BILL NUMBER: S8002

SPONSOR: AMEDORE
 
TITLE OF BILL:  An act to amend the mental hygiene law, in relation to
directing the office of alcoholism and substance abuse services to
provide an ombudsman for substance use disorder insurance coverage

 
PURPOSE:

To create a state Ombudsman for substance use disorder insurance cover-
age within the Office of Alcoholism and Substance Abuse Services (OASAS)
to investigate and resolve consumer and provider complaints regarding
insurance coverage and reimbursement for initial or continuing substance
use disorder care and network adequacy and access to care.

 
SUMMARY OF PROVISIONS:

Section 1 of the bill amends section 19.07 of the mental hygiene law to
provide that OASAS shall establish an ombudsman for substance use disor-
der insurance coverage to identify, accept, investigate, refer and
resolve consumer complains relative to health insurance coverage and
              

access to substance use disorder care, including medication assisted
treatment, both inpatient and outpatient. The ombudsman shall also
accept, investigate refer and resolve complaints of treatment providers
relative to insurance coverage, and both providers and consumers rela-
tive to network adequacy for access to and continuing substance use
disorder care. The legislation also directs the ombudsman to make recom-
mendations to the Commissioner and Superintendent of Financial Services
biennially beginning October 1, 2019 on regulatory and/or statuary
changes necessary to ensure access to appropriate care, whether the roll
of the ombudsman should be expanded to include broader behavioral health
insurance complaints and concerns, and to share those recommendations
with the legislature upon issuance.

Section 2 provides an effective date.

 
JUSTIFICATION:

New York continues to be in the midst of an opioid epidemic despite
added funding for prevention and treatment and many policy initiatives
implemented to provide access to care and limit over prescribing of
opioids. New York State took the lead in 2007 by requiring insurers to
provide mental health parity and the federal government followed suit in
2008 and added the requirement that substance abuse services also be
covered in parity with other health care coverage. Between 20014 and
2016 the legislature adopted and the Governor signed into law many
insurance law provisions to remove additional barriers to substance
abuse treatment including Chapter 41 of 2014, Chapter 371 of 2015, and
Chapters 69 and 71 of 2016. These more recent changes to the law have
all been in effect for more than a year, yet consumers and providers
continue to come forward with complaints about accessing care.

This legislation creates an Ombudsman for Substance Use Disorder Insur-
ance Coverage, within OASAS, charged with assisting consumers and
providers in addressing insurance problems around substance use disor-
der, including network adequacy. The legislation also directs the
Ombudsman to make recommendations on regulatory and/or statutory changes
necessary to ensure access to appropriate care and whether the role of

the Ombudsman should be expanded to include broader behavioral health
insurance complaints and concerns.

Establishing an Ombudsman focused specifically on making sure those in
need can access substance use disorder care is vitally important as we
continue to fight the opioid epidemic.

 
LEGISLATIVE HISTORY:

New Bill

 
FISCAL IMPLICATIONS:

To be determined

 
EFFECTIVE DATE:
120 days after enactment