S 5361: Provides for a minimum reimbursement rate for ambulatory behavioral health services.

  
  STATE OF NEW YORK ________________________________________________________________________ 5361 2025-2026 Regular Sessions  IN SENATE February 20, 2025 ___________ Introduced by Sen. COMRIE -- read twice and ordered printed, and when printed to be committed to the Committee 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 (L) to read as 3 follows: 4 (L) 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 (L) to read as follows: 23 (L) Every insurer delivering a group or blanket policy or issuing a 24 group or blanket policy for delivery in this state that provides cover- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD09497-01-5 
 S. 5361 2 1 age for hospital, major medical, or similar comprehensive-type 2 coverage shall reimburse in network, participating providers licensed 3 pursuant to article twenty-eight of the public health law or article 4 thirty-one or thirty-two of the mental hygiene law for ambulatory behav- 5 ioral health services provided to its insureds, at a minimum, at a rate 6 equivalent to the payments established for such services under the ambu- 7 latory patient group (APG) rate-setting methodology at the time of 8 service, utilized by the department of health or by the office of mental 9 health or offices of addiction services and supports for rate-setting 10 purposes for ambulatory behavioral health services provided to enrollees 11 in the medical assistance program under title eleven of article five of 12 the social services law. Insurers and in network, participating provid- 13 ers may negotiate different rates and methods of payments, however 14 insurers shall pay no less than the equivalent of rates that would be 15 paid for ambulatory behavioral health services pursuant to the medical 16 assistance program under title eleven of article five of the social 17 services law. 18 § 3. Subsection (g) of section 4303 of the insurance law is amended by 19 adding a new paragraph 13 to read as follows: 20 (13) A medical expense indemnity corporation, a hospital service 21 corporation or a health service corporation that provides coverage for 22 medical, major medical, or similar comprehensive-type coverage shall 23 reimburse in network, participating providers licensed pursuant to arti- 24 cle twenty-eight of the public health law or article thirty-one or thir- 25 ty-two of the mental hygiene law for ambulatory behavioral health 26 services provided to its insureds, at a minimum, at a rate equivalent to 27 the payments established for such services under the ambulatory patient 28 group (APG) rate-setting methodology at the time of service, utilized by 29 the department of health or by the office of mental health or offices of 30 addiction services and supports for rate-setting purposes for ambulatory 31 behavioral health services provided to enrollees in the medical assist- 32 ance program under title eleven of article five of the social services 33 law. Insurers and in network, participating providers may negotiate 34 different rates and methods of payments, however insurers shall pay no 35 less than the equivalent of rates that would be paid for ambulatory 36 behavioral health services pursuant to the medical assistance program 37 under title eleven of article five of the social services law. 38 § 4. Section 4403 of the public health law is amended by adding a new 39 subdivision 10 to read as follows: 40 10. A health maintenance organization shall reimburse in network, 41 participating providers licensed pursuant to article twenty-eight of 42 this chapter or article thirty-one or thirty-two of the mental hygiene 43 law for ambulatory behavioral health services provided to its enrollees, 44 at a minimum, at a rate equivalent to the payments established for such 45 services under the ambulatory patient group (APG) rate-setting methodol- 46 ogy at the time of service, utilized by the department or by the office 47 of mental health or offices of addiction services and supports for rate- 48 setting purposes for ambulatory behavioral health services provided to 49 enrollees in the medical assistance program under title eleven of arti- 50 cle five of the social services law. Organizations and in network, 51 participating providers may negotiate different rates and methods of 52 payments, however organizations shall pay no less than the equivalent of 53 rates that would be paid for ambulatory behavioral health services 54 pursuant to the medical assistance program under title eleven of article 55 five of the social services law. 
 S. 5361 3 1 § 5. This act shall take effect September 1, 2025 and shall apply to 2 all policies and contracts issued, renewed, modified, altered or amended 3 on or after such date.