Governor Hochul’s Proposed Behavioral Health Insurance Reforms
The proposed changes would expand several provisions of insurance coverage of behavioral health services including:
Subpart A:
Expands coverage for medically monitored residential treatment, mobile crisis services (not subject to preauthorization and regardless of network participation), critical time intervention, and assertive community treatment. Also requires coverage of school based mental health services, at a negotiated rate or if there is no negotiated rate, at no less than the Medicaid rate.
Effective: January 1, 2024
Subpart B:
Prohibits insurers from performing preauthorization or concurrent reviews within the first thirty (30) days of inpatient or residential admission, providing the provider notifies the insurer of the admission and treatment plan within two (2) days of admission, performs daily clinical review and participates in consultations with insurer. Exceptions for concurrent review for individuals who meet clinical criteria as determined by the Office of Mental Health (OMH) or where admission is at a facility designated by OMH for concurrent review in consultation with DOH and Superintendent of Department of Financial Services (DFS).
Effective: One year after enactment
Subpart C:
Requires payment parity for telehealth services for providers licensed by OMH, the Office of Addiction Services and Supports (OASAS), or the Office for People with Developmental Disabilities (OPWDD) without regard to the physical location of the attending practitioner or the patient.
Effective: Upon enactment
Subpart D:
Allows those who are insured to bring legal action if state parity laws are violated to redeem damages or $1,000, whichever is greater.
Effective: Upon enactment
Subpart E:
Prohibits prior authorization of detoxification or treatment of substance use disorder, including for medication for opioid overdose reversal.
Effective: Upon enactment and apply to policies issued, renewed, amended or modified after such date
Subpart F:
Require DFS and DOH to promulgate regulations, in consultation with OMH and OASAS, regarding network advocacy standards for behavioral health services, including appointment availability timeframes, time and distance standards.
Effective: Upon enactment
Also requires insurers to provide out-of-network referrals and reimburse for out-of-network services provided by OMH or OASAS licensed or certified providers at a negotiated rate or when there is no negotiated rate at no less than the Medicaid rates then in effect.
Legislature’s Response to Proposed Behavioral Health Insurance Reforms:
- The Assembly rejected the Governor’s proposal to impose new requirements on plans related to behavioral health services, while the Senate accepted the proposal.
- Senate One House Bill:
“The Senate accepts the Executive proposal to require commercial insurance coverage of certain behavioral health services, exempt certain behavioral health services and substance use disorder drugs from preauthorization or utilization review, require payment parity for telehealth mental health services, create penalties for payment parity violations, and require DFS to promulgate regulations related to behavioral health and substance use disorder network adequacy.”