Primary Focus: Enforcement: Reporting Requirement
Title/Description: Reporting requirements
Citation: ISC §343
Summary: This law amends the NYS Insurance Law by requiring insurers to submit a report every 2 years to the Superintendent of Insurance that demonstrates a plan’s compliance with state and federal parity requirement using records of its actual coverage over the past two years, including data and information such as: Rates of prior and concurrent authorization requests, adverse determinations, and in-network paid claims of mental health and substance use disorder claims compared to that of medical/surgical claims; cost-sharing requirements of mental health and substance use disorder benefits compared to that of medical/surgical benefits; and in-network participant information.
Effective Date: Immediate
Notes: Enacted through A6186A/ S4356
Primary Focus: Parity: General; Medical Management LImitation; Enforcement: Reporting Requirements; Compliance: Reporting Requirements; Access to Services
Title/Description: NYS 2019-2020 Budget Bill
Summary: Among many things, this bill amends NYS insurance law:
Primary Focus: Compliance: Reporting requirement; Enforcement: Reporting requirement
Title/Description: An act to amend the insurance law in relation to establishing the Mental Health and Substance Abuse Parity Report Act
Citation: ISC §210
Summary: This law amends ISC §210 (a) and (d) to require the Superintendent of Insurance to include in the annual Consumer Guide a “Mental Health Parity Report” that ranks insurers’ and health benefit plans’ compliance with the federal parity law using rates of medical management techniques, mental health and substance use disorder benefit claims, complaints, etc. Insurers and health plans are required to submit to the Department of Insurance the information needed for this report, including comparative analyses of utilization review rates, appeals, cost sharing requirements, verified network adequacy data, etc. Additionally, the law amends ICS §210(c)(2) by adding a requirement that the Consumer Report include the percentage of mental health professionals who are participating providers, the number of claims each type of professional has submitted, and how many professionals have not had submitted any claims.
Effective Date: February 20, 2019
Notes: Enacted through A 3694/S 1156
Primary Focus: Mental Health in Schools
Title/Description: Health education regarding mental health, alcohol, drugs, tobacco abuse and the prevention and detection of certain cancers
Citation: N.Y. COMP. CODES R. & REGS. tit. 1, §804.
Summary: The New York Education Law § 804 was amended by bill, A3887B, to include mental health as well as physical health in the health education of New York school. The law seeks to ensure young people learn about mental health and increase the likelihood that they will be able to more effectively recognize signs in themselves and others and seek appropriate help. The law also seeks to remove the stigma surrounding mental illness by openly discussing mental health issues.
Effective Date: July 1, 2018
Primary Focus: Parity: General
Citation: NY CLS Ins § 4303
Summary: Subsection (1) of Section 4303 was amended by adding a new paragraph 5, providing that coverage provided under this subsection shall not be subject to preauthorization. Coverage applies to facilities in the state certified by the Office of Alcoholism and Substance Abuse Services for the provision of outpatient, intensive outpatient, outpatient rehabilitation and opioid treatment that are participating in the corporation’s provider network. Coverage shall not be subject to concurrent review for the first two weeks of continuous treatment, not to exceed fourteen visits, provided the facility notifies the corporation of both the state of treatment and the initial treatment plan within forty-eight hours and the facility shall perform clinical assessment of the patient for each visit. A subscriber shall not have any financial obligations to the facility for any treatment other than any copayment, coinsurance, or deductible otherwise required under the contract.
Effective Date: April 12, 2018
Notes: Amended by N.Y. SB 7507
Primary Focus: Parity: General
Title/Description: Group or blanket accident and health insurance policies; standard provisions
Citation: NY CLS Ins § 3221
Summary: Paragraph 7 of Subsection (1) of Section 3221 was amended by adding a new subparagraph (E), providing that coverage provide under this paragraph shall not be subject to preauthorization. Coverage applies to facilities in the state certified by the Office of Alcoholism and Substance Abuse Services for the provision of outpatient, intensive outpatient, outpatient rehabilitation and opioid treatment that are participating und the insurer’s provider network. Coverage shall not be subject to concurrent review for the first two weeks of continuous treatment, not to exceed fourteen visits, provided the facility notifies the insurer of both the state of treatment and the initial treatment plan within forty-eight hours and the facility shall perform clinical assessment of the patient for each visit. An insured shall not have any financial obligations to the facility for any treatment other than any copayment, coinsurance, or deductible otherwise required under the contract.
Effective Date: April 12, 2017
Notes: Amended by N.Y. SB 7507.
Primary Focus: Mental Health Parity Insurance Coverage
Title/Description: Individual Accident and Health Insurance Policy Revisions
Citation: N.Y. Ins. Law § 3216
Summary: The insurance law was amended by Senate Bill 8139 to add inpatient coverage to include unlimited medically necessary treatment for substance use disorder treatment services provided in residential settings as required by the Mental Health Parity Act. Additionally the law was amended to add, “Further, such inpatient” shall not apply financial requirements, treatment limitations, “including utilization review requirements,” to inpatient substance abuse disorder benefits that are more restrictive than the requirements and limitations for medical and surgical benefits covered by the policy.
Effective Date: June 22, 2016
Sponsor: Assm. Cusik and Sen. Seward
Status: Signed into law 6/2014
Summary: This bill amends the insurance law so that insurance plans must use peer-reviewed clinical review criteria that is approved by the Office of Alcohol and Substance Abuse Services when making medical necessity review decisions for people with substance use disorders. In addition, medical necessity decisions for substance use disorder treatment must now be made by professionals who specialize in substance use treatment. The law also allows people with substance use disorders to use an expedited appeals process and not be denied care during the appeals process. The law also requires all substance use disorder coverage to comply with the Federal Parity Law.
Sponsor: Assm. Morelle and Sen. Fuschillo
Status: Signed into law 11/2011
Summary: This bill amended the insurance law so that insurance plans must cover screening, diagnosis, and treatment for autism spectrum disorders. A more detailed explanation of how this bill changed the insurance law can be found at the bottom of the page.
Note: All of the sections of the law summarized below are located within New York’s Insurance Law. It is not possible to link to specific articles and sections of New York’s consolidated laws due to the construction of the website that hosts them. Please send an email to firstname.lastname@example.org to receive the actual text of these sections of New York’s Insurance Law.
New York state law, known as “Timothy’s Law” has sections that address insurance coverage for behavioral health services.
There are several layers to New York’s law. Different sections of the law apply to different groups of behavioral health conditions:
The section of the law that applies to mental health conditions in general requires small employer fully-insured plans, and large employer fully-insured plans to cover “mental, nervous or emotional disorders or ailments, however defined in such policy, at least equal to the coverage provided for other health conditions.” The law does not go into any further detail about how these conditions are defined or reference any outside classification material such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). This section of the law includes the following coverage requirements:
The section of the law that applies to “biologically-based mental illnesses” states that coverage must be provided on the “same terms and conditions” as coverage for other medical services. large employer fully-insured plans must provide this coverage while small employer fully-insured plans must only offer this coverage, but it may be rejected by the small employer. “Biologically-based mental illnesses” are defined as:
This section of the law also applies to children with “serious emotional disturbances.” These are defined as attention deficit disorders, disruptive behavior disorders, or pervasive development disorders with any one of the following symptoms:
Small employer plans are not required to abide by this section.
This section of the law requires individual plans, small employer fully-insured plans, and large to cover substance use disorder treatment services and that treatment limitations and financial requirements cannot be different than those in place for other medical services. It also states that coverage in general must follow the Federal Parity Law.
This section of the law requires individual plans, small employer fully-insured plans, and large to cover screening, diagnosis, and treatment of autism spectrum disorders. It defines autism spectrum disorder as any condition in the DSM that is considered a pervasive developmental disorder. Additionally, it specifically mentions autistic disorder, asperger’s disorder, Rhett’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified as conditions that must be covered.
This section states that the following are treatments that must be covered:
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