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Mental Health Update

October 28, 2019
Mental Health Update

MH Update – 10/28/19 – NYS OMH Guiding Principles for the Review and Approval of Mental Health Clinical Review Criteria: Impact to Mental Health Parity

The Non Quantitative Treatment Limits (NQTL) of mental health parity include medical necessity. This has been used to reject claims for mental health benefits.   We strongly support the Governor and the Office of Mental Health for developing a reliable clinical tool for medical necessity that recognizes evidenced-based and peer reviewed criteria.   Changing this criteria will play a significant role in insuring that an individual will have a greater chance of their benefit claims not being rejected.

The public comment period for guiding principles must be submitted by November 8th. Information is listed below.

The New York State Office of Mental Health (OMH) is dedicated to providing individuals and families access to quality, integrated services and supports that foster recovery and well-being. To ensure adequate access to treatment for mental health conditions, OMH is committed to identifying and eliminating insurance barriers to care in order to help all New Yorkers access their insurance coverage for mental health services.

New provisions included in the 2020 New York State Enacted Budget require insurers use evidence-based and peer reviewed clinical review criteria that is appropriate to the age of the patient and which has been approved by the Office of Mental Health when making coverage determinations for mental health treatment. Insurers must submit their clinical review criteria to OMH for review and approval, in consultation with the Department of Financial Services (DFS) and the Department of Health (DOH).

OMH believes that public input is crucial in assisting the agency in meeting the needs of all of the people we serve. Therefore, OMH is soliciting comments on the proposed guiding principles that OMH will use to assess the adequacy of an insurer’s clinical review criteria for the treatment of mental health conditions. These guiding principles can be found on the OMH website here:

To be considered, comments must be submitted to by Friday, November 8th, 2019.