New York State Tweaks Insurance Rules To Combat Opioid Crisis

Dec. 29--New health insurance reforms aimed at combating New York State's heroin and opioid crisis will go into effect Sunday, according to a media release Wednesday from the governor's office.

These reforms were part of the legislative package signed by Gov. Andrew Cuomo 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, the release said.

The legislative package included several best practices and recommendations identified by the Governor's Heroin and Opioid Task Force, according to the release. The new insurance-related protections are the final components of the package to take effect and include the following:

--Insurers must 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.

--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.

--All insurers operating in New York state must use objective, state-approved criteria when making coverage determinations for all substance use disorder treatment to make sure individuals get the treatment they need.

--Insurance companies must cover the costs of naloxone when prescribed to a person who is addicted to opioids and to his/her family member/s on the same insurance plan.

The new insurance coverage requirements apply to small-group and large -plans regulated by the Department of Financial Services that are issued or renewed beginning Sunday, as well as plans sold to individual consumers.

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