News: Victory for the Mental Health and Substance Abuse Community

Last week the 2019-2020 New York State Budget approved dramatic provisions to enhance parity for New Yorkers suffering from mental health disorders, substance use disorders and autism spectrum disorders.  The Behavioral Health Insurance Parity Reforms (BHIPR) landmark provisions apply to all New York State health insurance and health benefit plans including both group and individual plans and HMOs.   This movement represents an overhaul of the New York Insurance Law with the aim of eliminating discrimination in care coverage for mental health, substance use and autism spectrum disorders.  The BHIPR provisions take effect for all policies issued, renewed, modified or altered as of January 1, 2020.

The New York State Psychiatric Association published an e-bulletin listing some of the central provisions:

  • Guaranteed coverage for all mental health conditions, substance use disorders and autism spectrum disorders, as defined in the most recent edition of DSM or ICD;
  • Medical necessity criteria must be made available to the insureds, prospective insureds, or in-network providers upon request;
  • No preauthorization or concurrent review of psychiatric inpatient services for the first 14 days for individuals under the age of 18 and no preauthorization or concurrent review of substance use disorder services during the initial 28 days of inpatient and outpatient treatment;
  • Insurers are prohibited from retaliating against providers if they file a formal complaint in response to insurer violation of any of these statutes;
  • Insurers and health plans must post additional information regarding their in-network providers of mental health and substance use disorder services, including if the provider is accepting new patients.

Additional funding was designated to manage oversight and enforcement of the new provisions. Unfortunately, self-insured plans are not impacted by these new provisions; they do however, remain subject to federal parity law and regulations.

For more information on NY State parity law, click here.