Legislative Update: Behavioral Health Insurance Parity Reforms


As we near the end of budget negotiations, NASW-NYS would like to share the following important updates related to the latest budget bill (Health and Mental Hygiene), as it relates to our profession.

Behavioral Health Insurance Parity Reforms

Collective efforts by social workers, psychiatrists, psychologists, and other community advocates have resulted in a final Health and Mental Hygiene budget bill that includes the groundbreaking Behavioral Health Insurance Parity Reforms – a tremendous and hard-fought victory for the broader mental health and substance use disorder community!

Between this expansion, the original Timothy’s Law, codification of the Affordable Care Act in NYS, and our Parity Reporting Bill, New York now has the strongest parity foundation in the country! The Health and Mental Hygiene budget bill will be voted on this Sunday, March 31st.

 

What are Behavioral Health Insurance Parity Reforms?

The Behavioral Health Insurance Parity Reforms (BHIPR) are a comprehensive overhaul of New York State’s Insurance Law aimed at dramatically curtailing health insurance/health plan practices that restrict New Yorkers who are suffering from Mental Health Conditions (MHCs), Substance Use Disorders (SUDs) and Autism Spectrum Disorders (ASDs) from accessing their health insurance benefits for care and treatment. The BHIPR is applicable to all health insurance and/or health benefit plans, individual and group, that are issued for delivery in New York State.

The BHIPR sets as a floor the landmark federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and surpasses it in scope and effect – prohibiting financial requirements or quantitative and non-quantitative treatment limitations for MHCs, SUDs, and ASDs that are more restrictive “than the predominant financial requirements and treatment limitations applied to substantially all medical and surgical benefits under the policy [or contract].”

 

Among the BHIPR provisions of importance:

  • Provides coverage of all MHCs, SUDs, and ASDs as each is defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the most recent edition of another generally recognized independent standard of current medical practice such as the International Classification of Diseases (ICD).

  • Prohibits preauthorization and concurrent utilization review of SUD services during the initial 28 days of treatment (expansion from the current 14 days and Governor’s original proposal for 21 days).

  • Prohibits preauthorization and concurrent utilization review of inpatient psychiatric services for youth services during the initial 14 days of treatment.

  • Prohibits prior authorization for formulary forms of prescribed medications for treatment of SUDs.

  • Requires that medical necessity criteria with respect to benefits for MHCs/SUDs and ASDs be made available to the insured, prospective insured, or in-network provider upon request.

  • Requires that clinical review criteria used by utilization review agents must be approved by the Commissioner of the Office of Mental Health (OMH) or designated by the Commissioner of Office of Alcoholism and Substance Abuse Services (OASAS).

  • Prohibits taking any adverse action in retaliation for a provider filing a complaint, making a report, or commenting to a government body regarding policies and practice that violate this statute.

  • Requires insurers and health plans to post additional information regarding their in-network providers of MH/SUD services, including whether the provider is accepting new patients as well as the provider’s affiliations with participating facilities certified or authorized by OMH or OASAS.

  • Additional funding resources for staffing at the Department of Financial Services (DFS) and the Department of Health (DOH) to handle oversight and enforcement of parity.

  • The provisions take effect January 1, 2020, and apply to all policies issued, renewed, modified or altered after such date.

 

In addition to the enactment of the BHIPR, the final state budget for 2019-20 also includes the codification of the Affordable Care Act and Essential Health Benefits, which collectively will provide the most robust set of parity and consumer protections of any state.

Thanks to your support and dedication, we have gained momentum in the Capitol and we will continue to advocate for you, our members, each and every day.

Stay in touch and stay tuned for a full report on our work this legislative session. More great work is ahead of us!