May 26, 2021
For the last 15 years the NYS Council has led advocacy efforts designed to highlight and address insurance and other barriers that prevent New Yorkers from receiving the mental health and/or substance use disorder services they are entitled to. Enhancing access to and continuity of care has been our north star.
We know that both OASAS and OMH have been working hard to ensure adequate surveillance, monitoring and enforcement of various contract provisions and regulations that plans are required to follow, and we applaud them for their perseverance. To help them along, the NYS Council recently filed several FOIL requests seeking specific information from the state regarding the performance of MMC plans along a number of metrics.
According to our information over 60 citations have been issued to various health plans to date however none of these citations are accessible by the general public We believe that sunshine is the best disinfectant. All New Yorkers should be able to review the citations and the follow-up work performed by the health plans to address the issues raised by the state.
Below is an article that appeared in yesterday’s Albany Times Union that discusses some of the ways in which the Department of Financial Services (DFS) is enhancing health plan surveillance and monitoring to ensure access to care and network adequacy. Below the article is a press release on these new protections. Stand by for more.
NY Tightens Protections For Consumers Seeking Mental Health, Addiction Services Rules Aim to Increase Compliance with Mental Health, Substance Use Disorder Parity Laws
By Bethany Bump, Albany Times Union, May 25, 2021
ALBANY – New York’s top insurance regulator is beefing up rules that require health insurers to cover mental health and substance use disorders at the same level they cover physical health conditions.
The state Department of Financial Services will propose a new regulation requiring insurers to hold consumers harmless when their provider directory incorrectly lists a mental health provider as in-network, DFS Superintendent Linda A. Lacewell announced Tuesday.
Many individuals have reported struggling to find mental health providers through these lists, which are often outdated and force consumers to make dozens of inquiries – sometimes to no avail<https://www.statnews.com/2019/06/17/ghost-networks-psychiatrists-hinder-patient-care/>. The lists also make it appear as though an insurer has complied with mental health parity laws, when in fact they have not.
“Mental health matters now more than ever in the midst of a pandemic and as we continue to fight economic and social injustices,” Lacewell said. “Ensuring that New Yorkers receive full benefits for mental health and substance use disorder services on the same basis as other medical benefits is critically important to break down access barriers to treatment.”
DFS will also require insurers to prove that their policies will protect consumers seeking mental health and addiction services from being unfairly charged higher co-payments or co-insurance than those seeking other medical services. They must prove this before the consumer purchases the policy, DFS said.
State and federal law require insurers to provide coverage for mental health and substance use disorders that’s on par with coverage they would provide for other medical conditions. Numerous studies over the years, however, have found that insurers continue to violate<https://www.nami.org/Blogs/NAMI-Blog/March-2020/Health-Insurers-Still-Don-t-Adequately-Cover-Mental-Health-Treatment> so-called parity laws – in part because of a shortage of providers, but also because insurers don’t pay providers enough to adequately provide the services. Courts have also found<https://casetext.com/case/wit-v-united-behavioral-health-8> that insurers set unreasonable criteria for people to qualify for mental health and addiction services.
Lacewell announced Tuesday that DFS will initiate a review of parity compliance later this year based on reports insurers must submit by the end of July. The department will investigate any potential parity violations, including cost-sharing requirements, rates of medical necessity denials and approvals of services, and the number and type of mental health and addiction providers who are in network, she said.
DURING MENTAL HEALTH AWARENESS MONTH, SUPERINTENDENT LACEWELL ANNOUNCES “MENTAL HEALTH MATTERS”: CONSUMER PROTECTION INITIATIVES FOR MENTAL HEALTH AND SUBSTANCE USE DISORDER PARITY IN INSURANCE COVERAGE
DFS to Propose New Regulation to Protect Consumers from Provider Directory Misinformation
DFS to Review Parity Compliance and Review Policyholder Cost-Sharing Requirements and Coverage Limitations
Following Final DFS Parity Compliance Program Regulation, DFS to Review Insurers’ Adoption of Program Requirements
For Mental Health Awareness month, Superintendent of Financial Services Linda A. Lacewell today announced “Mental Health Matters,” a series of initiatives to ensure that New York consumers who need mental health and substance use disorder services are not discriminated against when seeking coverage under their health insurance policies. The initiatives include a new regulation to protect consumers from provider directory misinformation and a comprehensive review of insurers for parity compliance.
Every year, more than 1 in 5 New Yorkers has symptoms of a mental health or substance use disorder. Several studies have shown that the ongoing pandemic has exacerbated mental health and substance use disorder issues, especially for people of color and low-income New Yorkers. To support all New Yorkers at this critical time, DFS is taking steps to strengthen New York consumers’ access to essential mental health and substance use disorder services.
“Mental health matters now more than ever in the midst of a pandemic and as we continue to fight economic and social injustices,” said Superintendent Lacewell. “Ensuring that New Yorkers receive full benefits for mental health and substance use disorder services on the same basis as other medical benefits is critically important to break down access barriers to treatment.”
New York law requires insurers to cover mental health and substance use disorder treatment. In addition, under Federal and State law, health insurers must cover mental health and substance use disorder treatment at the same level that they cover other health conditions. These “parity” requirements ensure that mental health and substance use disorder services can be readily accessed by New Yorkers.
Last year, DFS issued one of the most comprehensive regulations in the nation requiring insurers to establish parity compliance programs. The regulation strengthens insurers’ obligations under State and Federal law to provide comparable coverage for mental health and substance use disorder treatment. DFS has instructed insurers that they must be in compliance with the regulation by the end of this year.
“Mental health and physical health are closely connected, and these regulations will help ensure parity in health insurance coverage, improving public health across New York State,” said New York State Department of Health (DOH) Commissioner Dr. Howard Zucker. “The COVID-19 pandemic has put incredible strains on us all, and there should be no unnecessary roadblocks to New Yorkers seeking treatment for mental health conditions and substance use disorder.”
“Mental health is absolutely essential to overall health,” Office of Mental Health (OMH) Commissioner Dr. Ann Sullivan said. “When insurance providers impose limits on coverage for behavioral health and substance abuse treatments, they create barriers that limit access to necessary healthcare, and these barriers can have far-reaching and sometimes tragic consequences. The work DFS is doing to ensure parity regulations are being followed is helping people get the vital services they need.”
“Treating substance use and mental health conditions is as important as treating any physical ailment or illness,” said Office of Addiction Services and Supports (OASAS) Commissioner Arlene González-Sánchez. “These new regulations will help gain access to greater health equity and strengthen protections for individuals and families who are in need of essential behavioral health treatment and recovery services.”
Today, following the final parity compliance program regulation that went into effect in December, and in recognition of Mental Health Awareness month, Superintendent Lacewell announced the following DFS actions to ensure that New York insurers provide equitable coverage for mental health and substance use disorders:
- Regulation to Protect Consumers from Provider Directory Misinformation: DFS will propose a regulation requiring insurers to hold consumers harmless when the insurer’s provider directory lists a provider as participating in an insurer’s network when the provider does not in fact participate in the insurer’s network. Access to providers of mental health and substance use disorder services is especially important now when so many New Yorkers have been struggling with mental health issues due to the pandemic.
- Up-Front Review of Cost-Sharing: Before policies are sold to New Yorkers, DFS is requiring insurers to prove that those policies meet parity requirements that protect consumers from being unfairly charged higher copayments or coinsurance for mental health and substance use disorder benefits than for medical benefits.
- Comprehensive Review of Biennial Parity Reports: DFS will initiate a comprehensive review of insurers for parity compliance based on reports due from insurers in July 2021. DFS will investigate any potential parity violations, including cost-sharing requirements, rates of medical necessity denials and approvals of services, as well as the number and type of mental health and substance use disorder providers who are in network.
DFS expects full adherence to these critical State and Federal consumer protections for New Yorkers and their families and will hold insurers accountable for any parity violations.
General questions about coverage provided by an insurer regulated by DFS should be sent to Consumers@dfs.ny.gov. Anyone who has been denied coverage by an insurer that DFS regulates can file a complaint at www.dfs.ny.gov/complaint.