Governor Andrew M. Cuomo today announced that the Department of Financial Services has issued guidance to ensure that insurers do not unfairly discriminate against individuals facing mental health disorders. In a letter, DFS informed health insurers of their responsibility to provide the same level of coverage for mental health and substance use disorders as for medical or surgical care.
"This administration will have zero tolerance for insurance companies that seek to shirk their obligations to provide coverage for substance abuse and mental health treatment," Governor Cuomo said. “With this action, they're on notice as we seek to create a stronger, healthier New York for all."
This guidance comes on the heels of recent legislation signed by Governor Cuomo that limits burdensome insurance barriers to access for treatment and medication to treat substance use disorders. Under New York Insurance Law, insurers cannot impose prior insurance authorization for inpatient treatment or for greater access to drug treatment medications. The law also requires insurers to use objective state-designated criteria to determine the level of care for individuals suffering from substance use disorder.
Financial Services Superintendent Maria T. Vullo said, “DFS is steadfast in its commitment to mental health and substance use disorder parity in all insurance coverage. Insurers are required to provide coverage for mental health and substance use disorder on par with medical and surgical benefits. DFS is working with all stakeholders to ensure that health insurers comply with and apply the same standards for cost sharing and utilization review so that New Yorkers in need of mental health and substance use disorder receive necessary treatment and are not improperly charged for benefits to which they are entitled.”
DFS’s letter notifies insurers that the United States Department of Labor and the United States Department of Health and Human Services have jointly issued guidance on compliance with the federal Mental Health Parity and Addiction Equity Act. The MHPAEA requires health insurance plans to provide the same level of coverage for mental health and substance use disorders as for medical or surgical care, including quantitative limitations, such as copays, deductibles, and limits on inpatient or outpatient visits that are covered by the health insurance plan, and Non-Quantitative Treatment Limitations, such as pre-authorizations, providers available through a plan's network, and what a plan considers "medically necessary".
Given the importance of the issue and concerns raised by stakeholders, DFS is seeking input from consumers, insurers, and providers as part of a comprehensive review of MHPAEA compliance issues. DFS will evaluate comments and determine future guidance or directives that will ensure consistency in the application of mental health and substance use disorder benefits for all health insurers.
DFS is also directing insurers to evaluate whether the following categories of NQTLs that are applied in a plan or policy are being applied consistently with MHPAEA requirements:
- Preauthorization and pre-service notice requirements;
- Fail-first protocols;
- Probability of improvement requirements;
- Requirement to provide a written treatment plan; and
- Other requirements, such as patient non-compliance rules, residential treatment limits, geographical limitations, and licensure requirements.