Requires health insurance policies and Medicaid to cover patient navigation services

2025 Regular Session Introduced by Joe Addabbo and 8 co-sponsors

Requires private insurers and Medicaid to cover patient navigation services to help patients access care, coordinate treatment, and connect to resources.

REPORTED AND COMMITTED TO FINANCE

Summary of S 5565 — Requires health insurance policies and Medicaid to cover patient navigation services

Overview

S 5565 is a New York State Senate bill introduced on February 25, 2025, seeking to require coverage for patient navigation services by all health insurance policies and the Medicaid program. The bill’s stated aim is to improve access to care by helping patients navigate the health system, coordinate care, and connect with necessary services.

What the bill would do

Mandate coverage for patient navigation services under private health insurance policies and Medicaid.

The exact scope, definitions, and standards for these services would be specified in the bill, but generally would encompass assistance with care coordination, appointment scheduling, referrals, understanding treatment options, and linking patients to community resources.

Establish and/or clarify reimbursement mechanisms and provider qualifications as part of implementing coverage.

Scope and definitions

Who is covered: Individuals enrolled in private health insurance policies issued in New York and enrollees in the state Medicaid program.

What qualifies as “patient navigation services”: To be defined within the bill, likely including activities that help patients navigate appointments, referrals, financial information, transportation options, and social/support services related to accessing care.

Affected stakeholders

Private health insurers and health plans offering coverage in New York.

Medicaid beneficiaries and the Medicaid program.

Patient navigation providers and organizations that deliver navigation services.

Healthcare providers who refer patients to navigation services and coordinate care.

Procedural history and timeline

Introduced: February 25, 2025.

2025-02-25: Referred to Insurance.

2025-05-12: Reported and Committed to Finance (noted twice in the record).

Status: Referred to Insurance earlier in the process; subsequently reported and committed to the Senate Finance Committee.

Sponsors and related measures

Primary sponsor: Jamaal Bailey

Cosponsors: Mario Mattera, Julia Salazar, Patricia Fahy, James Skoufis, Cordell Cleare, Leroy Comrie, Kevin S. Parker, Joseph P. Addabbo Jr.

Companion bill: A 6586 (Assembly), listed as a companion measure.

Potential impact and considerations

Expected benefits: Improved care access, better care coordination, and reduced barriers for patients needing navigation assistance.

Fiscal considerations: The bill would have implications for Medicaid expenditures and private insurer costs; final fiscal impact would be assessed by the Finance Committee.

Implementation: Depends on the bill’s final definitions and regulatory rules, including any phased implementation and provider standards.

This summary reflects the information available from the bill’s current status and does not include text not provided here.