NY State Senate Bill 2015-S7988

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 02, 2016	referred to insurance

co-Sponsors

2015-S7988 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §210, Ins L
Versions Introduced in 2017-2018 Legislative Session:: S1156

2015-S7988 (ACTIVE) - Summary

Relates to establishing the mental health parity report act.

2015-S7988 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S7988

 TITLE OF BILL :  An act to amend the insurance law, in relation to
establishing the mental health parity report act

 PURPOSE OR GENERAL IDEA OF BILL :

The purpose of the bill is to require insurers and health plans to
submit certain data to the Department of Financial Services and the
Commissioner of Health, as a way of measuring compliance with federal
and state mental health and substance abuse parity laws. The data will
be used by the Department of Financial Services to prepare an annual
Mental Health Parity report as part of the annual Consumer Guide.

 SUMMARY OF SPECIFIC PROVISIONS :

Amends Section 210 of the Insurance Law to require the submission of
certain data by insurers and health plans.

 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.

2015-S7988 (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  7988

                            I N  S E N A T E

                              June 2, 2016
                               ___________

Introduced  by  Sen.  ORTT  --  read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance  law,  in  relation  to  establishing  the
  mental health parity report act

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Short title. This act shall be known and may  be  cited  as
the "mental health parity report act".
  S 2. Subsection (a) of section 210 of the insurance law, as amended by
chapter 579 of the laws of 1998, is amended to read as follows:
  (a)  The  superintendent shall annually publish on or before September
first, nineteen hundred ninety-nine, and annually thereafter, a consumer
guide to insurers providing managed care products,  individual  accident
and  health  insurance or group or blanket accident and health insurance
and entities licensed pursuant  to  article  forty-four  of  the  public
health  law providing comprehensive health service plans which includes,
in detail, a ranking from best to worst based upon each company's  claim
processing or medical payments record during the preceding calendar year
using  criteria  available  to  the  department,  adjusted for volume of
coverage provided. Such ranking shall also take into  consideration  the
corresponding  total  number  or  percentage of claims denied which were
reversed or compromised after intervention by  the  department  and  the
department  of  health,  consumer  complaints  to the department and the
department of health, violations of section three thousand  two  hundred
twenty-four-a  of  this  chapter  and  other  pertinent data which would
permit the department to objectively determine a company's  performance.
The  department  in  publishing  such  consumer  guide shall publish one
state-wide guide or no more than five regional guides so as  to  facili-
tate comparisons among individual insurers and entities within a service
market  area. Such rankings shall be printed in a format which ranks all
health insurers and all entities certified pursuant  to  article  forty-
four  of  the public health law in one combined list. THE CONSUMER GUIDE
ON OR BEFORE SEPTEMBER FIRST, TWO THOUSAND SEVENTEEN AND ANNUALLY THERE-
AFTER, SHALL INCLUDE A MENTAL HEALTH PARITY REPORT THAT INCLUDES A RANK-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.

                                                           LBD15732-01-6

S. 7988                             2

ING FROM BEST TO WORST BASED UPON EACH COMPANY'S COMPLIANCE WITH  MENTAL
HEALTH  AND  SUBSTANCE  ABUSE PARITY LAWS BASED ON EACH COMPANY'S RECORD
DURING THE PRECEDING CALENDAR  YEAR  USING  CRITERIA  AVAILABLE  TO  THE
DEPARTMENT,  INCLUDING, BUT NOT LIMITED TO, INFORMATION REQUIRED BY THIS
SUBSECTION AND SUBSECTIONS (B), (C) AND (D) OF THIS  SECTION.  IN  ADDI-
TION, NOTWITHSTANDING SUCH REQUIREMENTS AND ANY LAW TO THE CONTRARY, THE
DATA  TO BE INCLUDED IN THE MENTAL HEALTH PARITY REPORT AND COLLECTED BY
THE SUPERINTENDENT AND THE COMMISSIONER OF  HEALTH,  FOR  SUCH  PURPOSES
SHALL INCLUDE:
  (1)  ANNUAL  MENTAL  HEALTH PARITY COMPLIANCE REPORT FROM EACH INSURER
OUTLINING  HOW  IT  COMPLIES  WITH  TIMOTHY'S  LAW,  THE  INSURANCE  LAW
PROVISIONS  REGARDING  SUBSTANCE ABUSE AND EATING DISORDERS AND THE PAUL
WELLSTONE AND PETE DOMENICI MENTAL HEALTH PARITY  AND  ADDICTION  EQUITY
ACT OF TWO THOUSAND EIGHT;
  (2)  RATES OF UTILIZATION REVIEW FOR MENTAL HEALTH AND SUBSTANCE ABUSE
CLAIMS VERSUS PHYSICAL HEALTH, INCLUDING RATE OF DENIAL;
  (3) THE NUMBER OF PRIOR AUTHORIZATION REQUESTS FOR MENTAL  HEALTH  AND
SUBSTANCE  ABUSE  SERVICES  AND THE NUMBER OF DENIALS FOR SUCH REQUESTS,
COMPARED WITH THE NUMBER  OF  PRIOR  AUTHORIZATION  REQUESTS  FOR  OTHER
HEALTH  CARE SERVICES AND THE NUMBER OF DENIALS FOR SUCH REQUESTS, WHICH
SHALL ALSO INCLUDE THE RATES OF INTERNAL AND EXTERNAL APPEALS, INCLUDING
RATES OF APPEALS UPHELD AND OVERTURNED, SPECIFICALLY FOR  MENTAL  HEALTH
AND SUBSTANCE ABUSE;
  (4) THE PERCENTAGE OF CLAIMS PAID FOR OUT-OF-NETWORK MENTAL HEALTH AND
SUBSTANCE ABUSE SERVICES COMPARED WITH THE PERCENTAGE OF CLAIMS PAID FOR
OTHER TYPES OF OUT-OF-NETWORK HEALTH CARE AND SURGICAL SERVICES;
  (5) THE MEDICAL NECESSITY CRITERIA IT USES TO MAKE PRIOR AUTHORIZATION
OR  ADVERSE  DETERMINATIONS,  WHICH IN CONJUNCTION MUST BE CONSPICUOUSLY
POSTED FOR POLICYHOLDERS AND PROVIDERS TO  BE  ABLE  TO  REVIEW  WITHOUT
MAKING A REQUEST;
  (6) THE NUMBER OF COMPLAINTS RECEIVED FROM POLICY HOLDERS WITH RESPECT
TO  COVERAGE  FOR MENTAL ILLNESS AND SUBSTANCE ABUSE, WITHOUT PATIENT-I-
DENTIFYING INFORMATION.   UPON REQUEST FROM A  DEPARTMENT,  THE  INSURER
WILL PROVIDE A COPY OF THE INDIVIDUAL COMPLAINT TO SUCH DEPARTMENT;
  (7)  THE  NUMBER OF BEHAVIORAL HEALTH ADVOCATES, PURSUANT TO AN AGREE-
MENT WITH THE OFFICE OF ATTORNEY GENERAL IF APPLICABLE, OR STAFF ON HAND
TO ASSIST POLICYHOLDERS WITH BENEFITS FOR  MENTAL  HEALTH  OR  SUBSTANCE
ABUSE;
  (8)  THE NETWORK ADEQUACY OF INSURERS AND HEALTH PLANS, WHICH IN ADDI-
TION TO THE REQUIREMENTS OF SUBSECTION (A) OF SECTION THREE THOUSAND TWO
HUNDRED FORTY-ONE OF THIS CHAPTER AND SUBSECTION (C)  OF  THIS  SECTION,
SHALL CONSIST OF VERIFYING THE MENTAL HEALTH AND SUBSTANCE ABUSE PROVID-
ERS  LISTED  IN  AN  INSURERS  OR  HEALTH PLANS PROVIDER DIRECTORY AS IN
NETWORK. SUCH VERIFICATION SHALL BE PROVIDED BY THE  INSURER  OR  HEALTH
PLAN,  ON  AN  ANNUAL  BASIS, BY PROVIDING ITS LIST OF IN-NETWORK MENTAL
HEALTH AND SUBSTANCE ABUSE PROVIDERS  AND  THE  NUMBER  OF  CLAIMS  EACH
PROVIDER HAS SUBMITTED WITHIN THE PAST TWELVE MONTHS. FOR PROVIDERS THAT
HAVE HAD NO CLAIMS IN THE PAST TWELVE MONTHS, THE INSURER OR HEALTH PLAN
MUST  PROVIDE  AN  ATTESTATION  THAT  SUCH PROVIDER IS STILL PART OF THE
NETWORK. FOR QUALIFIED HEALTH PLANS OFFERED ON NEW YORK STATE OF HEALTH,
THE DEPARTMENT OF HEALTH SHALL REVIEW THE NETWORK ADEQUACY TO ENSURE  IT
IS  CONSISTENT  WITH  45  CFR  S  156.230 AND THE DEPARTMENT OF HEALTH'S
MANAGED CARE NETWORK ADEQUACY STANDARD AND, IN ADDITION,  SHALL  CONSIST
OF VERIFYING THE MENTAL HEALTH AND SUBSTANCE ABUSE PROVIDERS LISTED IN A
QUALIFIED  HEALTH PLANS PROVIDER DIRECTORY AS IN NETWORK. SUCH VERIFICA-
TION SHALL BE PROVIDED BY A QUALIFIED HEALTH PLAN, ON AN  ANNUAL  BASIS,

S. 7988                             3

BY  PROVIDING  ITS  LIST OF IN-NETWORK MENTAL HEALTH AND SUBSTANCE ABUSE
PROVIDERS AND THE NUMBER OF CLAIMS EACH PROVIDER  HAS  SUBMITTED  WITHIN
THE  PAST  TWELVE  MONTHS. FOR PROVIDERS THAT HAVE NO CLAIMS IN THE PAST
TWELVE  MONTHS,  THE  QUALIFIED  HEALTH PLAN MUST PROVIDE AN ATTESTATION
THAT SUCH PROVIDER IS STILL PART OF THE NETWORK; AND
  (9) ANY OTHER DATA OR METRIC THE SUPERINTENDENT OR THE COMMISSIONER OF
HEALTH DEEMS IS NECESSARY TO MEASURE COMPLIANCE WITH MENTAL  HEALTH  AND
SUBSTANCE ABUSE PARITY.
  S  3.  Paragraph  2  of subsection (c) of section 210 of the insurance
law, as added by chapter 579 of the laws of 1998, is amended to read  as
follows:
  (2) the percentage of primary care physicians who remained participat-
ing  providers,  provided  however,  that  such percentage shall exclude
voluntary terminations due to physician retirement, relocation or  other
similar  reasons,  AND  THE  PERCENTAGE  OF MENTAL HEALTH PROFESSIONALS,
DEFINED AS PHYSICIANS WHO ARE LICENSED PURSUANT TO ARTICLE  ONE  HUNDRED
THIRTY-ONE  OF THE EDUCATION LAW WHO ARE DIPLOMATS OF THE AMERICAN BOARD
OF PSYCHIATRY AND NEUROLOGY OR ARE ELIGIBLE  TO  BE  CERTIFIED  BY  THAT
BOARD,  OR  ARE CERTIFIED BY THE AMERICAN OSTEOPATHIC BOARD OF NEUROLOGY
AND PSYCHIATRY OR ARE ELIGIBLE TO BE CERTIFIED BY THAT BOARD,  A  SOCIAL
WORKER LICENSED PURSUANT TO ARTICLE ONE HUNDRED FIFTY-FOUR OF THE EDUCA-
TION  LAW  OR  A  PSYCHOLOGIST  LICENSED PURSUANT TO ARTICLE ONE HUNDRED
FIFTY-THREE OF THE EDUCATION LAW, WHO REMAINED AS PARTICIPATING  PROVID-
ERS AND THE NUMBER OF CLAIMS EACH TYPE OF MENTAL HEALTH PROFESSIONAL HAS
SUBMITTED  IN  THE  LAST  TWELVE  MONTHS AND THE NUMBER OF MENTAL HEALTH
PROFESSIONALS, IF ANY, WHO HAVE NOT HAD ANY CLAIMS IN  THE  LAST  TWELVE
MONTHS;
  S  4.  Subsection (d) of section 210 of the insurance law, as added by
chapter 579 of the laws of 1998, is amended to read as follows:
  (d) Health insurers and entities certified pursuant to article  forty-
four  of the public health law shall provide annually to the superinten-
dent and the commissioner of health,  and  the  commissioner  of  health
shall  provide  to  the superintendent, all of the information necessary
for the superintendent to produce the annual consumer  guide,  INCLUDING
THE  MENTAL  HEALTH  PARITY REPORT.   In compiling the guide, the super-
intendent shall make every effort to  ensure  that  the  information  is
presented  in  a clear, understandable fashion which facilitates compar-
isons among individual insurers and entities,  and  in  a  format  which
lends  itself  to  the  widest  possible  distribution to consumers. The
superintendent shall either include  the  information  from  the  annual
consumer guide in the consumer shopping guide required by subsection (a)
of  section  four thousand three hundred twenty-three of this chapter or
combine the two guides as long as consumers in the individual market are
provided with the information required by subsection (a) of section four
thousand three hundred twenty-three of this chapter.
  S 5. This act shall take effect on the sixtieth  day  after  it  shall
have  become a law, provided, however, effective immediately, the amend-
ment and/or repeal of any rule or regulation necessary for the implemen-
tation of this act on its effective date are authorized and directed  to
be made and completed on or before such effective date.

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Senate Bill S7988

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

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co-Sponsors

2015-S7988 (ACTIVE) - Details

2015-S7988 (ACTIVE) - Summary

2015-S7988 (ACTIVE) - Sponsor Memo

2015-S7988 (ACTIVE) - Bill Text download pdf

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Sponsored By

Robert G. Ortt

Archive: Last Bill Status - In Senate Committee Insurance Committee

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co-Sponsors

Phil Boyle

2015-S7988 (ACTIVE) - Details

2015-S7988 (ACTIVE) - Summary

2015-S7988 (ACTIVE) - Sponsor Memo

2015-S7988 (ACTIVE) - Bill Text download pdf

Comments