NY governor announces action to ensure insurer compliance with mental health equity standards

(New York, NY – Insurance News and Markets) – The New York Department of Financial Services issued guidance meant to ensure that health insurers do not unfairly discriminate against individuals with mental health disorders. The letter issued to health insurers pointed out the responsibility of insurers to provide the same level of coverage for mental health and substance use disorders as for medical or surgical care.

“This administration will have zero tolerance for insurance companies that seek to shirk their obligations to provide coverage for substance abuse and mental health treatment,” Governor Andrew Cuomo said. “With this action, they’re on notice as we seek to create a stronger, healthier New York for all.”

This guidance comes on the heels of recent legislation signed by Governor Cuomo that limits burdensome insurance barriers to access for treatment and medication to treat substance use disorders. Under New York Insurance Law, insurers cannot impose prior insurance authorization for inpatient treatment or for greater access to drug treatment medications. The law also requires insurers to use objective state-designated criteria to determine the level of care for individuals suffering from substance use disorder.

The letter advises insurers that the United States Department of Labor and the United States Department of Health and Human Services have jointly issued guidance on compliance with the federal Mental Health Parity and Addiction Equity Act. The MHPAEA requires health insurance plans to provide the same level of coverage for mental health and substance use disorders as for medical or surgical care, including quantitative limitations, such as copays, deductibles, and limits on inpatient or outpatient visits that are covered by the health insurance plan, and Non-Quantitative Treatment Limitations, such as pre-authorizations, providers available through a plan’s network, and what a plan considers “medically necessary”.

DFS is also directing insurers to evaluate whether the following categories of NQTLs that are applied in a plan or policy are being applied consistently with MHPAEA requirements:

Preauthorization and pre-service notice requirements;

Fail-first protocols;

Probability of improvement requirements;

Requirement to provide a written treatment plan; and

Other requirements, such as patient non-compliance rules, residential treatment limits, geographical limitations, and licensure requirements.

Stakeholders can submit comments directly to DFS at mentalhealthparity@dfs.ny.gov. A copy of the letter DFS sent to insurers can be found here.

Source: Department of Financial Services, New York State.