February 28, 2023

NYS Health Plan Association (HPA) testimony.

Of particular interest, see pages 5-8 of the testimony in which the HPA vigorously opposes a proposal included in the Governor’s executive budget that would allow individuals to sue commercial insurers for parity violations as well as other actions that are prohibited.  

HPA also opposes the mandatory expansions in coverage by commercial insurers that we outlined in our testimony to include mandated coverage for certain mental health and substance use disorder programs (excerpt from our Health/Medicaid testimony is pasted directly below in italics):

SUPPORT:  Access to Care Expansions (Article VII, Health/Mental Hygiene proposals)

Commercial insurance would be required to cover:

1.     OMH Residential (medically monitored, not community residences)

2.     Crisis Residential 

3.     OCD/Eating Disorders residential services

4.     Residential Treatment Facilities (RTFs)

5.     *Mobile Crisis Intervention

6.     Care Coordination

7.     Critical Time Interventions

8.     ACT

SUPPORT: *Mobile Crisis services must be covered just like ambulance services – no Prior Auth, no limits as to which Mobile Crisis provider can be called.

SUPPORT:  School-based MH clinics will be paid at no less than Medicaid rate or (if provider prefers) a negotiated rate, by commercial insurers.  If the school-based clinic is out of network, the family will be held harmless for in-network cost sharing, and there will be no balance billing permitted.