New York Assembly Bill A07038

New York 2025-2026 Regular Session

• Introduced: 3/18/25
• Refer: 3/18/25
• Report Pass: 4/2/25
• Engrossed: 5/20/25
• Refer: 5/20/25
• Engrossed: 6/12/25

Caption

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

Impact

The implementation of A07038 is expected to standardize reimbursement rates across various facilities that provide addiction services, which may lead to greater stability in the treatment landscape. This change could help lower the financial burden on these facilities, allowing them to operate more efficiently and potentially expand their services. As state-mandated rates would apply to facilities authorized by the office of addiction services and supports, it would ensure that outpatient treatment remains affordable and accessible for many individuals dealing with addiction, particularly those relying on insurance coverage.

Summary

Bill A07038 proposes to amend the insurance law concerning the rates paid for rehabilitation and opioid treatment services. The bill mandates that reimbursement for covered outpatient treatment from certain facilities be determined through rates negotiated between insurers and the facilities. These rates must not fall below the rates established by the medical assistance program under state social services law. The overall aim of the bill is to ensure consistent funding for addiction treatment services in the state, ultimately impacting the accessibility and quality of care provided to individuals seeking rehabilitation.

Contention

While supporters of A07038 highlight the need for standardized rates to facilitate better treatment options, there may be concerns from insurers regarding the implications of mandated rates on their financial operations. Opponents could argue that such regulations may limit insurers' flexibility in negotiating fair rates based on market conditions. Additionally, potential challenges could arise in balancing the need for adequate reimbursement rates with the financial sustainability of insurance companies, which could affect policyholders in the long term.