Relates to establishing the mental health parity report act

Justification

Ensuring New Yorkers have access to care and treatment for mental illness and substance abuse disorders is critical and is the reason New York enacted one of the strongest mental health parity laws in the nation (Timothy's Law) in 2006. New York reaffirmed its commitment to mental health parity when Timothy's Law was made permanent in 2009.

Although mental health parity has been the law of the land on the federal and state level for a number years now, the five settlements the New York State Attorney General has reached over the last two years with managed behavioral health companies and health plans or subcontractors for non-compliance is a reminder of the challenges that remain to ensure that the law is properly implemented and enforced.

In one of the instances, the Attorney General found that an insurer, through its behavioral health subcontractor issued 64 percent more denials of coverage in mental health and substance abuse cases than in care for physical health conditions requiring previously denied claims to be submitted for review with potential for $31 million in restitution for 15,000 policyholders. In another, the Attorney General found an insurer, through its behavioral subcontractor issued 40 percent more denials for coverage of mental health and substance abuse care and treatment. Furthermore, in one of the investigations, the Attorney General found a health plan rejected inpatient addiction treatment twice as often as inpatient treatment for physical health between 2011 and 2014 and in 2012 alone - the rate of denial was nearly seven times higher.

While such data raises serious concerns, the investigations found further unequal treatment of mental health and substance abuse including charging a higher co-payment for outpatient mental health visits compared to outpatient primary care visits, sometimes twice as high. Other findings included lack of coverage of residential treatment for mental health and substance abuse treatment and adverse determination letters that did not provide adequate information including the medical necessity criteria used to deny treatment. In other cases, the Attorney General found utilization review of mental health and substance abuse treatment was more intensive and frequent as compared for other medical conditions, which required providers to spend an inordinate amount of time justifying necessary and life-saving treatment. An example, from one of the settlements is one pertaining to a 14 year old with an eating disorder who was receiving partial hospitalization until the behavioral health subcontractor for the health plan denied additional days of treatment. The settlement goes on state, "As result, the member had to interrupt treatment while

an appeal was lodged on her behalf, exacerbating the symptoms of her illness, and causing her and her family extreme emotional distress."

Other states have enacted statutes requiring insurers and health plans to submit data as a mechanism for measuring implementation and compliance with federal and state parity laws. It is time New York do the same to provide the public and stakeholders with an annual analysis that will provide critical insight into the following:

(A) coverage for mental health and substance abuse services, (B) the adequacy of coverage for mental health and substance abuse conditions, (C) the adequacy of mental health and substance abuse health care provider networks, and (D) the rate of denials for treatment, prior authorization requests, and utilization review for mental health and substance abuse as compared to other medical care.

This legislation is needed to assure that New York achieves the full implementation of the parity laws, while also working to reduce the stigma surrounding mental illness and substance abuse, which in and of itself can be one of the most prohibitive barriers for the nearly one in ten individuals who have diagnosable mental health or substance abuse condition in any given year. At time a when many of New York's communities are gripped be an epidemic tied to heroin and abuse of prescription medications, it is imperative we have data that is publicly available measuring compliance with the laws aimed at assuring access to care and treatment.

Prior legislative history

New bill.

Fiscal implications

None

Effective date

This act shall take effect on the sixtieth day.