June 14, 2017: The Legal Action Center strongly supports the proposed Mental Health and Substance Use Disorder Parity Report Act, a bill introduced in the New York Senate and Assembly to improve oversight of health insurers’ compliance with state and federal mental health and substance use disorder parity laws.
Senator Robert Ortt, Chair of the Senate Committee on Mental Health and Disabilities, introduced the bill (S1156A) in the Senate and co-sponsored by Senator Phil Boyle. In the Assembly, the bill (A3694A) was sponsored by Aileen Gunther, who serves as Chair of the Assembly Committee on Mental Health.
The proposed legislation requires health insurers to submit certain data to the State Department of Financial Services and Department of Health to facilitate the Departments’ enforcement of federal and state parity laws, which bar discriminatory insurance coverage of mental health and substance use disorder benefits. The legislation also requires the Department of Financial Services to annually publish a report detailing each health insurance plan’s compliance with the parity laws, as part of its annual Consumer Guide.
Currently, enforcement of the parity laws depends largely on consumer-driven complaints and appeals, or upon extensive and complex review of plan documents by regulators. The legislation would help regulators and consumers to gain a clearer picture of health plans’ coverage, reimbursement and capacity to deliver mental health and substance use disorder services, and where policies and practices may violate parity laws.
Ellen Weber, LAC’s Vice President for Health Initiatives, says “the importance of having accurate and comprehensive service delivery data from insurers is vital to enforcing the parity laws, and to ensuring that New Yorkers have access to the mental health and addiction services that should be covered by their health plans.” She adds, “In the midst of an opioid epidemic, it is essential to remove all discriminatory barriers to care. This legislation would be a significant step towards achieving that goal.”
In crafting the legislation, the State Assembly noted investigations by the Health Care Bureau of the New York Attorney General’s office have revealed widespread violations of the parity laws by New York health plans, including: denying coverage of behavioral health services at a much higher rate than other medical services; imposing more intensive utilization review requirements on behavioral health care; and charging higher co-pays for behavioral health services. As a result, Attorney General Schneiderman has reached eight agreements with seven plans over the past three years under which the plans are required to change their policies and practices and, in some cases, pay fines and reimburse policyholders. With annual data reporting, this legislation would allow state regulators to flag these same trends. “Over the past few years, the AG’s team has uncovered many examples of insurers not complying with the parity law, thereby putting lives at risk by improperly denying or delaying coverage of critical behavioral healthcare services” says Legal Action Center’s New York Policy Director Sebastian Solomon. “We applaud Senator Ortt and Assemblywoman Gunther for sponsoring this legislation, which would create a new level of transparency and accountability about service delivery and help regulators better enforce state and federal parity laws.”
The Legal Action Center has worked at the forefront of educating consumers and providers about the parity law at both the state and federal levels, and advocating for better implementation and enforcement of the law. More information about the federal parity law can be found here.