Requires all policies that provide coverage for inpatient hospital care to include benefits for child and family treatment and support services and children's home and community based services.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A5389
SPONSOR: Weprin TITLE OF BILL:
An act to amend the insurance law, in relation to requiring insurance
coverage for child and family treatment and support services and chil-
dren's home and community based services
PURPOSE:
This bill ensures that health insurers are providing certain coverages
for outpatient children's behavioral health services.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends section 3216 of the insurance law by adding child and
family treatment and support services and children's home and communi-
ty-based services to the list of covered outpatient services.
Section 2 amends section 3221 of the insurance law by adding child and
family treatment and support services and children's home and communi-
ty-based services to the list of covered outpatient services.
Section 3 amends section 4303 of the insurance law by adding child and
family treatment and support services and children's home and communi-
ty-based services to the list of covered outpatient services.
Section 4 sets forth an effective date of January 1, 2026.
JUSTIFICATION:
New York's Medicaid Plan offers robust behavioral health services for
children and families. Child and Family Treatment and Support Services
(CFTSS) and Children's Home and Community Based Services (HCBS) are two
critical treatment options for children experiencing a behavioral health
issue. CFTSS and HCBS are unique in that they meet young people and
families where they are - in their homes and in their communities. They
provide treatment and supports for the youth, and more importantly,
offer modalities that serve the family and caregiving unit. The services
reach people earlier on in the service continuum, providing treatments
up front, often leading to better outcomes, avoiding crisis visits to
hospitals and emergency rooms, and ultimately saving money for the
patient, state, and healthcare system.
CFTSS and HCBS services are readily available in the state's Medicaid
Plan, and more recently were added to the Child Health Plus Plan (CHP)
in 2022.
This is of course a great benefit to those with Medicaid and CHP cover-
age, and there is significant demand for these services that is greatly
outpacing system capacity. Sadly, commercial health plans, including
employer-sponsored and individual health plans, that many New Yorkers
find their coverage through, are not providing similar coverage. This
leaves many families and caregivers without access to these critical
community-based services simply because of the health benefits card in
their pocket. Indeed, it has created two-tiered system for access to
care that has perpetuated mental health disparities in a time of crisis
where treatment is desperately needed.
To ensure broad access to CFTSS and HCBS services, this bill would clar-
ify that commercial health insurance policies are required to cover
these two services. This action would more closely align commercial
behavioral health benefits with those of Medicaid. It would further
ensure that health plans are in compliance with federal mental health
parity coverage requirements. This legislation is intended to comport
with the coverage outlined in New York's Essential Health Benefits Pack-
age (Benchmark Plan) and is not intended to create a new mandated health
benefit.
LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
This act shall take effect on January 1, 2025.
