S T A T E   O F   N E W   Y O R K
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                                  6186--A
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 28, 2019
                                ___________
 
 Introduced  by M. of A. GUNTHER -- read once and referred to the Commit-
   tee on  Insurance  --  committee  discharged,  bill  amended,  ordered
   reprinted as amended and recommitted to said committee
 
 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 and A.  3694-C, is REPEALED.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.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10356-02-9
              

 A. 6186--A                          2
 
   (B)  EACH  PERSON REQUIRED TO SUBMIT A REPORT UNDER THIS SECTION SHALL
 INCLUDE IN THE REPORT 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;
   (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

 A. 6186--A                          3
 
 REIMBURSEMENT  FOR  IN-NETWORK  AND  OUT-OF-NETWORK MEDICAL AND SURGICAL
 SERVICES.
   § 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.