January 22nd, 2019: The Legal Action Center (LAC) applauds Governor Cuomo’s proposals to enforce parity and remove insurance barriers to improve access to substance use disorder (SUD) and mental health (MH) care for tens of thousands of New Yorkers. As a longstanding advocate of the federal Mental Health Parity and Addiction Equity Act (Parity Act) and a leader of the New York Parity at 10 Coalition, LAC knows that barriers to treatment can jeopardize health and paths to recovery and must be dismantled. While the Parity Act was passed in 2008 to prohibit discriminatory insurance coverage for those with mental and substance use disorders, too many insurers are not complying with the law, and enhanced enforcement is critical to helping individuals and families at risk. The proposed reforms included in Governor Cuomo’s 2019 Justice Agenda will help all New Yorkers obtain the services they need and achieve the health outcomes they deserve.
While New York has made great strides, we must go further. The Governor’s proposals will continue New York State’s position as a model for the nation in addressing the significant barriers, stigma, discrimination, and inequity faced by individuals and families struggling with MH issues and SUDs, including the epidemics of suicide and opioid use disorder and other SUDs ravaging our state and country.
The Governor’s proposed parity and insurance reforms will enhance State monitoring and oversight of insurance coverage for MH and SUDs, and specifically include:
- Making permanent the Behavioral Health Ombudsman Program established in 2018 to help all New Yorkers access their insurance coverage for MH and SUD services. Named the Community Health Access to Addiction and Mental Healthcare Project, CHAMP was developed in partnership with the Community Service Society (CSS), the NYS Council for Community Behavioral Healthcare, The Legal Aid Society, the Medicare Rights Center, and LAC.
- CHAMP helps educate individuals and families on their legal rights to insurance coverage, resolve complaints when care is denied, and identify areas where insurers may have an inadequate network of treatment programs and providers.
- Consumers can get more information about CHAMP by calling the new helpline number (888-614-5400) or by writing to [email protected]
- Requiring insurers to provide their members with a comparative analysis detailing their compliance with the Parity Act.
- Prohibiting prior authorization for minors entering inpatient psychiatric treatment and prohibiting concurrent utilization review during the initial 14 days of treatment.
- Prohibiting insurers from requiring prior authorization to receive medication-assisted treatment (MAT) for SUDs and extending the time period for concurrent review for inpatient and outpatient addiction treatment.
- Limiting patient co-payments for outpatient mental health services and SUD treatment to the equivalent cost of a primary care visit and limiting co-payments for outpatient SUD treatment to one per day.
- Codifying key parity standards in State law for both MH and SUD benefits.
Lack of access to insurance benefits is one of the greatest barriers to people seeking mental health and substance use disorder treatment. The Governor’s proposals will help to decrease those barriers and increase transparency and accountability among insurers and health plans to ensure that New Yorkers receive all the benefits they are entitled to under the law. We look forward to working with the Legislature to enact these crucial reforms and improve the well-being of New Yorkers and our communities.
Established in 1973, the Legal Action Center is the only non-profit law and policy organization in the United States whose sole mission is to fight discrimination against people with histories of addiction, HIV/AIDS, or criminal records, and to advocate for sound public policies in these areas.