Information for Insurers and Providers on Coverage for Mental Health Services for Essential Workers
No, the regulation applies to all outpatient mental health services when provided by an in-network provider.
No, the regulation does not extend to prescription drugs.
The regulation became effective on May 2, 2020 and applies to any outpatient mental health service provided on or after that date, even if a course of treatment began prior to that date.
The regulation applies to insurers, Article 43 corporations, HMOs, and student health plans with a certificate of authority pursuant to Insurance Law section 1124, providing comprehensive coverage for hospital, surgical or medical care.
The Department of Health is applying the waiver of cost-sharing to the Essential Plan to the extent that the Essential Plan is subject to cost-sharing. Child Health Plus and Medicaid Managed Care Plans do not impose cost-sharing.
No, the regulation does not apply to Medicare plans (including Medicare Advantage). Insurers should consult the Centers for Medicare and Medicaid Services for applicable rules.
Yes, the regulation applies to all individuals who are, or were, essential workers during the state of emergency declared by Governor Cuomo on March 7, 2020.
The regulation requires that insurers provide written notification, which may include e-mail, to its in-network outpatient mental health providers that they shall not collect any deductible, copayment, or coinsurance from an essential worker in accordance with this subdivision. The notification must include the definition of essential worker and include the list of those essential workers that is set forth in the regulation.
Insurers should advise their in-network providers that, prior to collecting any cost-sharing, the provider should ask the individual whether they are or were employed as an essential worker at any time during the state of emergency that was declared on March 7, 2020, using the list of essential workers provided in the insurer’s notice.
The regulation requires that no essential worker shall be required to pay for cost-sharing for in-network outpatient mental health services, however the issuer is still responsible for reimbursing the provider for the cost-sharing amount.
If an essential worker contacts an insurer indicating that a provider improperly collected a deductible, copayment, or coinsurance from them, the insurer should provide a refund or credit to the insured for the amount collected.
Yes, insurers are still subject to the requirements of Insurance Law § 3224-a, including the timeframes contained therein related to payment of claims.