Relates to insurance coverage for diagnosis and treatment of substance use disorder benefits

1 Co-sponsor

• Kemp Hannon

BILL NUMBER:S7882

Title of bill

An act to amend the insurance law and the public health law, in relation to requiring health insurance coverage for diagnosis and treatment of substance use disorder treatment services and creating a workgroup to study and make recommendations

Purpose

This legislation clarifies that health insurance coverage must provide for substance abuse disorder treatment services improves the utilization review process for determining such insurance coverage and requires insurers to continue to provide coverage throughout the entire appeals process.

Summary of provisions

Sections one, two and three amend sections 3216, 3221 and 4303 of the insurance law to clarify that health plans shall include specific coverage for drug and alcohol abuse and dependency treatment services pursuant to the federal Mental Health and Parity Act of 2008 and applicable state statutes. It also requires a health plan to use a health care provider who specializes in substance abuse disorder treatment when conducting medical management or utilization review and requires the use of evidence-based and peer-reviewed clinical review criteria as deemed appropriate and approved by OASAS in consultation with DFS and DOH. This section also requires all internal and external appeals to be conducted on an expedited basis and health plans to provide coverage for substance abuse services until all appeals, both internal and external, have been exhausted.

Sections four through nine make similar corresponding changes in sections 4902, 4903, and 4904 of the insurance law, and sections 4902, 4903 and 4904 of the public health law.

Section ten requires DFS to select a random sampling of substance abuse coverage determinations and provide an analysis of whether or not such determinations are in compliance with the criteria established in this act and to submit a report by December 31, 2015.

Section eleven creates a workgroup to study and make recommendations on improving access to and availability of substance abuse and dependency treatment services. The workgroup shall submit a report by December 31, 2015.

Section twelve provides for a January 1, 2015.

Justification

The New York State Senate Heroin and Opioid Task Force has held hearings throughout the state to discuss the rise in the use of heroin and other opioids in New York State and to develop recommendations for treating and preventing addiction. At each of these hearings, the issue of health insurance coverage has been at the forefront. This legislation will improve access to care by ensuring that decisions regarding treatment are standardized and that they are made by medical doctors who specialize in behavioral health and substance abuse. Further, the legislation also ensures that individuals requiring treatment have access to an expedited appeals process and that they are not denied care while the appeals process is underway. The legislation also establishes a workgroup to be convened jointly with OASAS, DFS and DOH in order to study and develop

recommendations on improving access to and availability of substance abuse and dependency treatment services.

Legislative history

New bill.

Fiscal implications

None.

Effective date

Jan 1, 2015