Bill Text: NY A03694 | 2017-2018 | General Assembly | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relates to establishing the mental health and substance use disorder parity report act to ensure compliance of insurers and health plans with state and federal requirements for the provision of mental health and substance use disorder treatment and claims.
Spectrum: Partisan Bill (Democrat 11-0)
Status: (Passed) 2018-12-21 - approval memo.13 [A03694 Detail]
Download: New_York-2017-A03694-Amended.html
Bill Title: Relates to establishing the mental health and substance use disorder parity report act to ensure compliance of insurers and health plans with state and federal requirements for the provision of mental health and substance use disorder treatment and claims.
Spectrum: Partisan Bill (Democrat 11-0)
Status: (Passed) 2018-12-21 - approval memo.13 [A03694 Detail]
Download: New_York-2017-A03694-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 3694--A 2017-2018 Regular Sessions IN ASSEMBLY January 30, 2017 ___________ Introduced by M. of A. GUNTHER -- read once and referred to the Commit- tee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to establishing the mental health and substance use disorder parity report act The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Short title. This act shall be known and may be cited as 2 the "mental health and substance use disorder parity report act". 3 § 2. Subsection (a) of section 210 of the insurance law, as amended by 4 chapter 579 of the laws of 1998, is amended to read as follows: 5 (a) The superintendent shall annually publish on or before September 6 first, nineteen hundred ninety-nine, and annually thereafter, a consumer 7 guide to insurers providing managed care products, individual accident 8 and health insurance or group or blanket accident and health insurance 9 and entities licensed pursuant to article forty-four of the public 10 health law providing comprehensive health service plans which includes, 11 in detail, a ranking from best to worst based upon each company's claim 12 processing or medical payments record during the preceding calendar year 13 using criteria available to the department, adjusted for volume of 14 coverage provided. Such ranking shall also take into consideration the 15 corresponding total number or percentage of claims denied which were 16 reversed or compromised after intervention by the department and the 17 department of health, consumer complaints to the department and the 18 department of health, violations of section three thousand two hundred 19 twenty-four-a of this chapter and other pertinent data which would 20 permit the department to objectively determine a company's performance. 21 The department in publishing such consumer guide shall publish one 22 state-wide guide or no more than five regional guides so as to facili- 23 tate comparisons among individual insurers and entities within a service 24 market area. Such rankings shall be printed in a format which ranks all EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD02509-08-7A. 3694--A 2 1 health insurers and all entities certified pursuant to article forty- 2 four of the public health law in one combined list. The consumer guide 3 on or before September first, two thousand eighteen and annually there- 4 after, shall include a mental health parity report and a substance uses 5 disorder parity report based upon each company's compliance with mental 6 health parity and substance use disorder parity laws based on each 7 company's record during the preceding calendar year using criteria 8 available to the department, including, but not limited to, information 9 required by this subsection and subsections (b), (c) and (d) of this 10 section. In addition, notwithstanding such requirements and any law to 11 the contrary, the data to be included in the mental health parity report 12 and the substance use disorder parity report and collected by the super- 13 intendent and the commissioner of health from insurers and health plans, 14 for such purposes shall include: 15 (1) Annual mental health parity and substance use disorder parity 16 compliance reports from each insurer and health plan outlining how it 17 complies with Timothy's law, the insurance law provisions regarding 18 substance use disorder and eating disorders and the Paul Wellstone and 19 Pete Domenici mental health parity and addiction equity act of two thou- 20 sand eight; 21 (2) Rates of utilization review for mental health and substance use 22 disorder claims as compared to medical and surgical claims, including 23 rates of approval and denial, categorized by benefits provided under the 24 following classifications, as required under 45 C.F.R. § 146.136, 29 25 C.F.R. § 2590.712 and 26 C.F.R. § 54.9812-1.: inpatient in-network, 26 inpatient out-of-network, outpatient in-network, outpatient out-of-net- 27 work, emergency care, and prescription drugs; 28 (3) The number of prior or concurrent authorization requests for 29 mental health services and for substance use disorder services and the 30 number of denials for such requests, compared with the number of prior 31 or concurrent authorization requests for medical and surgical services 32 and the number of denials for such requests, categorized by the same 33 classifications identified in paragraph two of this subsection which 34 shall also include the rates of internal and external appeals, including 35 rates of appeals upheld and overturned, specifically for mental health 36 benefits and substance use disorder benefits; 37 (4) The number of prior or concurrent authorization requests for 38 mental health services and substance use disorder services that went to 39 clinical peer review as a result of a disagreement between the service 40 provider and the insurer or health plan and the number that went to 41 clinical peer review for medical and surgical services categorized in 42 the same manner as provided in paragraph two of this subsection; 43 (5) The list of services that have a prior or concurrent authorization 44 requirement based on a numerical threshold defined by a specific number 45 of visits or days of care for mental health services, substance use 46 disorder services and medical and surgical services and identification 47 of the threshold requirements; 48 (6) The list of covered medications for the treatment of a substance 49 use disorder on the prescription drug list of the insurer or health plan 50 including tier placement, authorization requirements and all other 51 utilization management requirements; 52 (7) The percentage of claims paid for in-network mental health 53 services and for substance use disorder services and the percentage of 54 claims paid for in-network medical and surgical services; 55 (8) The percentage of claims paid for out-of-network mental health 56 services and substance use disorder services compared with the percent-A. 3694--A 3 1 age of claims paid for other types of out-of-network medical and surgi- 2 cal services; 3 (9) The medical necessity criteria the insurer or health plan uses to 4 make prior authorization or continuing care and discharge determi- 5 nations, which in conjunction must be conspicuously posted for policy- 6 holders and providers to be able to review without making a request on 7 the insurer's or the health plan's website and be made available in hard 8 copy upon request; 9 (10) The number of behavioral health advocates, pursuant to an agree- 10 ment with the office of the attorney general if applicable, or staff on 11 hand to assist policyholders with benefits for mental health or 12 substance use disorder; 13 (11) The network adequacy of insurers and health plans, which in addi- 14 tion to the requirements of subsection (a) of section three thousand two 15 hundred forty-one of this chapter and subsection (c) of this section, 16 shall consist of verifying the mental health and substance use disorder 17 providers listed in an insurer's or health plan's provider directory as 18 in network. Such verification shall be provided by the insurer or health 19 plan, on a semi-annual basis, by providing its list of in-network mental 20 health and substance use disorder providers and the number of claims 21 each provider has submitted within the past six months. The list shall 22 include the name, address and telephone number of all participating 23 in-network providers. For providers that have had no claims in the past 24 six months, the insurer or health plan must provide an attestation that 25 such provider is still part of the network and that the provider is 26 accepting new patients. For qualified health plans offered on New York 27 state of health, the department of health shall review the network 28 adequacy to ensure it is consistent with 45 CFR § 156.230 and the 29 department of health's managed care network adequacy standard including 30 verification of the mental health and substance use disorder providers 31 listed in a qualified health plan's provider directory as in-network. 32 Such verification shall be provided by a qualified health plan, on a 33 semi-annual basis, by providing its list of in-network mental health and 34 substance use disorder providers and the number of claims each provider 35 has submitted within the past six months. The list shall include the 36 name, address and telephone number of all participating providers. For 37 providers that have no claims in the past six months, the qualified 38 health plan must provide an attestation that such provider is still part 39 of the network and that the provider is accepting new patients; 40 (12) The number of mental health and substance use disorder providers 41 who have left or been removed from the provider network in the past six 42 months and the reason that they have left or been removed; and 43 (13) Any other data or metric the superintendent or the commissioner 44 of health deems is necessary to measure compliance with mental health 45 parity and substance use disorder parity. 46 § 3. Paragraph 2 of subsection (c) of section 210 of the insurance 47 law, as added by chapter 579 of the laws of 1998, is amended to read as 48 follows: 49 (2) the percentage of primary care physicians who remained participat- 50 ing providers, provided however, that such percentage shall exclude 51 voluntary terminations due to physician retirement, relocation or other 52 similar reasons, and the percentage of mental health professionals, 53 defined as physicians who are licensed pursuant to article one hundred 54 thirty-one of the education law who are diplomats of the American board 55 of psychiatry and neurology or are eligible to be certified by that 56 board, or are certified by the American osteopathic board of neurologyA. 3694--A 4 1 and psychiatry or are eligible to be certified by that board, a social 2 worker licensed pursuant to article one hundred fifty-four of the educa- 3 tion law or a psychologist licensed pursuant to article one hundred 4 fifty-three of the education law, who remained as participating provid- 5 ers and the number of claims each type of mental health professional has 6 submitted in the last twelve months and the number of mental health 7 professionals, if any, who have not had any claims in the last twelve 8 months; 9 § 4. Subsection (d) of section 210 of the insurance law, as added by 10 chapter 579 of the laws of 1998, is amended to read as follows: 11 (d) Health insurers and entities certified pursuant to article forty- 12 four of the public health law shall provide annually to the superinten- 13 dent and the commissioner of health, and the commissioner of health 14 shall provide to the superintendent, all of the information necessary 15 for the superintendent to produce the annual consumer guide, including 16 the mental health parity report and the substance use disorder parity 17 report. In compiling the guide, the superintendent shall make every 18 effort to ensure that the information is presented in a clear, under- 19 standable fashion which facilitates comparisons among individual insur- 20 ers and entities, and in a format which lends itself to the widest 21 possible distribution to consumers. The superintendent shall either 22 include the information from the annual consumer guide in the consumer 23 shopping guide required by subsection (a) of section four thousand three 24 hundred twenty-three of this chapter or combine the two guides as long 25 as consumers in the individual market are provided with the information 26 required by subsection (a) of section four thousand three hundred twen- 27 ty-three of this chapter. 28 § 5. This act shall take effect on the sixtieth day after it shall 29 have become a law, provided, however, effective immediately, the amend- 30 ment and/or repeal of any rule or regulation necessary for the implemen- 31 tation of this act on its effective date are authorized and directed to 32 be made and completed on or before such effective date.
