Bill > S05361

This bill requires various types of health insurance providers (including individual and group policies, medical expense indemnity corporations, hospital service corporations, health service corporations, and health maintenance organizations) to reimburse in-network, participating providers for ambulatory behavioral health services at a minimum rate equivalent to the Ambulatory Patient Group (APG) rate-setting methodology used by New York state health departments for medical assistance program enrollees. The APG is a specific rate-setting approach used to determine reimbursement rates for outpatient services. While insurers and providers can negotiate different rates, they cannot pay less than the equivalent rates established for the medical assistance program. This means that providers of behavioral health services like mental health and addiction treatment will receive a standardized minimum reimbursement rate across different types of health insurance. The bill will take effect on September 1, 2025, and will apply to all insurance policies issued, renewed, modified, altered, or amended on or after that date, with the goal of ensuring fair compensation for behavioral health service providers and potentially improving access to these critical healthcare services.

Business and Industry

https://www.nysenate.gov/legislation/bills/2025/S5361