S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1156
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                              January 6, 2017
                                ___________
 
 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 and substance abuse 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 and substance abuse parity report act".
   § 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-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD02509-02-7

 S. 1156                             2
 
 four  of  the public health law in one combined list. THE CONSUMER GUIDE
 ON OR BEFORE SEPTEMBER FIRST, TWO THOUSAND EIGHTEEN AND ANNUALLY  THERE-
 AFTER, SHALL INCLUDE A MENTAL HEALTH PARITY REPORT THAT INCLUDES A RANK-
 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 AND SUBSTANCE ABUSE 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 §  156.230  AND  THE  DEPARTMENT  OF  HEALTH'S
 MANAGED  CARE  NETWORK ADEQUACY STANDARD AND, IN ADDITION, SHALL CONSIST

 S. 1156                             3
 
 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,
 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.
   § 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;
   § 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.
   §  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.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1156--B
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                              January 6, 2017
                                ___________
 
 Introduced  by  Sens. ORTT, BOYLE -- read twice and ordered printed, and
   when printed to be committed to the Committee on Insurance --  commit-
   tee  discharged, bill amended, ordered reprinted as amended and recom-
   mitted to said committee -- recommitted to the Committee on  Insurance
   in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill
   amended,  ordered reprinted as amended and recommitted to said commit-
   tee
 
 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:
 
   Section 1. Short title. This act shall be known and may  be  cited  as
 the "mental health and substance use disorder parity report act".
   § 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.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD02509-09-8

 S. 1156--B                          2
 
 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 NINETEEN AND ANNUALLY  THERE-
 AFTER,  SHALL INCLUDE A MENTAL HEALTH PARITY REPORT AND A SUBSTANCE USES
 DISORDER PARITY REPORT BASED UPON EACH COMPANY'S COMPLIANCE WITH  MENTAL
 HEALTH  PARITY  AND  SUBSTANCE  USE  DISORDER  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  ADDITION, NOTWITHSTANDING SUCH REQUIREMENTS AND ANY LAW TO
 THE CONTRARY, THE DATA TO BE INCLUDED IN THE MENTAL HEALTH PARITY REPORT
 AND THE SUBSTANCE USE DISORDER PARITY REPORT AND COLLECTED BY THE SUPER-
 INTENDENT AND THE COMMISSIONER OF HEALTH FROM INSURERS AND HEALTH PLANS,
 FOR SUCH PURPOSES SHALL INCLUDE:
   (1) ANNUAL MENTAL HEALTH PARITY  AND  SUBSTANCE  USE  DISORDER  PARITY
 COMPLIANCE  REPORTS  FROM  EACH INSURER AND HEALTH PLAN OUTLINING HOW IT
 COMPLIES WITH TIMOTHY'S LAW,  THE  INSURANCE  LAW  PROVISIONS  REGARDING
 SUBSTANCE  USE  DISORDER AND EATING DISORDERS AND THE PAUL WELLSTONE AND
 PETE DOMENICI MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT OF TWO THOU-
 SAND EIGHT;
   (2) RATES OF UTILIZATION REVIEW FOR MENTAL HEALTH  AND  SUBSTANCE  USE
 DISORDER  CLAIMS  AS  COMPARED TO MEDICAL AND SURGICAL CLAIMS, INCLUDING
 RATES OF APPROVAL AND DENIAL, CATEGORIZED BY BENEFITS PROVIDED UNDER THE
 FOLLOWING CLASSIFICATIONS, AS REQUIRED UNDER 45  C.F.R.  §  146.136,  29
 C.F.R.  §  2590.712  AND  26  C.F.R. § 54.9812-1.: INPATIENT IN-NETWORK,
 INPATIENT OUT-OF-NETWORK, OUTPATIENT IN-NETWORK, OUTPATIENT  OUT-OF-NET-
 WORK, EMERGENCY CARE, AND PRESCRIPTION DRUGS;
   (3)  THE  NUMBER  OF  PRIOR  OR  CONCURRENT AUTHORIZATION REQUESTS FOR
 MENTAL HEALTH SERVICES AND FOR SUBSTANCE USE DISORDER SERVICES  AND  THE
 NUMBER  OF  DENIALS FOR SUCH REQUESTS, COMPARED WITH THE NUMBER OF PRIOR
 OR CONCURRENT AUTHORIZATION REQUESTS FOR MEDICAL AND  SURGICAL  SERVICES
 AND  THE  NUMBER  OF  DENIALS FOR SUCH REQUESTS, CATEGORIZED BY THE SAME
 CLASSIFICATIONS IDENTIFIED IN PARAGRAPH TWO  OF  THIS  SUBSECTION  WHICH
 SHALL ALSO INCLUDE THE RATES OF INTERNAL AND EXTERNAL APPEALS, INCLUDING
 RATES  OF  APPEALS UPHELD AND OVERTURNED, SPECIFICALLY FOR MENTAL HEALTH
 BENEFITS AND SUBSTANCE USE DISORDER BENEFITS;
   (4) THE NUMBER OF  PRIOR  OR  CONCURRENT  AUTHORIZATION  REQUESTS  FOR
 MENTAL  HEALTH SERVICES AND SUBSTANCE USE DISORDER SERVICES THAT WENT TO
 CLINICAL PEER REVIEW AS A RESULT OF A DISAGREEMENT BETWEEN  THE  SERVICE
 PROVIDER  AND  THE  INSURER  OR  HEALTH PLAN AND THE NUMBER THAT WENT TO
 CLINICAL PEER REVIEW FOR MEDICAL AND SURGICAL  SERVICES  CATEGORIZED  IN
 THE SAME MANNER AS PROVIDED IN PARAGRAPH TWO OF THIS SUBSECTION;
   (5) THE LIST OF SERVICES THAT HAVE A PRIOR OR CONCURRENT AUTHORIZATION
 REQUIREMENT  BASED ON A NUMERICAL THRESHOLD DEFINED BY A SPECIFIC NUMBER
 OF VISITS OR DAYS OF CARE FOR  MENTAL  HEALTH  SERVICES,  SUBSTANCE  USE
 DISORDER  SERVICES  AND MEDICAL AND SURGICAL SERVICES AND IDENTIFICATION
 OF THE THRESHOLD REQUIREMENTS;
   (6) THE LIST OF COVERED MEDICATIONS FOR THE TREATMENT OF  A  SUBSTANCE
 USE DISORDER ON THE PRESCRIPTION DRUG LIST OF THE INSURER OR HEALTH PLAN
 INCLUDING  TIER  PLACEMENT,  AUTHORIZATION  REQUIREMENTS  AND  ALL OTHER
 UTILIZATION MANAGEMENT REQUIREMENTS;

 S. 1156--B                          3
 
   (7) THE  PERCENTAGE  OF  CLAIMS  PAID  FOR  IN-NETWORK  MENTAL  HEALTH
 SERVICES  AND  FOR SUBSTANCE USE DISORDER SERVICES AND THE PERCENTAGE OF
 CLAIMS PAID FOR IN-NETWORK MEDICAL AND SURGICAL SERVICES;
   (8)  THE  PERCENTAGE  OF  CLAIMS PAID FOR OUT-OF-NETWORK MENTAL HEALTH
 SERVICES AND SUBSTANCE USE DISORDER SERVICES COMPARED WITH THE  PERCENT-
 AGE  OF CLAIMS PAID FOR OTHER TYPES OF OUT-OF-NETWORK MEDICAL AND SURGI-
 CAL SERVICES;
   (9) THE MEDICAL NECESSITY CRITERIA THE INSURER OR HEALTH PLAN USES  TO
 MAKE  PRIOR  AUTHORIZATION  OR  CONTINUING  CARE  AND DISCHARGE DETERMI-
 NATIONS, WHICH IN CONJUNCTION MUST BE CONSPICUOUSLY POSTED  FOR  POLICY-
 HOLDERS  AND  PROVIDERS TO BE ABLE TO REVIEW WITHOUT MAKING A REQUEST ON
 THE INSURER'S OR THE HEALTH PLAN'S WEBSITE AND BE MADE AVAILABLE IN HARD
 COPY UPON REQUEST;
   (10) THE NUMBER OF BEHAVIORAL HEALTH ADVOCATES, PURSUANT TO AN  AGREE-
 MENT  WITH THE OFFICE OF THE ATTORNEY GENERAL IF APPLICABLE, OR STAFF ON
 HAND  TO  ASSIST  POLICYHOLDERS  WITH  BENEFITS  FOR  MENTAL  HEALTH  OR
 SUBSTANCE USE DISORDER;
   (11) 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 USE  DISORDER
 PROVIDERS  LISTED IN AN INSURER'S OR HEALTH PLAN'S PROVIDER DIRECTORY AS
 IN NETWORK. SUCH VERIFICATION SHALL BE PROVIDED BY THE INSURER OR HEALTH
 PLAN, ON A SEMI-ANNUAL BASIS, BY PROVIDING ITS LIST OF IN-NETWORK MENTAL
 HEALTH AND SUBSTANCE USE DISORDER PROVIDERS AND  THE  NUMBER  OF  CLAIMS
 EACH  PROVIDER  HAS SUBMITTED WITHIN THE PAST SIX MONTHS. THE LIST SHALL
 INCLUDE THE NAME, ADDRESS AND  TELEPHONE  NUMBER  OF  ALL  PARTICIPATING
 IN-NETWORK PROVIDERS.  FOR PROVIDERS THAT HAVE HAD NO CLAIMS IN THE PAST
 SIX  MONTHS, THE INSURER OR HEALTH PLAN MUST PROVIDE AN ATTESTATION THAT
 SUCH PROVIDER IS STILL PART OF THE NETWORK  AND  THAT  THE  PROVIDER  IS
 ACCEPTING  NEW  PATIENTS. 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 § 156.230 AND THE
 DEPARTMENT OF HEALTH'S MANAGED CARE NETWORK ADEQUACY STANDARD  INCLUDING
 VERIFICATION  OF  THE MENTAL HEALTH AND SUBSTANCE USE DISORDER PROVIDERS
 LISTED IN A QUALIFIED HEALTH PLAN'S PROVIDER  DIRECTORY  AS  IN-NETWORK.
 SUCH  VERIFICATION  SHALL  BE  PROVIDED BY A QUALIFIED HEALTH PLAN, ON A
 SEMI-ANNUAL BASIS, BY PROVIDING ITS LIST OF IN-NETWORK MENTAL HEALTH AND
 SUBSTANCE USE DISORDER PROVIDERS AND THE NUMBER OF CLAIMS EACH  PROVIDER
 HAS  SUBMITTED  WITHIN  THE  PAST SIX MONTHS. THE LIST SHALL INCLUDE THE
 NAME, ADDRESS AND TELEPHONE NUMBER OF ALL PARTICIPATING  PROVIDERS.  FOR
 PROVIDERS  THAT  HAVE  NO  CLAIMS  IN THE PAST SIX MONTHS, THE QUALIFIED
 HEALTH PLAN MUST PROVIDE AN ATTESTATION THAT SUCH PROVIDER IS STILL PART
 OF THE NETWORK AND THAT THE PROVIDER IS ACCEPTING NEW PATIENTS;
   (12) THE NUMBER OF MENTAL HEALTH AND SUBSTANCE USE DISORDER  PROVIDERS
 WHO  HAVE LEFT OR BEEN REMOVED FROM THE PROVIDER NETWORK IN THE PAST SIX
 MONTHS AND THE REASON THAT THEY HAVE LEFT OR BEEN REMOVED; AND
   (13) ANY OTHER DATA OR METRIC THE SUPERINTENDENT OR  THE  COMMISSIONER
 OF  HEALTH  DEEMS  IS NECESSARY TO MEASURE COMPLIANCE WITH MENTAL HEALTH
 PARITY AND SUBSTANCE USE DISORDER PARITY.
   § 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

 S. 1156--B                          4
 
 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;
   § 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 AND THE SUBSTANCE  USE  DISORDER  PARITY
 REPORT.    In  compiling  the guide, the superintendent shall make every
 effort to ensure that the information is presented in  a  clear,  under-
 standable  fashion which facilitates comparisons among individual insur-
 ers 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 twen-
 ty-three of this chapter.
   § 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.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1156--C
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                              January 6, 2017
                                ___________
 
 Introduced  by  Sens. ORTT, BOYLE, HAMILTON, HELMING, MARCHIONE, RITCHIE
   -- read twice and ordered printed, and when printed to be committed to
   the Committee on Insurance  --  committee  discharged,  bill  amended,
   ordered  reprinted  as  amended  and  recommitted to said committee --
   recommitted to the Committee on Insurance in  accordance  with  Senate
   Rule  6,  sec.  8  --  committee  discharged,  bill  amended,  ordered
   reprinted as amended and recommitted to said  committee  --  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:
 
   Section  1.  Short  title. This act shall be known and may be cited as
 the "mental health and substance use disorder parity report act".
   § 2. Section 210 of the insurance law  is  amended  by  adding  a  new
 subsection (c-1) to read as follows:
   (C-1)  BEGINNING  SEPTEMBER  FIRST, TWO THOUSAND NINETEEN AND ANNUALLY
 THEREAFTER, THE SUPERINTENDENT SHALL INCLUDE  IN  SUCH  GUIDE  A  MENTAL
 HEALTH AND SUBSTANCE USE DISORDER PARITY REPORT DETAILING EACH COMPANY'S
 COMPLIANCE WITH FEDERAL AND STATE MENTAL HEALTH AND SUBSTANCE USE DISOR-
 DER  PARITY  LAWS  BASED  ON  EACH COMPANY'S RECORD DURING THE PRECEDING
 CALENDAR YEAR.  THE SUPERINTENDENT SHALL INCLUDE  IN  SUCH  REPORT,  AND
 EACH  COMPANY  SHALL  PROVIDE  TO  THE  SUPERINTENDENT  THE  INFORMATION
 REQUIRED FOR SUCH GUIDE IN A TIMELY FASHION, THE FOLLOWING INFORMATION:
   (1) RATES OF UTILIZATION REVIEW FOR MENTAL HEALTH  AND  SUBSTANCE  USE
 DISORDER  CLAIMS  AS  COMPARED TO MEDICAL AND SURGICAL CLAIMS, INCLUDING
 RATES OF APPROVAL AND DENIAL, CATEGORIZED BY BENEFITS PROVIDED UNDER THE
 FOLLOWING CLASSIFICATIONS:  INPATIENT IN-NETWORK, INPATIENT  OUT-OF-NET-
 WORK,  OUTPATIENT IN-NETWORK, OUTPATIENT OUT-OF-NETWORK, EMERGENCY CARE,
 AND PRESCRIPTION DRUGS;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD02509-12-8

 S. 1156--C                          2
 
   (2) THE NUMBER OF  PRIOR  OR  CONCURRENT  AUTHORIZATION  REQUESTS  FOR
 MENTAL  HEALTH  SERVICES AND FOR SUBSTANCE USE DISORDER SERVICES AND THE
 NUMBER OF DENIALS FOR SUCH REQUESTS, COMPARED WITH THE NUMBER  OF  PRIOR
 OR  CONCURRENT  AUTHORIZATION REQUESTS FOR MEDICAL AND SURGICAL SERVICES
 AND  THE  NUMBER  OF  DENIALS FOR SUCH REQUESTS, CATEGORIZED BY THE SAME
 CLASSIFICATIONS IDENTIFIED IN PARAGRAPH ONE OF THIS SUBSECTION;
   (3) THE RATES OF APPEALS  OF  ADVERSE  DETERMINATIONS,  INCLUDING  THE
 RATES OF ADVERSE DETERMINATIONS UPHELD AND OVERTURNED, FOR MENTAL HEALTH
 CLAIMS  AND  SUBSTANCE  USE  DISORDER  CLAIMS COMPARED WITH THE RATES OF
 APPEALS OF ADVERSE DETERMINATIONS, INCLUDING THE RATES OF ADVERSE DETER-
 MINATIONS UPHELD AND OVERTURNED, FOR MEDICAL AND SURGICAL CLAIMS;
   (4) THE  PERCENTAGE  OF  CLAIMS  PAID  FOR  IN-NETWORK  MENTAL  HEALTH
 SERVICES  AND  FOR  SUBSTANCE  USE  DISORDER  SERVICES COMPARED WITH THE
 PERCENTAGE OF CLAIMS PAID FOR IN-NETWORK MEDICAL AND  SURGICAL  SERVICES
 AND  THE  PERCENTAGE  OF  CLAIMS  PAID  FOR OUT-OF-NETWORK MENTAL HEALTH
 SERVICES AND SUBSTANCE USE DISORDER SERVICES COMPARED WITH THE  PERCENT-
 AGE OF CLAIMS PAID FOR OUT-OF-NETWORK MEDICAL AND SURGICAL SERVICES;
   (5)  THE  NUMBER OF BEHAVIORAL HEALTH ADVOCATES, PURSUANT TO AN AGREE-
 MENT WITH THE OFFICE OF THE ATTORNEY GENERAL  IF  APPLICABLE,  OR  STAFF
 AVAILABLE  TO  ASSIST  POLICYHOLDERS  WITH  MENTAL  HEALTH  BENEFITS AND
 SUBSTANCE USE DISORDER BENEFITS;
   (6) A COMPARISON OF THE COST SHARING REQUIREMENTS  INCLUDING  BUT  NOT
 LIMITED  TO CO-PAYS AND COINSURANCE, AND THE BENEFIT LIMITATIONS INCLUD-
 ING LIMITATIONS ON THE SCOPE AND DURATION OF COVERAGE, FOR  MEDICAL  AND
 SURGICAL SERVICES, AND MENTAL HEALTH SERVICES AND SUBSTANCE USE DISORDER
 SERVICES;
   (7) THE NUMBER BY TYPE OF PROVIDERS LICENSED TO PRACTICE IN THIS STATE
 THAT  PROVIDE  SERVICES FOR THE TREATMENT AND DIAGNOSIS OF SUBSTANCE USE
 DISORDER WHO ARE  IN-NETWORK,  AND  THE  NUMBER  BY  TYPE  OF  PROVIDERS
 LICENSED TO PRACTICE IN THIS STATE THAT PROVIDE SERVICES FOR THE DIAGNO-
 SIS  AND  TREATMENT  OF  MENTAL,  NERVOUS  OR  EMOTIONAL  DISORDERS  AND
 AILMENTS, HOWEVER DEFINED IN A COMPANY'S POLICY, WHO ARE IN-NETWORK;
   (8) THE PERCENTAGE OF PROVIDERS OF  SERVICES  FOR  THE  TREATMENT  AND
 DIAGNOSIS  OF  SUBSTANCE USE DISORDER WHO REMAINED PARTICIPATING PROVID-
 ERS, AND THE PERCENTAGE OF PROVIDERS OF SERVICES FOR THE  DIAGNOSIS  AND
 TREATMENT OF MENTAL, NERVOUS OR EMOTIONAL DISORDERS AND AILMENTS, HOWEV-
 ER  DEFINED IN A COMPANY'S POLICY, WHO REMAINED PARTICIPATING PROVIDERS;
 AND
   (9) ANY OTHER DATA OR METRIC THE  SUPERINTENDENT  DEEMS  NECESSARY  TO
 MEASURE  COMPLIANCE WITH MENTAL HEALTH AND SUBSTANCE USE DISORDER PARITY
 INCLUDING, BUT NOT LIMITED TO AN EVALUATION AND ASSESSMENT OF:  (I)  THE
 ADEQUACY   OF  THE  COMPANY'S  IN-NETWORK  MENTAL  HEALTH  SERVICES  AND
 SUBSTANCE USE DISORDER PROVIDER PANELS PURSUANT  TO  PROVISIONS  OF  THE
 INSURANCE  LAW  AND PUBLIC HEALTH LAW; AND (II) THE COMPANY'S REIMBURSE-
 MENT FOR  IN-NETWORK  AND  OUT-OF-NETWORK  MENTAL  HEALTH  SERVICES  AND
 SUBSTANCE  USE  DISORDER  SERVICES  AS COMPARED TO THE REIMBURSEMENT FOR
 IN-NETWORK AND OUT-OF-NETWORK MEDICAL AND SURGICAL SERVICES.
   § 3. 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 AND SUBSTANCE USE DISORDER PARITY REPORT.  In  compil-
 ing the guide, the superintendent shall make every effort to ensure that

 S. 1156--C                          3
 
 the  information  is  presented in a clear, understandable fashion which
 facilitates comparisons among individual insurers and entities, and in a
 format which lends itself to the widest possible distribution to consum-
 ers.  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 indi-
 vidual market are provided with the information required  by  subsection
 (a) of section four thousand three hundred twenty-three of this chapter.
   §  4.  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.