Bill Text: NY A03694 | 2017-2018 | General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relates to establishing the mental health and substance use disorder parity report act to ensure compliance of insurers and health plans with state and federal requirements for the provision of mental health and substance use disorder treatment and claims.

Spectrum: Partisan Bill (Democrat 11-0)

Status: (Passed) 2018-12-21 - approval memo.13 [A03694 Detail]

Download: New_York-2017-A03694-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          3694
                               2017-2018 Regular Sessions
                   IN ASSEMBLY
                                    January 30, 2017
                                       ___________
        Introduced  by M. of A. GUNTHER -- read once and referred to the Commit-
          tee on Insurance
        AN ACT to amend the insurance  law,  in  relation  to  establishing  the
          mental health and substance abuse parity report act
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Short title. This act shall be known and may  be  cited  as
     2  the "mental health and substance abuse parity report act".
     3    § 2. Subsection (a) of section 210 of the insurance law, as amended by
     4  chapter 579 of the laws of 1998, is amended to read as follows:
     5    (a)  The  superintendent shall annually publish on or before September
     6  first, nineteen hundred ninety-nine, and annually thereafter, a consumer
     7  guide to insurers providing managed care products,  individual  accident
     8  and  health  insurance or group or blanket accident and health insurance
     9  and entities licensed pursuant  to  article  forty-four  of  the  public
    10  health  law providing comprehensive health service plans which includes,
    11  in detail, a ranking from best to worst based upon each company's  claim
    12  processing or medical payments record during the preceding calendar year
    13  using  criteria  available  to  the  department,  adjusted for volume of
    14  coverage provided. Such ranking shall also take into  consideration  the
    15  corresponding  total  number  or  percentage of claims denied which were
    16  reversed or compromised after intervention by  the  department  and  the
    17  department  of  health,  consumer  complaints  to the department and the
    18  department of health, violations of section three thousand  two  hundred
    19  twenty-four-a  of  this  chapter  and  other  pertinent data which would
    20  permit the department to objectively determine a company's  performance.
    21  The  department  in  publishing  such  consumer  guide shall publish one
    22  state-wide guide or no more than five regional guides so as  to  facili-
    23  tate comparisons among individual insurers and entities within a service
    24  market  area. Such rankings shall be printed in a format which ranks all
    25  health insurers and all entities certified pursuant  to  article  forty-
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02509-02-7
        A. 3694                             2
     1  four  of  the public health law in one combined list. The consumer guide
     2  on or before September first, two thousand eighteen and annually  there-
     3  after, shall include a mental health parity report that includes a rank-
     4  ing  from best to worst based upon each company's compliance with mental
     5  health and substance abuse parity laws based on  each  company's  record
     6  during  the  preceding  calendar  year  using  criteria available to the
     7  department, including, but not limited to, information required by  this
     8  subsection  and  subsections  (b), (c) and (d) of this section. In addi-
     9  tion, notwithstanding such requirements and any law to the contrary, the
    10  data to be included in the mental health parity report and collected  by
    11  the  superintendent  and  the  commissioner of health, for such purposes
    12  shall include:
    13    (1) Annual mental health and substance abuse parity compliance  report
    14  from  each  insurer  outlining  how  it complies with Timothy's law, the
    15  insurance law provisions regarding substance abuse and eating  disorders
    16  and  the  Paul  Wellstone  and  Pete  Domenici  mental health parity and
    17  addiction equity act of two thousand eight;
    18    (2) Rates of utilization review for mental health and substance  abuse
    19  claims versus physical health, including rate of denial;
    20    (3)  The  number of prior authorization requests for mental health and
    21  substance abuse services and the number of denials  for  such  requests,
    22  compared  with  the  number  of  prior  authorization requests for other
    23  health care services and the number of denials for such requests,  which
    24  shall also include the rates of internal and external appeals, including
    25  rates  of  appeals upheld and overturned, specifically for mental health
    26  and substance abuse;
    27    (4) The percentage of claims paid for out-of-network mental health and
    28  substance abuse services compared with the percentage of claims paid for
    29  other types of out-of-network health care and surgical services;
    30    (5) The medical necessity criteria it uses to make prior authorization
    31  or adverse determinations, which in conjunction  must  be  conspicuously
    32  posted  for  policyholders  and  providers  to be able to review without
    33  making a request;
    34    (6) The number of complaints received from policy holders with respect
    35  to coverage for mental illness and substance abuse,  without  patient-i-
    36  dentifying  information.    Upon  request from a department, the insurer
    37  will provide a copy of the individual complaint to such department;
    38    (7) The number of behavioral health advocates, pursuant to  an  agree-
    39  ment with the office of attorney general if applicable, or staff on hand
    40  to  assist  policyholders  with  benefits for mental health or substance
    41  abuse;
    42    (8) The network adequacy of insurers and health plans, which in  addi-
    43  tion to the requirements of subsection (a) of section three thousand two
    44  hundred  forty-one  of  this chapter and subsection (c) of this section,
    45  shall consist of verifying the mental health and substance abuse provid-
    46  ers listed in an insurers or  health  plans  provider  directory  as  in
    47  network.  Such  verification  shall be provided by the insurer or health
    48  plan, on an annual basis, by providing its  list  of  in-network  mental
    49  health  and  substance  abuse  providers  and  the number of claims each
    50  provider has submitted within the past twelve months. For providers that
    51  have had no claims in the past twelve months, the insurer or health plan
    52  must provide an attestation that such provider  is  still  part  of  the
    53  network. For qualified health plans offered on New York state of health,
    54  the  department of health shall review the network adequacy to ensure it
    55  is consistent with 45 CFR §  156.230  and  the  department  of  health's
    56  managed  care  network adequacy standard and, in addition, shall consist
        A. 3694                             3
     1  of verifying the mental health and substance abuse providers listed in a
     2  qualified health plans provider directory as in network. Such  verifica-
     3  tion  shall  be provided by a qualified health plan, on an annual basis,
     4  by  providing  its  list of in-network mental health and substance abuse
     5  providers and the number of claims each provider  has  submitted  within
     6  the  past  twelve  months. For providers that have no claims in the past
     7  twelve months, the qualified health plan  must  provide  an  attestation
     8  that such provider is still part of the network; and
     9    (9) Any other data or metric the superintendent or the commissioner of
    10  health  deems  is necessary to measure compliance with mental health and
    11  substance abuse parity.
    12    § 3. Paragraph 2 of subsection (c) of section  210  of  the  insurance
    13  law,  as added by chapter 579 of the laws of 1998, is amended to read as
    14  follows:
    15    (2) the percentage of primary care physicians who remained participat-
    16  ing providers, provided however,  that  such  percentage  shall  exclude
    17  voluntary  terminations due to physician retirement, relocation or other
    18  similar reasons, and the  percentage  of  mental  health  professionals,
    19  defined  as  physicians who are licensed pursuant to article one hundred
    20  thirty-one of the education law who are diplomats of the American  board
    21  of  psychiatry  and  neurology  or  are eligible to be certified by that
    22  board, or are certified by the American osteopathic board  of  neurology
    23  and  psychiatry  or are eligible to be certified by that board, a social
    24  worker licensed pursuant to article one hundred fifty-four of the educa-
    25  tion law or a psychologist licensed  pursuant  to  article  one  hundred
    26  fifty-three  of the education law, who remained as participating provid-
    27  ers and the number of claims each type of mental health professional has
    28  submitted in the last twelve months and  the  number  of  mental  health
    29  professionals,  if  any,  who have not had any claims in the last twelve
    30  months;
    31    § 4. Subsection (d) of section 210 of the insurance law, as  added  by
    32  chapter 579 of the laws of 1998, is amended to read as follows:
    33    (d)  Health insurers and entities certified pursuant to article forty-
    34  four of the public health law shall provide annually to the  superinten-
    35  dent  and  the  commissioner  of  health, and the commissioner of health
    36  shall provide to the superintendent, all of  the  information  necessary
    37  for  the  superintendent to produce the annual consumer guide, including
    38  the mental health parity report.   In compiling the  guide,  the  super-
    39  intendent  shall  make  every  effort  to ensure that the information is
    40  presented in a clear, understandable fashion which  facilitates  compar-
    41  isons  among  individual  insurers  and  entities, and in a format which
    42  lends itself to the  widest  possible  distribution  to  consumers.  The
    43  superintendent  shall  either  include  the  information from the annual
    44  consumer guide in the consumer shopping guide required by subsection (a)
    45  of section four thousand three hundred twenty-three of this  chapter  or
    46  combine the two guides as long as consumers in the individual market are
    47  provided with the information required by subsection (a) of section four
    48  thousand three hundred twenty-three of this chapter.
    49    §  5.  This  act  shall take effect on the sixtieth day after it shall
    50  have become a law, provided, however, effective immediately, the  amend-
    51  ment and/or repeal of any rule or regulation necessary for the implemen-
    52  tation  of this act on its effective date are authorized and directed to
    53  be made and completed on or before such effective date.