Governor releases guidance to ensure health insurers provide coverage for substance abuse treatment

(New York, NY – Insurance News and Markets) – Insurance providers in New York State must comply with legislation that requires insurers provide coverage for needed substance abuse treatment, as decreed this year in a law signed by Gov. Andrew Cuomo. In mid-October, he released guidance from the Department of Financial Services that clarifies insurance coverage requirements.

The new law requires that medication, including naloxone, is covered for substance use disorders in large group policies. The new requirement mirrors coverage requirements for individual and small group policies.. Health insurers will also be required to provide coverage without preauthorization for inpatient substance abuse treatment in facilities that participate in their networks and are certified by the New York State Office of Alcoholism and Substance Abuse Services.

“Health insurers have an obligation to cover costs for lifesaving substance abuse treatment and our administration will have zero tolerance for those who seek to sidestep this responsibility,” Governor Cuomo said. “This action is an important step toward breaking the cycle of addiction and put an ending the epidemic of opioid abuse in New York once and for all.”

The new guidance instructs health insurers that they must eliminate prior authorization requirements for a five-day emergency supply of prescribed medications for the treatment of substance use disorder when an emergency arises. The guidance by DFS outlines insurer utilization review requirements, and includes timeframes under which the utilization review determinations must be made by health insurers.

The landmark legislation signed by Governor Cuomo was a comprehensive package of bills passed as part of the 2016 Legislative Session. The measures marked a major step forward in the fight to expand access to treatment and community prevention strategies, as well as to limit the over-prescription of opioids. DFS will review health insurers’ compliance with requirements for coverage during market conduct exams and will take action against any insurers found to have failed to meet all statutory and regulatory requirements for coverage of substance use disorder treatment.

Source: Department of Financial Services, New York State.