The New York State Department of Financial Services (“DFS”) has issued guidance to health insurers outlining new insurance coverage requirements for substance abuse treatment.
Under legislation enacted in New York earlier this year, health insurers will be required to cover medication, including naloxone, for detoxification or maintenance treatment of substance use disorders under large group policies. This new requirement mirrors the coverage requirements for individual and small group policies. Health insurers also will be required to provide coverage without preauthorization for inpatient substance abuse treatment in facilities that participate in their networks and are certified by the New York State Office of Alcoholism and Substance Abuse Services.
“Health insurers have an obligation to cover costs for lifesaving substance abuse treatment and our administration will have zero tolerance for those who seek to sidestep this responsibility,” Governor Andrew M. Cuomo said in a statement. “This action is an important step toward breaking the cycle of addiction and ending the epidemic of opioid abuse in New York once and for all.”
Maria T. Vullo, the DFS's superintendent, said, “The guidance issued today outlines the specific requirements insurers must satisfy, and DFS will enforce, to ensure that New Yorkers suffering from opioid abuse receive the kinds of treatment, such as inpatient and outpatient coverage for detoxification, that are essential for recovery so that they can rebuild their lives.”
The new guidance alerts health insurers that they must provide inpatient and outpatient coverage for detoxification and maintenance treatment medication, including naloxone. It also instructs health insurers that they must eliminate prior authorization requirements for a five-day emergency supply of prescribed medications for the treatment of substance use disorder when an emergency arises. The guidance by DFS outlines insurer utilization review requirements, and includes timeframes under which the utilization review determinations must be made by health insurers.
The DFS said that it will review health insurers' compliance with requirements for coverage during market conduct exams and will take action against any insurers found to have failed to meet all statutory and regulatory requirements for coverage of substance use disorder treatment.
Learn more: Guidance.
Steven A. Meyerowitz
Steven A. Meyerowitz, a Harvard Law School graduate, is the founder and president of Meyerowitz Communications Inc., a law firm marketing communications consulting company. He may be contacted at [email protected].