New York Announces Health Insurance Reforms to Combat Opioid Crisis

December 30, 2016

Governor Andrew M. Cuomo has announced that new health insurance reforms aimed at combatting New York State’s heroin and opioid crisis will go into effect January 1, 2017.

These reforms were part of the legislative package that the Governor signed earlier this year. Once in effect, health insurance plans will be required to cover treatment services provided to New Yorkers suffering from opioid addiction, increase access to treatment, expand community prevention strategies and limit the over-prescription of opioids in New York.

“With these landmark reforms fully enacted, we have removed artificial barriers that prevented New Yorkers from receiving the help they need and put into place new safeguards to get these drugs off the street,” Governor Cuomo said in a press release issued by the New York State Department of Financial Services (DFS). “As families and communities across the nation grapple with the devastating effects of this heroin and opioid crisis, New York is leading the fight to stamp out this disease once and for all.”

The legislative package included several best practices and recommendations identified by the Governor’s Heroin and Opioid Task Force and builds on New York’s aggressive efforts to break the cycle of heroin and opioid addiction. These new insurance-related protections are the final components of the package to take effect and include four measures to remove burdensome access barriers for inpatient treatment and medication.

These measures seek to end prior insurance authorization to allow for immediate access to inpatient treatment as long as treatment is needed. It will require that insurers cover necessary inpatient services for the treatment of substance use disorders for as long as an individual needs them. In addition, the legislation establishes that utilization review by insurers can begin only after the first 14 days of treatment, ensuring that every patient receives at least two weeks of uninterrupted care before the insurance company becomes involved.

Additionally, the measures aim to end prior insurance authorization to allow for greater access to drug treatment medications. Under the reforms, insurers cannot require prior approval for emergency supplies of drug treatment medications. Similar provisions that also apply to managed care providers treating Medicaid recipients who seek access to buprenorphine and injectable naltrexone took effect in June.

The new rules require all insurance companies to use objective state approved criteria to determine the level of care for individuals suffering from substance abuse. Going forward, all insurers operating in New York State will be required to use objective, state-approved criteria when making coverage determinations for all substance use disorder treatment in order to make sure individuals get the treatment they need.

The rules also mandate insurance coverage for opioid overdose-reversal medication. The measures state that insurance companies must cover the costs of naloxone when prescribed to a person who is addicted to opioids and to members of his or her family on the same insurance plan.

The new insurance coverage requirements apply to small group and large group plans regulated by the DFS that are issued or renewed beginning January 1, as well as plans sold to individual consumers.

“These new laws will save lives,” said Arlene Gonzalez Sanchez of the New York State Office of Alcoholism and Substance Abuse Services in the release. “They will make it possible for New Yorkers in need to get help when they seek it.”

Source: New York State Department of Financial Services Press Office

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Latest Comments

  • June 29, 2017 at 4:03 pm
    andy says:
    I think our government always have something new to do. I would really mind if they think that it will help those people who are addictive under control. But, whatever it is I... read more
  • January 6, 2017 at 1:44 pm
    mrbob says:
    If I truly thought that this would solve the problem as a consumer of medical insurance I would not be opposed to paying the higher premiums that will result from this legisla... read more
  • January 6, 2017 at 1:32 pm
    FFA says:
    Working very well in Wisconsin. with only 8% participation, very positive results have come about.

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