More Advocacy Directed at Assembly on Insurance Proposals

March 22, 2023

On Monday morning your Inbox included a request from us for advocacy designed to push the NYS Assembly to join with the Governor and the Senate in supporting a group of insurance proposals that (if enacted) will increase access to care, firm up coverage for individuals with commercial insurance, and require the state to update Network Adequacy standards.  We shared a link you could use to generate a letter to the members of the Assembly and specifically, the Chair and members of the Assembly Insurance Committee.  If you sent letters as requested, thank you!  If not, here’s the link to quickly send letters to Assembly representatives:

If you would prefer to contact your Assembly representative by phone, here’s a link to phone numbers for members of the Assembly: (A list of the insurance proposals and what they propose, is included below).  If the person you speak with states that the Assembly is waiting until after a new state budget is enacted to take up these proposals, please respond by reminding the person you are speaking with that NYS is in the midst of two public health crises and can not wait another day for these proposals to be enacted into law. (For more ideas on what to say, read the letter attached to this email).

If you previously sent a letter using the automatic letter generator (linked above), I have attached a different letter that you can send to your Assembly reps office via email (using the link directly above to find his/her email address).  See attached document.

Finally, for your information, below is a list of the insurance proposals we are pushing for the Assembly to include in the final budget agreement (the Senate and the Governor have already indicated support for these proposals).

THANK YOU for taking action to compel the Assembly to support these critical state budget proposals!

The insurance proposals are embedded in the Article VII, Health/Mental Hygiene budget bill.

·     Part II, subpart A would ensure that school-based mental health clinics are reimbursed at the Medicaid rate for services provided to children and youth whose parents have commercial insurance. 

·     Part II, subpart B would prohibit 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.  In addition, the proposal would require 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  

·     Part II, subpart C wouldrequire 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 

·     Part II, subpart D authorizes insureds to bring legal actions against state-regulated commercial insurers to address state law parity violations. 

·     Part II, subpart E 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

·     Part II, subpart F would require the state to update Network Adequacy standards that Medicaid and commercial plans must abide by.