A 6586: Requires health insurance policies and Medicaid to cover patient navigation services.

  
  STATE OF NEW YORK ________________________________________________________________________ 6586 2025-2026 Regular Sessions  IN ASSEMBLY March 6, 2025 ___________ Introduced by M. of A. WEPRIN -- read once and referred to the Committee on Insurance 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 The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subsection (i) of section 3216 of insurance law is amended 2 by adding a new paragraph 40 to read as follows: 3 (40) (A) Every policy which provides medical, major medical, or simi- 4 lar comprehensive-type coverage shall provide coverage for patient navi- 5 gation services to improve access to care for individuals who are eligi- 6 ble for screening, follow-up or treatment services. Eligibility for 7 patient navigation services coverage includes individuals with a serious 8 condition that is expected to last at least three months and places the 9 individual at high risk for one or more of the following: 10 (i) Hospitalization; 11 (ii) Nursing home placement; 12 (iii) A sudden worsening of preexisting symptoms; 13 (iv) Physical or mental decline; or 14 (v) Death. 15 (B) Patient navigation services shall include, but not be limited to: 16 (i) Screening for nonclinical and social needs that do not require a 17 licensed healthcare provider to complete; 18 (ii) Referrals and follow-up to connect individuals to services 19 including, but not limited to transportation, employment, job training, 20 food insecurity, childcare, housing, language or health literacy 21 support; 22 (iii) Help with enrollment or maintaining enrollment in government 23 programs or other assistance programs; EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD08151-01-5 
 A. 6586 2 1 (iv) Arranging for and accompaniment to in-person and virtual health- 2 care visits; or 3 (v) Other prevention, screening and treatment health education, health 4 navigation, health advocacy, or individual supports including transition 5 of care supports. 6 (C) Reimbursement shall be provided to individuals who are trained and 7 have completed a national patient navigation certification or creden- 8 tialing program, or other certification or training program approved by 9 the department of health. Approved individuals shall be employed by or 10 in consultation with facilities certified under article twenty-eight of 11 the public health law, diagnostic and treatment centers, federally qual- 12 ified health centers, clinics, physicians or other licensed healthcare 13 providers, to provide patient navigation services. Individuals author- 14 ized to provide patient navigation services shall do so under the gener- 15 al supervision of a licensed physician or other licensed healthcare 16 provider. 17 § 2. Subsection (l) of section 3221 of insurance law is amended by 18 adding a new paragraph 23 to read as follows: 19 (23) (A) Every insurer delivering a group or blanket policy or issuing 20 a group or blanket policy for delivery in this state that provides 21 coverage for medical, major medical or similar comprehensive-type cover- 22 age shall provide coverage for patient navigation services to improve 23 access to care for individuals who are eligible for screening, follow-up 24 or treatment services. Eligibility for patient navigation services 25 coverage includes individuals with a serious condition that is expected 26 to last at least three months and places the individual at high risk for 27 one or more of the following: 28 (i) Hospitalization; 29 (ii) Nursing home placement; 30 (iii) A sudden worsening of preexisting symptoms; 31 (iv) Physical or mental decline; or 32 (v) Death. 33 (B) Patient navigation services shall include but not be limited to: 34 (i) Screening for nonclinical and social needs that do not require a 35 licensed healthcare provider to complete; 36 (ii) Referrals and follow-up to connect individuals to services 37 including, but not limited to transportation, employment, job training, 38 food insecurity, childcare, housing, language or health literacy 39 support; 40 (iii) Help with enrollment or maintaining enrollment in government 41 programs or other assistance programs; 42 (iv) Arranging for and accompaniment to in-person and virtual health- 43 care visits; or 44 (v) Other prevention, screening and treatment health education, health 45 navigation, health advocacy, or individual supports including transition 46 of care supports. 47 (C) Reimbursement shall be provided to individuals who are trained and 48 have completed a national patient navigation certification or creden- 49 tialing program, or other certification or training program approved by 50 the department of health. Approved individuals shall be employed by or 51 in consultation with facilities certified under article twenty-eight of 52 the public health law, diagnostic and treatment centers, federally qual- 53 ified health centers, clinics, physicians or other licensed healthcare 54 providers, to provide patient navigation services. Individuals author- 55 ized to provide patient navigation services shall do so under the gener- 
 A. 6586 3 1 al supervision of a licensed physician or other licensed healthcare 2 provider. 3 § 3. Section 4303 of the insurance law is amended by adding a new 4 subsection (ww) to read as follows: 5 (ww) (1) Every policy which provides medical, major medical, or simi- 6 lar comprehensive-type coverage shall provide coverage for patient navi- 7 gation services to improve access to care for individuals who are eligi- 8 ble for screening, follow-up or treatment services. Eligibility for 9 patient navigation services coverage includes individuals with a serious 10 condition that is expected to last at least three months and places the 11 individual at high risk for one or more of the following: 12 (A) Hospitalization; 13 (B) Nursing home placement; 14 (C) A sudden worsening of preexisting symptoms; 15 (D) Physical or mental decline; or 16 (E) Death. 17 (2) Patient navigation services shall include but not be limited to: 18 (A) Screening for nonclinical and social needs that do not require a 19 licensed healthcare provider to complete; 20 (B) Referrals and follow-up to connect individuals to services includ- 21 ing, but not limited to transportation, employment, job training, food 22 insecurity, childcare, housing, language or health literacy support; 23 (C) Help with enrollment or maintaining enrollment in government 24 programs or other assistance programs; 25 (D) Arranging for and accompaniment to in-person and virtual health- 26 care visits; or 27 (E) Other prevention, screening and treatment health education, health 28 navigation, health advocacy, or individual supports including transition 29 of care supports. 30 (3) Reimbursement shall be provided to individuals who are trained and 31 have completed a national patient navigation certification or creden- 32 tialing program, or other certification or training program approved by 33 the department of health. Approved individuals shall be employed by or 34 in consultation with facilities certified under article twenty-eight of 35 the public health law, diagnostic and treatment centers, federally qual- 36 ified health centers, clinics, physicians or other licensed healthcare 37 providers, to provide patient navigation services. Individuals author- 38 ized to provide patient navigation services shall do so under the gener- 39 al supervision of a licensed physician or other licensed healthcare 40 provider. 41 § 4. Subdivision 2 of section 365-a of the social services law is 42 amended by adding a new paragraph (nn) to read as follows: 43 (nn) (i) patient navigation services to improve access to care for 44 individuals who are eligible for screening, follow-up or treatment 45 services. Eligibility for patient navigation services coverage includes 46 individuals with a serious condition that is expected to last at least 47 three months and places the individual at high risk for one or more of 48 the following: 49 (A) hospitalization; 50 (B) nursing home placement; 51 (C) a sudden worsening of preexisting symptoms; 52 (D) physical or mental decline; or 53 (E) death. 54 (ii) Patient navigation services shall include but not be limited to: 55 (A) screening for nonclinical and social needs that do not require a 56 licensed healthcare provider to complete; 
 A. 6586 4 1 (B) referrals and follow-up to connect individuals to services includ- 2 ing, but not limited to transportation, employment, job training, food 3 insecurity, childcare, housing, language or health literacy support; 4 (C) help with enrollment or maintaining enrollment in government 5 programs or other assistance programs; 6 (D) arranging for and accompaniment to in-person and virtual health- 7 care visits; or 8 (E) other prevention, screening and treatment health education, health 9 navigation, health advocacy, or individual supports including transition 10 of care supports. 11 (iii) Reimbursement shall be provided to individuals who are trained 12 and have completed a national patient navigation certification or 13 credentialing program, or other certification or training program 14 approved by the department of health. Approved individuals shall be 15 employed by or in consultation with facilities certified under article 16 twenty-eight of the public health law, diagnostic and treatment centers, 17 federally qualified health centers, clinics, physicians or other 18 licensed healthcare providers, to provide patient navigation services. 19 Individuals authorized to provide patient navigation services shall do 20 so under the general supervision of a licensed physician or other 21 licensed healthcare provider. 22 § 5. This act shall take effect on the first of January next succeed- 23 ing the date on which it shall have become a law and shall apply to all 24 policies and contracts issued, renewed, modified, altered or amended on 25 or after such date. Effective immediately, the addition, amendment 26 and/or repeal of any rule or regulation necessary for the implementation 27 of this act on its effective date are authorized to be made and 28 completed on or before such effective date.