NY Tightens Protections For Consumers Seeking Mental Health, Addiction Services
Rules Aim to Increase Compliance with Mental Health, Substance Use Disorder Parity Laws
By Bethany Bump Albany Times Union May 25, 2021
ALBANY — ’s top insurance regulator is beefing up rules that require health insurers to cover mental health and substance use disorders at the same level they cover physical health conditions.
The state Department of Financial Services will propose a new regulation requiring insurers to hold consumers harmless when their provider directory incorrectly lists a mental health provider as in-network, DFS Superintendent Linda A. Lacewell announced Tuesday.
Many individuals have reported struggling to find mental health providers through these lists, which are often outdated and force consumers to make dozens of inquiries — . The lists also make it appear as though an insurer has complied with mental health parity laws, when in fact they have not.
“Mental health matters now more than ever in the midst of a pandemic and as we continue to fight economic and social injustices,” Lacewell said. “Ensuring that ers 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.”
DFS will also require insurers to prove that their policies will protect consumers seeking mental health and addiction services from being unfairly charged higher co-payments or co-insurance than those seeking other medical services. They must prove this before the consumer purchases the policy, DFS said.
State and federal law require insurers to provide coverage for mental health and substance use disorders that’s on par with coverage they would provide for other medical conditions. Numerous studies over the years, however, have found that insurers so-called parity laws — in part because of a shortage of providers, but also because insurers don’t pay providers enough to adequately provide the services. that insurers set unreasonable criteria for people to qualify for mental health and addiction services.
Lacewell announced Tuesday that DFS will initiate a review of parity compliance later this year based on reports insurers must submit by the end of July. The department will investigate any potential parity violations, including cost-sharing requirements, rates of medical necessity denials and approvals of services, and the number and type of mental health and addiction providers who are in network, she said.