NY S08137

Part A requires utilization review agents to use evidence-based and peer-reviewed clinical review tools designated by the Office of Alcoholism and Substance Abuse Services when reviewing substance use disorder treatment coverage, with all approved tools required to complete inter-rater reliability testing by December 31, 2016; effective January 1, 2017.

Part B mandates insurance policies and contracts provide immediate access without prior authorization to a five-day emergency supply of substance use disorder medications during emergencies, including opioid withdrawal management and overdose reversal medications, with copayment limits ensuring no additional charges if a 30-day supply follows within the same period; effective January 1, 2017.

Part B prohibits managed care providers and Medicaid from requiring prior authorization for initial or renewal prescriptions of buprenorphine or injectable naltrexone for opioid addiction treatment unless the prescription is for non-preferred or non-formulary forms; effective immediately.

Part C extends the heroin and opioid addiction wraparound services demonstration program to provide case management, peer support, employment support, and transportation services during treatment and for up to nine months after completion; requires program evaluation by June 30, 2018; program expires March 31, 2019.

Part D expands emergency services for incapacitated persons by defining "treatment facilities" to include certified medically managed withdrawal and inpatient rehabilitation programs, extends detention without consent from 48 to 72 hours, and requires formal discharge planning with continuing care referrals; effective 90 days after enactment.