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!

2019 (EM)POWER UP Conference Workshops Announced!

 

It's here! The 2019 (EM)POWER UP Conference schedule is now available. We are thrilled to offer five workshop tracks, as well as a variety of student-focused workshops at the conference. Keep reading to learn more! 

You will receive a separate reminder to log into the 2019 NASW-NYS Conference registration portal and make your workshop selections prior to the conference. Stay tuned!


Early bird deadline extended to April 19!

We have also extended our early bird deadline rates to Friday, April 19, 2019. 

We look forward to seeing you on June 5 - 7 in Saratoga Springs, NY!

 
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*Schedule subject to change
*Schedule subject to change
*Schedule subject to change

ACTION ALERT: Call Your Legislators and urge support for a 2.9% COLA increase for the Human Services Workforce!

This action alert has been updated on Monday, March 25, 2019. 

Call Your Senator & Assembly Member Today: Urge Behavioral Health Insurance Parity Reforms & 2.9% Human Services COLA Be Included in Final 2019-20 Budget

 

With only one week to go until a state budget is due to be adopted, NYSPA members are urged to call their Senator and Assembly Member TODAY to urge the final state budget for 2019-20 include two critical provisions.

(1) Behavioral Health Insurance Parity Reforms (BHIPR), which would dramatically curtail health insurance/health plan practices that restrict New Yorkers, 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. Any delay in the enactment of the BHIPR could delay the effective date by a whole year – leaving individuals and families vulnerable to utilization review and other practices that may not comply with the federal and state MH/SUD, ASD parity laws.

(2) 2.9% Cost of Living Adjustment (COLA) for human service workers, which is critical to addressing the staffing crisis facing human service nonprofits, including escalating turnover and vacancy rates.

Negotiations and discussions on the budget continue around the clock! Please make your voice heard today!

Don't wait to act – take five minutes to call your Senator and Assemblymember TODAY.

Your support can have a huge impact.  

 

Sample Phone/Email Script

CALL YOUR ASSEMBLYMEMBER
(518) 455-4100
NYS Assembly Switchboard

CALL YOUR SENATOR
(518) 455-2800
NYS Senate Switchboard


Hi, my name is _______________. I am a social worker practicing and/or living in your district. I am calling to urge you to support as part of the budget:

(1) the Behavioral Health Insurance Parity Reforms; and,
(2) 2.9% Cost of Living Adjustment (COLA) for human service workers.

Please make sure these important provisions are included in the final budget!

ACTION ALERT: Call the NYS Assembly and urge behavioral health insurance parity reforms be included in the budget!

URGENT: Call Your Assemblymember and Assembly Speaker Carl Heastie TODAY and urge Behavioral Health Insurance Parity Reforms Be Adopted as Part of 2019-2020 Budget!

With only a little over a week left until a state budget is due to be passed by the Legislature, it is imperative you call your Assembly Member and Assembly Speaker Heastie TODAY to urge the Behavioral Health Insurance Parity Reforms (BHIPR) be included in the budget for 2019-2020. The Assembly left the parity reforms out of its one-house budget with the intention to address the parity reforms later in the Legislative Session; however, not adopting the reforms as part of the budget could delay the effective date by a whole year – leaving individuals and families to face another year of insurers and health plans not complying with the federal and state mental health/substance use disorder (MH/SUD) parity laws. New Yorkers CANNOT afford this delay and their lives will depend on it!

Take Action.

 

(1) Call your Assemblymember – Call the main Assembly switchboard and ask to be connected to your Assemblymember. To find out who your Assemblymember is, enter your address at: http://assembly.state.ny.us/mem/search/:

NYS Legislature Switchboard:
Assembly: 518-455-4100

Find your NYS Assemblymember
Click here to find your NYS Assemblymember

(2)     Call Assembly Speaker Carl Heastie at (518) 455-3791 (Albany Office)

Sample Script/Message

Hi, my name is _______________. I am a social worker practicing in New York State. I am calling to urge you to support adoption of the Behavioral Health Insurance Parity Reforms as part of the 2019-2020 budget. These critical protections must be included in the 2019-2020 budget so they can take effect as early as possible and make a difference in the lives of New Yorkers with autism and MH/SUD. Don’t delay these critical protections!

 

Why this matters.

The BHIPR provides the most comprehensive overhaul of New York State’s Insurance Laws in generation — aimed at eliminating health insurance/health plan practices that restrict New Yorkers 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. Among the BHIPR provisions of importance

  • Provides coverage for ALL MHCs, SUDs, and ASDs.
  • Prohibits prior authorization for medication assisted treatment.
  • Medical necessity criteria with respect to benefits for MHCs/SUDs and ASDs shall be made available to the insured, prospective insured, or in-network provider upon request.
  • Clinical review criteria used by utilization review agents must be approved by the Commissioner of the OMH or designated by the Commissioner of OASAS.
  • New restrictions placed on insurers with respect to prior authorization requirements and concurrent reviews for inpatient treatment.
  • 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.
  • Prohibits 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]” and adds an extensive list of treatment limitations.
  • 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.
  • $2.7 million for additional staffing at DFS and DOH to handle oversight and enforcement of parity.

 

Win Free Admission to the 2019 Conference!

Enter our Facebook Contest for an opportunity to attend the 2019 NASW-NYS (EM)POWER UP Conference for FREE!

The 2019 (EM)POWER UP: Social Workers as the Vanguards of Change conference is one of the largest gatherings of social workers and like-minded professionals in New York. This three-day conference event will consist of acclaimed keynote presenters, continuing education workshops, networking opportunities, award ceremonies, and more!

Simply tell us, “How do YOU empower others?”


Ready to enter? Click here to get started!

Contest Rules:

1) Answer the following question in a comment: How do YOU empower others? (click here)

2) Include the hashtag #EMPOWERUP at the end of your comment

3) Have your friends/family/colleagues "Like" your comment and be sure to follow NASW-NYS on Facebook

4) The comment with the most "Likes" wins a three-day admission (Full (EM)POWER UP Conference Experience) to the 2019 NASW-NYS Conference!

5) Invite your social work friends and colleagues to join in for a chance to win FREE admission to the 2019 NASW-NYS Conference (up to a $300 value!) 

Enter between March 19 - April 16. Contest rules apply. Open to members and non-members. 

Enter Now


Contest rules apply. A full refund will be given if winner has paid for their conference attendance prior to the contest. For more details on the 2019 NASW-NYS Conference Facebook Contest rules and guidelines, please visit https://naswnys.org/contest


Countdown to the Conference!



 
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ACTION ALERT: Help save the Veterans Mental Health Training Initiative from being cut from the state budget!

Dear NASW-NYS Members,

We need your help! As you may know, NASW-NYS has been a part of the Veterans Mental Health Training Initiative (VMHTI) for nearly a decade but, this year, our funding is on the chopping block! This program allows us to provide webinars and in-person trainings specific to working with veteran populations, an ever-growing group and one with unique and desperate needs. While the State faces a deficit budget, this is no time to cut funding for programs that assist our veterans!

As such, we need you to contact Senator David Carlucci TODAY and let him know how important the Veterans Mental Health Training Initiative is to address the unmet mental health needs of our veterans and their families. Senator Carlucci is the Chair of the Mental Health Committee and desperately needs to hear from you to help save this program.

Call on Senator Carlucci to ensure that the Veterans Mental Health Training Initiative is in this year’s budget!

845-623-3627 (Rockland Office)

914-941-2041 (Ossining Office)

518-455-2991 (Albany)

Please take five minutes TODAY to call Senator Carlucci’s District Offices at 845-623-3627 (Rockland Office), 914-941-2041 (Ossining Office), or 518-455-2991 (Albany) and let them know that you believe the mental health of our veterans is important and that mental health professionals need training to address the unique needs faced by our veterans. 

Calls from all NASW-NYS members are strongly encouraged, but calls from the following groups will be particularly influential in this effort:
+ Senator Carlucci’s constituents (Find your Senator)
+ Veterans
+ Those who work with veterans
+ Those who have attended VMHTI in the past

 

Thank you!
Samantha Howell, Esq.
Executive Director



The Veterans Mental Health Training Initiative (VMHTI) is a multi-year comprehensive training project developed by the National Association of Social Workers – New York State Chapter (NASW-NYS), aimed at increasing the number of community health and mental health professionals clinically trained in the assessment and treatment of mental health issues specific to veterans and their families. VMHTI is supported by a grant from the New York State Legislature as part of its efforts to address the unmet mental health needs of returning Iraq and Afghanistan war veterans and their families.

Visit the VMHTI website