October 30, 2025

Inseparable, a national mental health advocacy organization, has become active in New York.  The group notified me in May that Inseparable had a bill,  S.5241 / A.6648 to address inappropriate medical necessity denials and post-payment clawbacks.   The ‘Same as’ bills are sponsored by Senator Fernandez and Assemblymember Hunter.

The bill would:

• • Establish a consistent, evidence-based definition of “medical necessity.”
  • Prevent denials of needed care that has been recommended by patients’ clinicians.
  • Allow OMH to designate specific level-of-care criteria, i.e., the LOCUS family.
  • Prohibit all post-payment clawbacks for services that were already approved and paid.

I’ve attached a fact sheet, fyi.  Going forward the NYS Council will continue to vigorously support this and other important legislation advancing rights and protections for the New Yorkers we assist and the organizations that serve them.