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Bill

S 8969

Requires health insurers to provide coverage for speech therapy for stuttering

2025 Regular Session Introduced by Jamaal Bailey

Requires health insurance to cover physician-referred speech therapy for stuttering with no benefit limits, across applicable policy types.

PRINT NUMBER 8969B
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WeVote Research Nonpartisan
Bill Summary · S 8969

Summary of Bill S. 8969 (2025-2026) – New York

Overview

  • Bill: S. 8969
  • Session: 2025-2026
  • Jurisdiction: New York
  • Introduced by: Sen. Bailey (co-sponsor: Jamaal Bailey)
  • Status: Referred to the Senate Insurance Committee; related actions include amendments and reprints (as of March 2026)

Purpose

To require certain health insurance policies to cover speech therapy for stuttering. The bill mandates coverage for speech therapy services arising from physician referrals, with explicit protections against durational or monetary benefit limits for such services, and clarifies that coverage may be coordinated with, but not restricted by, other programs (e.g., IFP or IEP).

Key Provisions

1) Expanded Coverage for Speech Therapy for Stuttering

  • Applies to:
    • Individual and group policies that provide medical, major medical, or similar comprehensive-type coverage.
    • Group or blanket policies delivered or issued for delivery in New York.
    • Medical expense indemnity, hospital service, and health service corporations (various types of health coverage).
  • Coverage triggers:
    • Upon physician referral.
    • For all costs associated with speech therapy for stuttering.
  • Services covered:
    • Habilitative speech therapy and rehabilitative speech therapy for stuttering.
    • Provided by a licensed health care professional (licensed under Title 8 of the Education Law).
  • Protection against limits:
    • No durational benefit limitation or maximum for benefits, services, or visits under this coverage, for speech therapy for stuttering.

2) Safeguards and Flexibility

  • Medical management or utilization review may apply.
  • Policies may require services to be provided through a network of participating providers.
  • Coverage denial possible if services are provided under:
    • An Individualized Family Service Plan (IFSP) under Public Health Law §2545, or
    • An Individualized Education Plan (IEP) under Education Law Article 89.
  • If services are provided under an IFSP or IEP, such provision does not affect the policy’s coverage for services provided on a supplemental basis outside an educational setting if referred by a physician.

3) Parallel Provisions for Different Policy Types

  • The same speech therapy coverage requirements are mirrored across:
    • Subsection (i) of §3216 (individual/major medical-style policies).
    • Subsection (k) of §3221 (group/blanket policies).
    • New subsection (xx) to §4303 (medical expense indemnity, hospital, and health service corporations).

4) Effective Date and Application

  • Effective date: January 1 of the year following the date the act becomes law.
  • Applies to policies/contracts issued, renewed, modified, altered, or amended on or after the effective date.
  • The act also authorizes rulemaking and regulatory actions necessary to implement the law immediately upon enactment (i.e., enforcement-ready upon/near effective date).

Who Is Affected

  • Health insurers offering medical/major medical or similar comprehensive coverage in New York.
  • Employers and group plan sponsors funding or administering these policies.
  • Enrollees seeking speech therapy for stuttering, including children and adults, who would obtain coverage upon physician referral.
  • Providers of speech therapy (licensed under Title 8 of the Education Law) who treat stuttering.
  • Potential coordination with IFSPs and IEPs, with protections ensuring educational-plan-based services do not undermine medical coverage for non-educational services.

Practical Implications

  • Could reduce out-of-pocket costs for patients requiring speech therapy for stuttering.
  • Removes benefit cap constraints specifically for speech therapy when prescribed by a physician.
  • Encourages broader access to habilitative/rehabilitative speech therapy services for stuttering across both individual and group plans.
  • May influence network adequacy requirements due to potential reliance on network providers.

Key Dates to Monitor

  • Legislative actions noted: amendments and committee recomposition in March 2026.
  • Upon becoming law, the act would take effect on January 1 of the year following enactment, with immediate authority for regulatory updates to implement the requirements.

Compiled from official sources — confirm details with the bill’s official record.

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