
consider in calculating the impact of rate changes for the purposes of
submitting premium rate filings and applications to the superintendent
for the subsequent policy year. To the extent that the rates with an
effective date of April first differ from the estimated rates incorpo-
rated in premium rate filings and applications, insurers may account for
such differences in future premium rate filings and applications submit-
ted to the superintendent for approval.
§ 2. Subparagraph (K) of paragraph 35 of subsection (i) of section
3216 of the insurance law, as added by section 2 of part AA of chapter
57 of the laws of 2024, is amended to read as follows:
(K) This subparagraph shall apply to outpatient treatment provided in
a facility issued an operating certificate by the commissioner of mental
health pursuant to the provisions of article thirty-one of the mental
hygiene law, or in a facility operated by the office of mental health,
or in a crisis stabilization center licensed pursuant to section 36.01
of the mental hygiene law, that is participating in the insurer's
provider network. Reimbursement for covered outpatient treatment
provided by such a facility shall be at rates negotiated between the
insurer and the participating facility, provided that such rates are not
less than the rates that would be paid for such treatment pursuant to
the medical assistance program under title eleven of article five of the
social services law. For the purposes of this subparagraph, the rates
that would be paid for such treatment pursuant to the medical assistance
program under title eleven of article five of the social services law
SHALL BE SET FORTH IN A FEE SCHEDULE SETTING FORTH THE SPECIFIC FEE FOR
EACH INDIVIDUAL SERVICE COVERED BY THIS SUBPARAGRAPH PUBLISHED BY THE
OFFICE OF MENTAL HEALTH BY NOVEMBER FIRST OF THE PRECEDING CALENDAR YEAR
AND shall be the rates with an effective date of April first of the
preceding year, which shall be established prior to October first of the
preceding calendar year. Prior to the submission of premium rate filings
and applications, the superintendent shall provide insurers with guid-
ance on factors to consider in calculating the impact of rate changes
for the purposes of submitting premium rate filings and applications to
the superintendent for the subsequent policy year. To the extent that
the rates with an effective date of April first differ from the esti-
mated rates incorporated in premium rate filings and applications,
insurers may account for such differences in future premium rate filings
and applications submitted to the superintendent for approval.
§ 3. Subparagraph (K) of paragraph 5 of subsection (l) of section 3221
of the insurance law, as added by section 3 of part AA of chapter 57 of
the laws of 2024, is amended to read as follows:
(K) This subparagraph shall apply to outpatient treatment provided in
a facility issued an operating certificate by the commissioner of mental
health pursuant to the provisions of article thirty-one of the mental
hygiene law, or in a facility operated by the office of mental health,
or in a crisis stabilization center licensed pursuant to section 36.01
of the mental hygiene law, that is participating in the insurer's
provider network. Reimbursement for covered outpatient treatment
provided by such a facility shall be at rates negotiated between the
insurer and the participating facility, provided that such rates are not
less than the rates that would be paid for such treatment pursuant to
the medical assistance program under title eleven of article five of the
social services law. For the purposes of this subparagraph, the rates
that would be paid for such treatment pursuant to the medical assistance
program under title eleven of article five of the social services law
A. 7038--A 3
SHALL BE SET FORTH IN A FEE SCHEDULE SETTING FORTH THE SPECIFIC FEE FOR
EACH INDIVIDUAL SERVICE COVERED BY THIS SUBPARAGRAPH PUBLISHED BY THE
OFFICE OF MENTAL HEALTH BY NOVEMBER FIRST OF THE PRECEDING CALENDAR YEAR
AND shall be the rates with an effective date of April first of the
preceding year, which shall be established prior to October first of the
preceding calendar year. Prior to the submission of premium rate filings
and applications, the superintendent shall provide insurers with guid-
ance on factors to consider in calculating the impact of rate changes
for the purposes of submitting premium rate filings and applications to
the superintendent for the subsequent policy year. To the extent that
the rates with an effective date of April first differ from the esti-
mated rates incorporated in premium rate filings and applications,
insurers may account for such differences in future premium rate filings
and applications submitted to the superintendent for approval.
§ 4. Subparagraph (J) of paragraph 7 of subsection (l) of section 3221
of the insurance law, as added by section 4 of part AA of chapter 57 of
the laws of 2024, is amended to read as follows:
(J) This subparagraph shall apply to facilities in this state that are
licensed, certified, or otherwise authorized by the office of addiction
services and supports for the provision of outpatient, intensive outpa-
tient, outpatient rehabilitation and opioid treatment that are partic-
ipating in the insurer's provider network. Reimbursement for covered
outpatient treatment provided by such facilities shall be at rates nego-
tiated between the insurer and the participating facility, provided that
such rates are not less than the rates that would be paid for such
treatment pursuant to the medical assistance program under title eleven
of article five of the social services law. For the purposes of this
subparagraph, the rates that would be paid for such treatment pursuant
to the medical assistance program under title eleven of article five of
the social services law SHALL BE SET FORTH IN A FEE SCHEDULE SETTING
FORTH THE SPECIFIC FEE FOR EACH INDIVIDUAL SERVICE COVERED BY THIS
SUBPARAGRAPH PUBLISHED BY THE OFFICE OF ADDICTION SERVICES AND SUPPORTS
BY NOVEMBER FIRST OF THE PRECEDING CALENDAR YEAR AND shall be the rates
with an effective date of April first of the preceding year, which shall
be established prior to October first of the preceding calendar year.
Prior to the submission of premium rate filings and applications, the
superintendent shall provide insurers with guidance on factors to
consider in calculating the impact of rate changes for the purposes of
submitting premium rate filings and applications to the superintendent
for the subsequent policy year. To the extent that the rates with an
effective date of April first differ from the estimated rates incorpo-
rated in premium rate filings and applications, insurers may account for
such differences in future premium rate filings and applications submit-
ted to the superintendent for approval.
§ 5. Paragraph 12 of subsection (g) of section 4303 of the insurance
law, as added by section 5 of part AA of chapter 57 of the laws of 2024,
is amended to read as follows:
(12) This paragraph shall apply to outpatient treatment provided in a
facility issued an operating certificate by the commissioner of mental
health pursuant to the provisions of article thirty-one of the mental
hygiene law, or in a facility operated by the office of mental health,
or in a crisis stabilization center licensed pursuant to section 36.01
of the mental hygiene law, that is participating in the corporation's
provider network. Reimbursement for covered outpatient treatment
provided by such facility shall be at rates negotiated between the
corporation and the participating facility, provided that such rates are
A. 7038--A 4
not less than the rates that would be paid for such treatment pursuant
to the medical assistance program under title eleven of article five of
the social services law. For the purposes of this paragraph, the rates
that would be paid for such treatment pursuant to the medical assistance
program under title eleven of article five of the social services law
SHALL BE SET FORTH IN A FEE SCHEDULE SETTING FORTH THE SPECIFIC FEE FOR
EACH INDIVIDUAL SERVICE COVERED BY THIS PARAGRAPH PUBLISHED BY THE
OFFICE OF MENTAL HEALTH BY NOVEMBER FIRST OF THE PRECEDING CALENDAR YEAR
AND shall be the rates with an effective date of April first of the
preceding year, which shall be established prior to October first of the
preceding calendar year. Prior to the submission of premium rate filings
and applications, the superintendent shall provide corporations with
guidance on factors to consider in calculating the impact of rate chang-
es for the purposes of submitting premium rate filings and applications
to the superintendent for the subsequent policy year. To the extent that
the rates with an effective date of April first differ from the esti-
mated rates incorporated in premium rate filings and applications,
corporations may account for such differences in future premium rate
filings and applications submitted to the superintendent for approval.
§ 6. Paragraph 10 of subsection (l) of section 4303 of the insurance
law, as added by section 6 of part AA of chapter 57 of the laws of 2024,
is amended to read as follows:
(10) This paragraph shall apply to facilities in this state that are
licensed, certified, or otherwise authorized by the office of addiction
services and supports for the provision of outpatient, intensive outpa-
tient, outpatient rehabilitation and opioid treatment that are partic-
ipating in the corporation's provider network. Reimbursement for covered
outpatient treatment provided by such facilities shall be at rates nego-
tiated between the corporation and the participating facility, provided
that such rates are not less than the rates that would be paid for such
treatment pursuant to the medical assistance program under title eleven
of article five of the social services law. For the purposes of this
paragraph, the rates that would be paid for such treatment pursuant to
the medical assistance program under title eleven of article five of the
social services law SHALL BE SET FORTH IN A FEE SCHEDULE SETTING FORTH
THE SPECIFIC FEE FOR EACH INDIVIDUAL SERVICE COVERED BY THIS PARAGRAPH
PUBLISHED BY THE OFFICE OF ADDICTION SERVICES AND SUPPORTS BY NOVEMBER
FIRST OF THE PRECEDING CALENDAR YEAR AND shall be the rates with an
effective date of April first of the preceding year, which shall be
established prior to October first of the preceding calendar year. Prior
to the submission of premium rate filings and applications, the super-
intendent shall provide corporations with guidance on factors to consid-
er in calculating the impact of rate changes for the purposes of submit-
ting premium rate filings and applications to the superintendent for the
subsequent policy year. To the extent that the rates with an effective
date of April first differ from the estimated rates incorporated in
premium rate filings and applications, corporations may account for such
differences in future premium rate filings and applications submitted to
the superintendent for approval.
§ 7. This act shall take effect immediately and shall apply to all
policies and contracts issued, renewed, modified, altered, or amended on
or after such date.Every fact on this page links to its source, starting with the official bill record.