NY Gov. Cuomo proposes equitable insurance coverage for mental health, substance use disorders

NY Gov. Cuomo proposes equitable insurance coverage for mental health, substance use disorders

As part of National Minority Mental Health Awareness Month, NY Gov. Andrew Cuomo has proposed new regulations for insurers’ to require equitable coverage for mental health and substance use disorder.

The proposed parity compliance program regulations from the New York State Department of Financial Services and the Department of Health would strengthen obligations for insurers’ to provide comparable coverage under both state and federal law.

“New Yorkers sacrificed greatly to bend the curve of COVID-19, but with the surge in cases around the country and the mental health challenges many of our fellow New Yorkers face, our work is far from over,” Cuomo said. “These new regulations will help people struggling with mental health and substance abuse issues by requiring insurers to provide the coverage and benefits they need, improving access to critical and potentially life-saving services during these unprecedented times.”

Under the proposed regulation, insurers must establish corporate governance for parity compliance, identify any discrepancies in coverage of mental health conditions and substance use disorders, and ensure the insurers will remedy those practices.

Insurers will designate an individual to assess, monitor, and manage parity compliance, and report directly to the insurers’ senior management. Additionally, according to the proposed regulation, the compliance person will report at least annually to the insurers’ governing body about the compliance program.

Insurers’ would have 60 days to remedy non-compliant situations like:
• Using review policies that have different standards to determine the level of documentation for mental health or substance use disorder benefits versus medical or surgical benefits;
• Requiring review for a higher percentage of mental health or substance use disorder benefits without defined clinical or quality triggers;
• Implementing methodology that reimburses mental health or substance use disorder benefits differently than reimbursement rates for medical or surgical benefits;
• Implementing claim edits or system configurations that result in higher rate of approval for inpatient medical or surgical benefits than for inpatient mental health or substance use disorder benefits.

“These proposed regulations will support the many New Yorkers with a mental health condition or substance use disorder by requiring that insurers have robust programs to meet their statutory mental health and substance use disorder parity compliance obligations,” New York State Superintendent of Financial Services Linda A. Lacewell said. “This is particularly important now as many are under increased stress as a result of the triple crises in public health, the economy, and civil rights. We will protect the rights of New Yorkers to obtain equal access to mental health treatment and substance use disorder services.”

Cuomo’s office said public comment on the proposed regulation would be accepted until Sept. 7, 2020.