Despite implementation of Timothy’s Law and National Parity, there have
still been too many instances of individuals being denied coverage for
mental health or substance abuse issues from commercial plans. This is in
direct conflict with the core set of values and the law that is based on
parity with medical and surgical benefits. MHANYS and others have sited
many examples of the abuse and misuse of the law. The recent Modern
Healthcare Report identified the impact of not adhering to parity with
medical and surgical benefits through both the non-quantitative parts of
parity (prior authorization and fail first) and the quantitative parts of
parity (benefit limits, out of pocket expenses, etc.). In other words,
despite the law, there are many instances when people with behavioral
health needs do not get the equivalent benefits of those with medical or
surgical benefits for other illnesses.

Advocates fought hard the last few years in New York to get legislation
that would provide stronger accountability and oversight regarding insurers
not following the parity language. This year we are pleased that the
legislation was approved in both houses. This legislation would include
parity compliance in the Consumer Guide to Health Insurers prepared by the
Department of Financial Services thereby creating greater public awareness
about parity in New York. Greater awareness leads to greater access to care
and treatment.

We thank our Mental Hygiene Chairs in the Legislature—Assemblymember
Gunther and Senator Ortt for their leadership and sponsorship of the bill.
Also great advocacy from Richard Gallo and Jamie Papapetros of Gallo
Associates and Karin Carreau of the Elk Street Group (as well as the voices
of many other behavioral health organizations) for putting on their old
Timothy’s Law hats and helping to lead the successful campaign.

As we have said time and time again, when the behavioral health community
speaks with one voice, it is incredible what can get done.

Now on to the Governor.

Legislation (A3694C/S1156C) Passed Requiring Insurers and Health Plans To
Submit Key Compliance Data with Federal and State MH/SUD Parity Laws: 

This legislation directs the Superintendent of the Department of Financial
Services to collect certain key data and matrixes from insurers and health
plans in order to scrutinize and analyze if they are in compliance with the
federal and state mental health and substance use (MH/SUD) disorder parity
laws. The information collected would be analyzed and used for the
preparation of a parity compliance report in the annual “Consumer Guide to
Health Insurers” issued by Department of Financial Services.

Why is this legislation so important and needed NOW? 

  • The current enforcement & compliance system is complaint driven
    — putting the onus on consumers!
  • This legislation is extremely important as we know non-compliance
    persists, which unnecessarily delays and/or denies access to care for MH/SUD.
  • The eight settlements/agreements the New York Attorney General
    reached with several major insurers, health plans and managers of
    behavioral health benefits found major acts of non-compliance, including
    among others:

    • applying more stringent and frequent utilization review for MH/SUD as
      compared to medical/surgical benefits;
    • denying care and treatment for mental health and substance use
      disorders at higher rates;
    • imposing a higher/specialist copayment rate for outpatient mental
      health and substance use disorder care than for outpatient/medical
      surgical care;
    • and, using medical necessary criteria and models inconsistent with the
      laws and regulations of the State.
  • Hence, New York needs this legislation to allow for annual review of
    compliance with MH/SUD parity laws.
  • Now more than ever, this legislation is needed as New York faces an
    increasing number of suicides and opioids deaths.

    • Recent CDC data shows a 28.8% increase in suicide in New York State
      between 1999 to 2016. Suicide is now the 10th leading cause of death with
      the number of suicides (nationally) surpassing the number of deaths by
      automobile accidents, homicides and most recently breast cancer. According
      to a recent OMH report and plan on suicide prevention, “1,700 New Yorkers
      died by suicide in 2014. Only four states in the country had a higher number.”
  • Nearly 3,600 opioid deaths in 2016 (a 135% increase between 2013-2016).
  • Compliance with the parity laws is critical to assuring access to care and treatment.
  • Under this legislation, insurers and health plans would have to submit data on:
    network adequacy; rates of utilization review; rates of adverse determinations;
    percentage of claims paid for in-network and out-of-network MH/SUD care and
    treatment; percentage of providers who remained in network; network adequacy;
    and any other data or metric the Superintendent deems necessary to evaluate
    compliance with the MH/SUD parity laws.