MONDAY MORNING ADVOCACY REQUEST: Help Ensure Insurance Proposals Are Enacted in Final State Budget

March 19, 2023

As discussed during last week’s NYS Council Membership Support and Public Policy meeting, we are now in a race to ensure the final enacted state budget includes a group of important insurance proposals designed to improve access to care, guarantee coverage for many important services for New Yorkers with commercial insurance benefits, and codify certain requirements that insurers often fail to comply with. The Senate included the insurance proposals in their one house budget bill (indicating support for the proposals) whereas the Assembly rejected the proposals. We must now push the Assembly to reverse their position and ensure all of these proposals are included in the soon-to-be-enacted new state budget.

Our colleagues at NAMI-NYS have created a letter that you can send to the Chair and members of the Assembly Insurance Committee.  Here’s a link to the letter:

Instructions:  Click on the “Write” button that takes you to a split screen page where you can choose the Assembly members you want to communicate with.  The list of Assembly members available includes David Weprin, Chair of the Assembly Insurance Committee, as well as the members of the Committee.  At a minimum, please generate a letter to the Chair (Weprin) as well as any of the representatives listed that represent your district, or those you are familiar with.  Many of the proposals we want the Assembly to support are discussed in the letter you will generate.
Here’s a full list of the insurance proposals we need the Assembly to support, fyi.   If you prefer to make phone calls, by all means please do so.  You can use this list when speaking with your representative/s:

  • Network Adequacy proposal that would require the state to update Network Adequacy standards that Medicaid and commercial plans must abide by (Article VII, HMH bill, Part II, subpart F)  NOTE:  The NYS Council submitted language in early February to the relevant Chairs and central staff that would result in the commercial rate for all in network and out of network MH and SUD services being paid at the Medicaid APG rate.  We also submitted language that steps up enforcement actions by the state when an insurer fails to meet Network Adequacy standards to include significant fines and suspension of new enrollments if an insurer fails to meet the standards 3 times in one year. 
  • Commercial insurance coverage for SUD Treatment and Medications:   Assures state-regulated commercial insurance coverage for detox or maintenance treatment of SUDs including all buprenorphine products, methadone, long-acting injectable naltrexone or medications for opioid overdose reversal, without prior authorization for initial or renewal of such treatments.   (Article VII, HMH, Part II, subpart E)
  • Private Right of Action for NYers with Commercial Insurance:   Authorizes insureds to bring legal actions against state-regulated commercial insurers to address state law parity violations.  (HMH, Part II, subpart D)
  • Preauthorization and Concurrent Review Rules: Prohibits insurers from performing preauthorization or concurrent reviews for the first 30 days of mental health treatment for adults in an in-network inpatient hospital or crisis residence licensed or operated by OMH, except where the insured meets designated clinical criteria or is receiving care in a facility designated by OMH in consultation with DFS and DOH, and,Requires utilization review determinations for mental health conditions to be made using evidence-based, age-appropriate clinical review criteria approved by OMH in consultation with DFS and DOH  (Article VII, HMH, Part II, subpart B)
  • Expands state-regulated commercial insurance coverage of sub-acute care in a medically monitored residential facility under OMH, outpatient care provided by crisis stabilization centers and outpatient care provided by a mobile crisis intervention services provider, critical time intervention services and assertive community treatment services, as defined in the proposal.  Coverage for mobile crisis intervention services shall not be subject to preauthorization and is to be covered regardless of whether the provider is in-network.  If provided out of network, the insurer shall not impose any administrative requirements or limitations on coverage.  The insured’s copayment/coinsurance shall be the same as in-network. (Article VII, HMH, Part II, subpart A)
  • Commercial coverage for school-based mental health clinic services:  Requires an insurer to provide reimbursement for covered outpatient care when provided by a school-based mental health clinic licensed under article 31, regardless of whether it is in-network. (Article VII, Health/MH, Part II, subpart A)
  • Telehealth Reimbursement Rates:   Requires state-regulated commercial insurance coverage for services provided via telehealth by Article 31, 32, 26 and 16 of mental hygiene law providers, reimbursed at the same rate as is reimbursed when delivered in person but not necessarily the Medicaid government rate (Article VII, HMH, Part II, subpart C) 

        THANK YOU !!!!