New York state will begin imposing major new addiction treatment service benefits mandates on all state-regulated health insurers Jan. 1.
The state will require individual major medical policies, state-regulated small-group plans, and state-regulated large group plans to eliminate insurance authorization requirements for patients seeking inpatient care for substance abuse disorders.
A carrier must pay for inpatient services for those disorders “as long as an individual needs them,” officials say in an announcement about the mandates.
Patients must be able to get emergency supplies of drug treatment medications without going through an insurance prior approval process, and all plans must cover naloxone, an opioid-overdose reversal medication, officials say.
Another provision will increase the amount of time families can force members who appear to be struggling with drug addiction to stay in emergency evaluation facilities to 72 hours, from 48 hours.
That provision will help stabilize people who appear to have drug addiction problems while protecting those people’s rights, officials say.
New York Gov. Andrew Cuomo says in a statement that the insurance provisions in the package will help his state fight use of heroin and other opiates.
“We have removed artificial barriers that prevented New Yorkers from receiving the help they needed,” Cuomo says.
The announcement does not talk about how the new mandates might affect health insurers’ claim costs or premiums.
Earlier this year, the Albany, New York-based New York Health Plan Association complained about the failure of addiction package designers to put any public or private entity in charge of overseeing treatment. The addiction treatment mandates “while well-intended, will increase utilization and costs of services, consequently adding to the overall price of coverage,” the association said.
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