STATE OF NEW YORK
________________________________________________________________________
6186--A
2019-2020 Regular Sessions
IN ASSEMBLY
February 28, 2019
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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:
1 Section 1. Subsection (c-1) of section 210 of the insurance law, as
2 amended by a chapter of the laws of 2018 amending the insurance law
3 relating to establishing the mental health and substance use disorder
4 parity report act, as proposed in legislative bills numbers S. 1156-C
5 and A. 3694-C, is REPEALED.
6 § 2. The insurance law is amended by adding a new section 343 to read
7 as follows:
8 § 343. Mental health and substance use disorder parity report. (a)
9 Beginning July first, two thousand nineteen and every two years there-
10 after, each insurer providing managed care products, individual compre-
11 hensive accident and health insurance or group or blanket comprehensive
12 accident and health insurance, each corporation organized pursuant to
13 article forty-three of this chapter providing comprehensive health
14 insurance and each entity licensed pursuant to article forty-four of the
15 public health law providing comprehensive health service plans shall
16 submit to the superintendent, in a form and manner prescribed by the
17 superintendent, a report detailing the entity's compliance with federal
18 and state mental health and substance use disorder parity laws based on
19 the entity's record during the preceding two calendar years. The super-
20 intendent shall publish on the department's website on or before October
21 first, two thousand nineteen, and every two years thereafter, the
22 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
1 (b) Each person required to submit a report under this section shall
2 include in the report the following information:
3 (1) Rates of utilization review for mental health and substance use
4 disorder claims as compared to medical and surgical claims, including
5 rates of approval and denial, categorized by benefits provided under the
6 following classifications: inpatient in-network, inpatient out-of-net-
7 work, outpatient in-network, outpatient out-of-network, emergency care,
8 and prescription drugs;
9 (2) The number of prior or concurrent authorization requests for
10 mental health services and for substance use disorder services and the
11 number of denials for such requests, compared with the number of prior
12 or concurrent authorization requests for medical and surgical services
13 and the number of denials for such requests, categorized by the same
14 classifications identified in paragraph one of this subsection;
15 (3) The rates of appeals of adverse determinations, including the
16 rates of adverse determinations upheld and overturned, for mental health
17 claims and substance use disorder claims compared with the rates of
18 appeals of adverse determinations, including the rates of adverse deter-
19 minations upheld and overturned, for medical and surgical claims;
20 (4) The percentage of claims paid for in-network mental health
21 services and for substance use disorder services compared with the
22 percentage of claims paid for in-network medical and surgical services
23 and the percentage of claims paid for out-of-network mental health
24 services and substance use disorder services compared with the percent-
25 age of claims paid for out-of-network medical and surgical services;
26 (5) The number of behavioral health advocates, pursuant to an agree-
27 ment with the office of the attorney general if applicable, or staff
28 available to assist policyholders with mental health benefits and
29 substance use disorder benefits;
30 (6) A comparison of the cost sharing requirements including but not
31 limited to co-pays and coinsurance, and the benefit limitations includ-
32 ing limitations on the scope and duration of coverage, for medical and
33 surgical services, and mental health services and substance use disorder
34 services for coverage in the individual, small group, and large group
35 markets, provided that the comparison captures at least seventy-five
36 percent of a company's enrollees in each market;
37 (7) The number by type of providers licensed to practice in this state
38 that provide services for the treatment and diagnosis of substance use
39 disorder who are in-network, and the number by type of providers
40 licensed to practice in this state that provide services for the diagno-
41 sis and treatment of mental, nervous or emotional disorders and
42 ailments, however defined in a company's policy, who are in-network;
43 (8) The percentage of providers of services for the treatment and
44 diagnosis of substance use disorder who remained participating provid-
45 ers, and the percentage of providers of services for the diagnosis and
46 treatment of mental, nervous or emotional disorders and ailments, howev-
47 er defined in a company's policy, who remained participating providers;
48 and
49 (9) Any other data, information, or metric the superintendent deems
50 necessary or useful to measure compliance with mental health and
51 substance use disorder parity including, but not limited to an evalu-
52 ation and assessment of: (i) the adequacy of the company's in-network
53 mental health services and substance use disorder provider panels pursu-
54 ant to provisions of the insurance law and public health law; and (ii)
55 the company's reimbursement for in-network and out-of-network mental
56 health services and substance use disorder services as compared to the
A. 6186--A 3
1 reimbursement for in-network and out-of-network medical and surgical
2 services.
3 § 3. Subsection (d) of section 210 of the insurance law, as amended by
4 a chapter of the laws of 2018 amending the insurance law relating to
5 establishing the mental health and substance use disorder parity report
6 act, as proposed in legislative bills numbers S. 1156-C and A. 3694-C,
7 is amended to read as follows:
8 (d) Health insurers and entities certified pursuant to article forty-
9 four of the public health law shall provide annually to the superinten-
10 dent and the commissioner of health, and the commissioner of health
11 shall provide to the superintendent, all of the information necessary
12 for the superintendent to produce the annual consumer guide[, including
13 the mental health and substance use disorder parity report]. In compil-
14 ing the guide, the superintendent shall make every effort to ensure that
15 the information is presented in a clear, understandable fashion which
16 facilitates comparisons among individual insurers and entities, and in a
17 format which lends itself to the widest possible distribution to consum-
18 ers. The superintendent shall either include the information from the
19 annual consumer guide in the consumer shopping guide required by
20 subsection (a) of section four thousand three hundred twenty-three of
21 this chapter or combine the two guides as long as consumers in the indi-
22 vidual market are provided with the information required by subsection
23 (a) of section four thousand three hundred twenty-three of this chapter.
24 § 4. This act shall take effect on the same date and in the same
25 manner as a chapter of the laws of 2018 amending the insurance law
26 relating to establishing the mental health and substance use disorder
27 parity report act, as proposed in legislative bills numbers S. 1156-C
28 and A. 3694-C, takes effect. Effective immediately, the amendment and/or
29 repeal of any rule or regulation necessary for the implementation of
30 this act on its effective date are authorized and directed to be made
31 and completed on or before such effective date.