New York Assembly Bill A03148

New York 2025-2026 Regular Session

• Introduced: 1/23/25
• Refer: 1/23/25
• Refer: 1/7/26

Caption

Provides that for a substance use disorder outpatient treatment episode of care by a provider licensed, certified or otherwise authorized by the office of addiction services and supports, an insured shall only be responsible for a cost sharing fee not to exceed two hundred fifty dollars.

Summary

This bill would limit what insured individuals pay out of pocket for outpatient substance use disorder treatment in New York. For treatment episodes provided by facilities licensed, certified, or otherwise authorized by the Office of Addiction Services and Supports (OASAS), the bill caps an insured’s cost-sharing responsibility at $250 for an episode of care, which is defined as up to 60 visits with the same provider. The bill also states that the insurer is responsible for all remaining financial obligations to the facility. The measure also revises existing insurance-law provisions governing outpatient, intensive outpatient, outpatient rehabilitation, and opioid treatment services in individual, large group, and nonprofit corporation health coverage. It preserves current protections against preauthorization and limits concurrent review during the first four weeks of continuous treatment, while tying medical-necessity review to evidence-based clinical tools designated by OASAS. In large group coverage, the bill further eliminates copayments for outpatient substance use disorder services and replaces prior references to the former Office of Alcoholism and Substance Abuse Services with OASAS terminology.

Impact

The bill would amend sections 3216, 3221, and 4303 of the Insurance Law, affecting individual policies, large group policies, and nonprofit health service corporation contracts. Its practical effect is to reduce or eliminate patient cost sharing for outpatient substance use disorder treatment and to shift more of the financial burden to insurers. It would also standardize how outpatient SUD episodes are treated for cost-sharing purposes, while maintaining existing utilization-review and medical-necessity safeguards for network providers licensed or authorized by OASAS. The changes would apply to policies and contracts issued, renewed, modified, altered, or amended on or after the effective date.

Sentiment

The bill appears generally supportive of expanded access to substance use disorder treatment, with its structure favoring lower out-of-pocket costs for patients and fewer upfront barriers to care. The absence of recorded committee transcripts or votes limits direct evidence of debate, but the bill’s framing suggests a policy goal of improving affordability and continuity of treatment. Overall, the measure reads as a patient-protection and access-to-care proposal.

Contention

The main policy tension is between reducing patient cost sharing and preserving insurer utilization management. The bill limits preauthorization and concurrent review early in treatment, which may be viewed by insurers as constraining cost control, while supporters are likely to see these limits as necessary to avoid treatment delays. Another point of potential contention is the $250 episode-of-care cap and the definition of an episode as up to 60 visits, which could shift substantial costs to insurers and raise questions about premium impact. The bill also narrows the circumstances under which insurers may deny coverage for the initial four weeks of treatment, requiring inconsistency with the designated evidence-based clinical review tool.