The Assembly and Senate have continued to push for an 8.5% COLA (look for the action steps later today).
One piece that the Assembly left out of their one house bill was in regard to several provisions around behavioral health parity including the importance of ensuring parity between Medicaid and Commercial insurance for individuals utilizing school based mental health clinics. As more and more school mental health clinics are established, we need individuals in commercial plans to have robust benefits so that their families do not have to deal with paying for clinic services in schools beyond deductibles and co—pays. This is an important step in responding to the youth mental health crisis in New York.
Listed below is MHANYS support for the parity provisions that were in the Governor’s initial budget proposal. We urge the Assembly in final negotiations to include these significant parity provisions.
Glenn Liebman
he/him/his
CEO, MHANYS
(518) 434-0439 | MHANYS.org
Follow us online: MHANYS.org
Facebook: @MHAacrossNYS
Twitter: @MHAacrossNYS
Memorandum in Support
A.3007-B / S.4007-B (Part II)
Parity/insurance reforms for behavioral health services
The Mental Health Association in New York State strongly supports Part II of the Governor’s Health & Mental Hygiene Article VII legislation which proposes to enact several statutory insurance reforms to provide better commercial insurance coverage and parity for behavioral health services. We note that the Senate included these provisions in its Article VII Bill, however, the Assembly did not include this Part in its one-house bill.
We believe that this legislation would close several loopholes and deficiencies to provide better mental health and substance use disorder coverage in commercial health insurance policies in this state. Among these needed reforms would include the following:
- expand inpatient psychiatric hospital commercial coverage to include “sub-acute care in a medically-monitored residential treatment facility;”
- includes minimum requirements for coverage of mobile crisis intervention services (without pre-authorization and includes out-of-network providers);
- require coverage for services following discharge from the hospital or ER, including outpatient care coordination services, critical time intervention services and ACT services;
- require coverage for OMH-licensed, school-based mental health clinic services, at rates no less than the applicable Medicaid rate and without regard to network participation status (insured could only be charged copayments, coinsurance, or deductibles under the terms of their policies);
- generally would prohibit commercial insurers from requiring pre-authorization or concurrent reviews within the first 30 days of mental health inpatient or residential care;
- require payment parity for tele-health services provided by providers licensed by OMH, OASAS, or OPWDD, without regard to the physical location of the attending practitioner or the patient;
- authorize private right of action by insureds to address state law parity violations (penalties could equal damages or $1000, whichever is greater);
- prohibit prior authorization of detoxification or treatment of substance use disorders, including buprenorphine and naloxone; and
- require the promulgation of regulations to ensure adequate provider network access for mental health and substance use disorder services, including appointment availability standards, and time and distance standards, as well as reimbursement requirements which shall provide that out-of-network services provided by OMH or OASAS licensed providers shall be at no less than the applicable Medicaid rates.
The COVID pandemic has exacerbated a behavioral health crisis that has existed in this state and nationally for several years. A February, 2023 Kaiser Family Foundation survey found that nearly three years after the start of the COVID pandemic, many people continue to grapple with worsened mental health and well-being, while facing barriers to care. The survey found that 32.3% of adults were having symptoms of anxiety or depressive disorders, and further found that negative mental health and substance use outcomes disproportionately affect communities of color and youth. 1
U.S. Surgeon General Vivek Murthy has stated that the COVID has had a “devastating” impact on the mental health of the country’s youth: “I’m deeply concerned as a parent and as a doctor that the obstacles this generation of young people face are unprecedented and uniquely hard to navigate and the impact that’s having on their mental health is devastating.” 2
While state and federal health insurance parity laws have helped many people access needed services, there remain several barriers and limitations to full access for services reimbursed by commercial insurers in this state. We applaud the Governor and the Executive Agencies for identifying these problems and proposing reasonable solutions to close these loopholes that limit coverage for vitally needed, and at times, life-sustaining treatments.
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