NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7211
SPONSOR: Clark TITLE OF BILL:
An act to amend the public health law, in relation to coverage of mental
health and alcohol and substance use services under the child health
insurance plan
PURPOSE:
To ensure that children who receive health insurance under the Child
Health Plus (CHP) program have access to necessary "early and periodic
screening, diagnosis, and treatment" (EPSDT) services, especially relat-
ing to children with physical or mental disabilities and to a full range
of mental health and alcohol and substance use services.
SUMMARY OF PROVISIONS:
Section 1 amends Public Health Law section 2510 subdivision.7 to add
"early and periodic screening, diagnosis and treatment for eligible
children under the age of six and for other eligible children to ascer-
tain physical and mental disabilities" to the definition of "covered
health care services" in the CHP program. It also removes the phrase
limiting mental health and substance use coverage to only services "as
defined by the commissioner in consultation with the superintendent."
Section 2. Takes effect April 1 after it becomes a law. Effective imme-
diately, the Commissioner of Health shall make regulations and take
other actions reasonably necessary to implement this act on that date.
JUSTIFICATION:
Since 1967, the Federal government has required state Medicaid programs
to include coverage of services under the umbrella of Early and Periodic
Screening, Diagnostic, and Treatment (EPSDT) services, a category that
captures a slate of preventive services for all enrollees under age 21.
The broad scope of this benefit entitles Medicaid-eligible children to
comprehensive health care and age-appropriate screenings and services
throughout their early life.
However, the CHP law does not require the full range of EPSDT services.
A variety of behavioral health individual and family treatment and
support services that are available through Medicaid are not covered by
CHP because current law gives the Commissioner of Health and the Super-
intendent of the Department of Financial Services the authority to limit
mental health and substance use services. This outdated limitation
violates the principle of parity for coverage of these services.
PRIOR LEGISLATIVE HISTORY:
2019-20: A.11117 (Gottfried) - Referred to Health
2021-22: A.343 (Gottfried) - Referred to Health
FISCAL IMPLICATIONS:
To be determined. Since the Federal government pays for 76.5% of New
York's CHP expenditures, adding these services to CHP will cost even
less state share than including them in Medicaid costs.
EFFECTIVE DATE:
April 1 after it becomes a law. Effective immediately, the Commissioner
of Health shall make regulations and take other actions reasonably
necessary to implement this act on that date.
STATE OF NEW YORK
________________________________________________________________________
7211
2023-2024 Regular Sessions
IN ASSEMBLY
May 15, 2023
___________
Introduced by M. of A. CLARK -- read once and referred to the Committee
on Health
AN ACT to amend the public health law, in relation to coverage of mental
health and alcohol and substance use services under the child health
insurance plan
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 7 of section 2510 of the public health law, as
2 amended by section 1 of part DDD chapter 56 of the laws of 2022, is
3 amended to read as follows:
4 7. "Covered health care services" means: the services of physicians,
5 optometrists, nurses, nurse practitioners, midwives and other related
6 professional personnel which are provided on an outpatient basis,
7 including routine well-child visits; diagnosis and treatment of illness
8 and injury; early and periodic screening, diagnosis and treatment for
9 eligible children under the age of six and for other eligible children
10 to ascertain physical and mental disabilities; inpatient health care
11 services; laboratory tests; diagnostic x-rays; prescription and non-
12 prescription drugs, ostomy and other medical supplies and durable
13 medical equipment; radiation therapy; chemotherapy; hemodialysis; outpa-
14 tient blood clotting factor products and other treatments and services
15 furnished in connection with the care of hemophilia and other blood
16 clotting protein deficiencies; emergency room services; ambulance
17 services; hospice services; emergency, preventive and routine dental
18 care, including orthodontia but excluding cosmetic surgery; emergency,
19 preventive and routine vision care, including eyeglasses; speech and
20 hearing services; inpatient and outpatient mental health, alcohol and
21 substance [abuse] use services, including children and family treatment
22 and support services, children's home and community based services,
23 assertive community treatment services and residential rehabilitation
24 for youth services which shall be reimbursed in accordance with the
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05830-01-3
A. 7211 2
1 ambulatory patient group (APG) rate-setting methodology as utilized by
2 the department of health, the office of addiction services and supports,
3 or the office of mental health for rate-setting purposes or any such
4 other fees established pursuant to article forty-three of the mental
5 hygiene law; and health-related services provided by voluntary foster
6 care agency health facilities licensed pursuant to article twenty-nine-I
7 of this chapter[; as defined by the commissioner]. "Covered health care
8 services" shall not include drugs, procedures and supplies for the
9 treatment of erectile dysfunction when provided to, or prescribed for
10 use by, a person who is required to register as a sex offender pursuant
11 to article six-C of the correction law, provided that any denial of
12 coverage of such drugs, procedures or supplies shall provide the patient
13 with the means of obtaining additional information concerning both the
14 denial and the means of challenging such denial.
15 § 2. This act shall take effect on the first of April after it shall
16 have become a law. Effective immediately, the commissioner of health
17 shall make regulations and take other actions reasonably necessary to
18 implement this act on that date.
