The following is a list of key provisions: 

  • Coverage for all mental health conditions, substance use disorders and autism spectrum disorders, as defined in the most recent edition of DSM or ICD;
  • Prohibits preauthorization and concurrent review of substance use disorder services during the initial 28 days of inpatient and outpatient treatment;
  • Prohibits preauthorization and concurrent review of psychiatric inpatient services for persons under the age of 18 for the first 14 days;
  • Prohibits prior authorization for formulary forms of prescribed medications for treatment of substance use disorders;
  • Clinical review criteria applied by utilization review agents must be approved/designated by OMH or OASAS, where applicable;
  • Medical necessity criteria must be made available to insureds, prospective insureds, or in-network providers upon request;
  • Prohibits taking any adverse action in retaliation against a provider filing a complaint, making a report, or commenting to a government body regarding policies and practices that violate this statute;
  • Requires insurers and health plans to post additional information regarding their in-network providers of mental health and substance use disorder services, including whether the provider is accepting new patients as well as the provider’s affiliations with participating facilities certified or authorized by OMH or OASAS; and
  • Provides additional funding resources for staffing at DFS and DOH to handle oversight and enforcement of parity.

Self-insured plans are not subject to these new provisions, but remain subject to the federal parity law and regulations. 

The BHIPR provisions take effect January 1, 2020 and apply to all policies issued, renewed, modified or altered after that date. 

These reforms are monumental and represent a hard-fought victory for NYSPA and the broader mental health and substance use disorder community. 

Click here for more information about the 2019-20 budget and items of interest for psychiatry and medicine.

Thank you for your support of our advocacy efforts on behalf of our members and their patients. Please continue to support our work by contributing to the New York State Psychiatric Political Action Committee