S T A T E O F N E W Y O R K
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4356
2019-2020 Regular Sessions
I N S E N A T E
March 8, 2019
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Introduced by Sen. ORTT -- read twice and ordered printed, and when
printed to be committed to the Committee on Rules
AN ACT to amend the insurance law, in relation to mental health and
substance use disorder parity reporting; and to repeal certain
provisions of such law relating thereto
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subsection (c-1) of section 210 of the insurance law, as
amended by a chapter of the laws of 2018 amending the insurance law
relating to establishing the mental health and substance use disorder
parity report act, as proposed in legislative bills numbers S. 1156-C
and A. 3694-C, is REPEALED.
§ 2. The insurance law is amended by adding a new section 343 to read
as follows:
§ 343. MENTAL HEALTH AND SUBSTANCE USE DISORDER PARITY REPORT. (A)
BEGINNING JULY FIRST, TWO THOUSAND NINETEEN AND EVERY TWO YEARS THERE-
AFTER, EACH INSURER PROVIDING MANAGED CARE PRODUCTS, INDIVIDUAL COMPRE-
HENSIVE ACCIDENT AND HEALTH INSURANCE OR GROUP OR BLANKET COMPREHENSIVE
ACCIDENT AND HEALTH INSURANCE, EACH CORPORATION ORGANIZED PURSUANT TO
ARTICLE FORTY-THREE OF THIS CHAPTER PROVIDING COMPREHENSIVE HEALTH
INSURANCE AND EACH ENTITY LICENSED PURSUANT TO ARTICLE FORTY-FOUR OF THE
PUBLIC HEALTH LAW PROVIDING COMPREHENSIVE HEALTH SERVICE PLANS SHALL
SUBMIT TO THE SUPERINTENDENT, IN A FORM AND MANNER PRESCRIBED BY THE
SUPERINTENDENT, A REPORT DETAILING THE ENTITY'S COMPLIANCE WITH FEDERAL
AND STATE MENTAL HEALTH AND SUBSTANCE USE DISORDER PARITY LAWS BASED ON
THE ENTITY'S RECORD DURING THE PRECEDING TWO CALENDAR YEARS. THE SUPER-
INTENDENT SHALL PUBLISH ON THE DEPARTMENT'S WEBSITE ON OR BEFORE OCTOBER
FIRST, TWO THOUSAND NINETEEN, AND EVERY TWO YEARS THEREAFTER, THE
REPORTS SUBMITTED PURSUANT TO THIS SECTION.
(B) EACH PERSON REQUIRED TO SUBMIT A REPORT UNDER THIS SECTION SHALL
INCLUDE IN THE REPORT THE FOLLOWING INFORMATION:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07031-01-9
S. 4356 2
(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;
(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 FOR COVERAGE IN THE INDIVIDUAL, SMALL GROUP, AND LARGE GROUP
MARKETS, PROVIDED THAT THE COMPARISON CAPTURES AT LEAST SEVENTY-FIVE
PERCENT OF A COMPANY'S ENROLLEES IN EACH MARKET;
(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, INFORMATION, OR METRIC THE SUPERINTENDENT DEEMS
NECESSARY OR USEFUL TO MEASURE COMPLIANCE WITH MENTAL HEALTH AND
SUBSTANCE USE DISORDER PARITY INCLUDING, BUT NOT LIMITED TO AN EVALU-
ATION AND ASSESSMENT OF: (I) THE ADEQUACY OF THE COMPANY'S IN-NETWORK
MENTAL HEALTH SERVICES AND SUBSTANCE USE DISORDER PROVIDER PANELS PURSU-
ANT TO PROVISIONS OF THE INSURANCE LAW AND PUBLIC HEALTH LAW; AND (II)
THE COMPANY'S REIMBURSEMENT 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.
S. 4356 3
§ 3. Subsection (d) of section 210 of the insurance law, as amended by
a chapter of the laws of 2018 amending the insurance law relating to
establishing the mental health and substance use disorder parity report
act, as proposed in legislative bills numbers S. 1156-C and A. 3694-C,
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
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 same date and in the same
manner as a chapter of the laws of 2018 amending the insurance law
relating to establishing the mental health and substance use disorder
parity report act, as proposed in legislative bills numbers S. 1156-C
and A. 3694-C, takes effect. Effective immediately, the amendment and/or
repeal of any rule or regulation necessary for the implementation of
this act on its effective date are authorized and directed to be made
and completed on or before such effective date.
