New YorkA 70382025-2026 Regular SessionHouseWALLET

Requires rates paid for rehabilitation and opioid treatment be pursuant to certain fee schedules published by the office of addiction services and supports

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 1 benefits, 0 costs, 2 mixed.

Insurers must meet Medicaid rates for addiction and mental health

The law requires insurers to pay in-network outpatient addiction and mental health providers at least the Medicaid-equivalent rate. It applies to OASAS- and OMH-licensed or operated clinics, including intensive outpatient, rehab, opioid treatment, and crisis stabilization centers that are in-network. OASAS and OMH must publish fee schedules by November 1 each year that use rates effective April 1 of the prior year and set before October 1. This applies to policies issued, renewed, or changed on or after enactment and helps keep providers in-network so people can get care.

Nonprofit plans must meet Medicaid rates

Nonprofit health plans must pay in-network outpatient addiction and mental health providers at least the Medicaid-equivalent rate. OASAS and OMH must publish fee schedules by November 1 each year using rates effective April 1 of the prior year and set before October 1. Plans may reflect differences between those rates and their earlier estimates in future premium filings. This applies to policies issued, renewed, or changed on or after enactment, helping preserve access to care but premiums could change later.

State guidance on health premium filings

The Superintendent of Financial Services gives plans guidance before they file next year’s premiums. The guidance explains how to use the April 1 Medicaid-equivalent fee schedules when estimating costs. Plans may account for differences between those rates and their earlier estimates in future premium filings.

Sponsors & Cosponsors

Sponsor

David Weprin
Democratic • House

Cosponsors

Angelo Santabarbara
Democratic • House

Roll Call Votes

All Roll Calls

Yes: 59 • No: 0

House vote • 6/12/2025

FLOOR Vote