New York health carriers should make health plan purchasers aware of new mental health benefits mandates in the next few weeks.
Charles Rapacciuolo, chief of the New York State Insurance Department health bureau, describes carriers’ new responsibilities in Circular Letter Number 3 (2007).
The New York department is acting on the fly because New York Gov. George Pataki, a Republican, signed “Timothy’s Law” Dec. 22, 2006, just a few days before the new law took effect, on Jan. 1.
The law, passed in the wake of a suicide of a 12-year-old boy, requires state-regulated health carriers in New York to provide comparable insurance coverage for mental illnesses and physical illnesses.
The coverage must include at least 30 days of active inpatient care per year and at least 20 days of active outpatient treatment.
Health coverage for employers with 50 or more employees must include treatment for schizophrenia, major depression, obsessive compulsive disorders, bulimia, anorexia, serious cases of attention deficit disorders in children, disruptive disorders, or pervasive development disorders, officials say.
Children under 18 years of age are eligible for coverage if they have serious suicidal symptoms or other life-threatening self-destructive behaviors; significant psychotic symptoms; behaviors caused by emotional disturbance that place the child at risk of causing personal injury or significant property damage; or behaviors caused by emotional disturbances that place the child at substantial risk of removal from the household.
A group coverage purchaser with 50 or fewer members must make mental health benefits comparable to physical health benefits available for employees to buy upon request, officials say.
The state general fund is supposed to help subsidize small employers’ purchases of the new mental health benefits, officials say.
The New York department is just starting to develop the regulations needed to implement the new law, but early notices should go out to group and school blanket policyholders and certificateholders “as soon as possible,” and no later than Feb. 15, Rapacciuolo writes.
When group contracts permit, carriers may provide to the group policyholder for distribution to the individual certificateholders and members, Rapacciuolo writes.
Rapacciuolo has attached a sample notice to the circular letter.
Rapacciuolo also discusses policy form and rate submission filing procedures and notes that failure to file the submissions by March 15 “will subject the insurer to appropriate disciplinary action.”
A copy of the circular letter and the sample notice are on the Web at Document Link