Support Behavioral Health Parity in the Budget—Make New York’s Law the Strongest in the Nation for Protecting Individuals with Mental Health and Addiction Disorders in Commercial Plans
We have been very supportive of Governor Cuomo’s Executive Budget in regard to behavioral health parity. This is an issue that can be life changing for people that have commercial insurance who have been denied benefits due to their mental health or addictions disorder. New York State has stepped up and is providing the strongest parity initiatives in the country that will make it much more difficult for a person to be denied benefits by a Commercial Plan
This sweeping proposal includes:
· Providing support to stop denials for Non Quantitative Treatment Limits (NQTL). These are the limits that are being used to reject benefits on the grounds that they are not comparable to the medical and surgical benefits afforded by parity. In other words, benefits are being rejected because of things that are more difficult to measure like medical necessity, prior authorization, out of network policies and fail first. Through the Governor’s initiative, this will no longer be used as a rational to reject benefits to those with mental health or addiction disorders based on NQTL. Instead of plans determining medical necessity criteria, the Office of Mental Health will review and approve criteria used to make treatment decisions. This alone can dramatically change the course of a person’s coverage in a positive way
· Providing 21 days of inpatient treatment for substance use disorders without having prior authorization. Currently the number is 14 days (The Senate’s Budget Proposal includes up to 28 days which we wholeheartedly support). The longer an individual can stay in an inpatient rehab facility, the better the chance for success.
· Hiring of staff at the Department of Financial Services (DFS) and the Department of Health (DOH) dedicated to insuring that plans are fulfilling their obligations around the parity law. Greater enforcement will provide greater assurances that individuals are receiving the benefits they have been denied in the past.
· 14 day of adolescent inpatient psychiatric treatment without prior authorization
· Benchmark co-pays for outpatient mental health and substance use disorder services to same as paid for in primary care visits
The Senate has completely embraced these changes but the Assembly has not to this point. The Assembly has done a wonderful job in supporting many mental health initiatives but in regard to parity, they have decided that this is a policy issue that should be discussed post budget. We believe that there are fiscal concerns about parity that should be addressed in budget. As a family member myself, I don’t want to have to wait any longer to get benefits for my loved one. Delay could mean denial
Please call Assembly Speaker Heastie at (518) 455–3791 and tell him to support the inclusion of behavioral health parity in this year’s budget.