New York Statutes

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.

Enacted through A6186A/ S4356

Among many things, this bill amends NYS insurance law:

• To codify NYS  parity requirements to be consistent with the Federal Parity Law,
• To prohibit commercial insurers from imposing prior authorization requirement of formulary forms of MAT,
• To require plans provide in their annually updated provider directory whether the provider is accepting new patients and the most recent comparative analysis performed by the insurer assessing parity compliance,
• To allow the Commissioner of Health to review parity compliance and out of network rates as part of reviewing a plan’s network adequacy,
• To designate the standardized OASAS tool for utilization review for treatment in NYS State,
• To allow OMH, in consultation with DOH and the superintendent of DFS, to approve of evidence-based and peer-reviewed clinical review criteria to be used for utilization review.

Enacted through S 15077-c/ A2007-c

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.

Enacted through A 3694/S 1156

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.

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.

Amended by N.Y. SB 7507

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.

Amended by N.Y. SB 7507.

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.

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.

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.