S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4356
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                               March 8, 2019
                                ___________
 
 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 and A.  3694-C, is REPEALED.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.