May 25, 2021
DURING MENTAL HEALTH AWARENESS MONTH, SUPERINTENDENT LACEWELL ANNOUNCES “MENTAL HEALTH MATTERS”: CONSUMER PROTECTION INITIATIVES FOR MENTAL HEALTH AND SUBSTANCE USE DISORDER PARITY IN INSURANCE COVERAGE
DFS to Propose New Regulation to Protect Consumers from Provider Directory Misinformation
DFS to Review Parity Compliance and Review Policyholder Cost-Sharing Requirements and Coverage Limitations
Following Final DFS Parity Compliance Program Regulation, DFS to Review Insurers’ Adoption of Program Requirements
For Mental Health Awareness month, Superintendent of Financial Services Linda A. Lacewell today announced “Mental Health Matters,” a series of initiatives to ensure that New York consumers who need mental health and substance use disorder services are not discriminated against when seeking coverage under their health insurance policies. The initiatives include a new regulation to protect consumers from provider directory misinformation and a comprehensive review of insurers for parity compliance.
Every year, more than 1 in 5 New Yorkers has symptoms of a mental health or substance use disorder. Several studies have shown that the ongoing pandemic has exacerbated mental health and substance use disorder issues, especially for people of color and low-income New Yorkers. To support all New Yorkers at this critical time, DFS is taking steps to strengthen New York consumers’ access to essential mental health and substance use disorder services.
“Mental health matters now more than ever in the midst of a pandemic and as we continue to fight economic and social injustices,” said Superintendent Lacewell. “Ensuring that New Yorkers receive full benefits for mental health and substance use disorder services on the same basis as other medical benefits is critically important to break down access barriers to treatment."
New York law requires insurers to cover mental health and substance use disorder treatment. In addition, under Federal and State law, health insurers must cover mental health and substance use disorder treatment at the same level that they cover other health conditions. These “parity” requirements ensure that mental health and substance use disorder services can be readily accessed by New Yorkers.
Last year, DFS issued one of the most comprehensive regulations in the nation requiring insurers to establish parity compliance programs. The regulation strengthens insurers' obligations under State and Federal law to provide comparable coverage for mental health and substance use disorder treatment. DFS has instructed insurers that they must be in compliance with the regulation by the end of this year.
“Mental health and physical health are closely connected, and these regulations will help ensure parity in health insurance coverage, improving public health across New York State,” said New York State Department of Health (DOH) Commissioner Dr. Howard Zucker. “The COVID-19 pandemic has put incredible strains on us all, and there should be no unnecessary roadblocks to New Yorkers seeking treatment for mental health conditions and substance use disorder.”
“Mental health is absolutely essential to overall health,” Office of Mental Health (OMH) Commissioner Dr. Ann Sullivan said. “When insurance providers impose limits on coverage for behavioral health and substance abuse treatments, they create barriers that limit access to necessary healthcare, and these barriers can have far-reaching and sometimes tragic consequences. The work DFS is doing to ensure parity regulations are being followed is helping people get the vital services they need.”
“Treating substance use and mental health conditions is as important as treating any physical ailment or illness,” said Office of Addiction Services and Supports (OASAS) Commissioner Arlene González-Sánchez. “These new regulations will help gain access to greater health equity and strengthen protections for individuals and families who are in need of essential behavioral health treatment and recovery services.”
Today, following the final parity compliance program regulation that went into effect in December, and in recognition of Mental Health Awareness month, Superintendent Lacewell announced the following DFS actions to ensure that New York insurers provide equitable coverage for mental health and substance use disorders:
- Regulation to Protect Consumers from Provider Directory Misinformation: DFS will propose a regulation requiring insurers to hold consumers harmless when the insurer’s provider directory lists a provider as participating in an insurer’s network when the provider does not in fact participate in the insurer’s network. Access to providers of mental health and substance use disorder services is especially important now when so many New Yorkers have been struggling with mental health issues due to the pandemic.
- Up-Front Review of Cost-Sharing: Before policies are sold to New Yorkers, DFS is requiring insurers to prove that those policies meet parity requirements that protect consumers from being unfairly charged higher copayments or coinsurance for mental health and substance use disorder benefits than for medical benefits.
- Comprehensive Review of Biennial Parity Reports: DFS will initiate a comprehensive review of insurers for parity compliance based on reports due from insurers in July 2021. DFS will investigate any potential parity violations, including cost-sharing requirements, rates of medical necessity denials and approvals of services, as well as the number and type of mental health and substance use disorder providers who are in network.
DFS expects full adherence to these critical State and Federal consumer protections for New Yorkers and their families and will hold insurers accountable for any parity violations.
General questions about coverage provided by an insurer regulated by DFS should be sent to [email protected]. Anyone who has been denied coverage by an insurer that DFS regulates can file a complaint at www.dfs.ny.gov/complaint.