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New York Attorney General Takes Strong Action to Enforce the Federal MH/SUD Parity Law

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Gabrielle de la Gueronniere, JD

Legal Action Center

New York Attorney General Takes Strong Action to Enforce the Federal MH/SUD Parity Law

April 16, 2015 | Parity | Comments
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Recently, the New York State Office of the Attorney General announced the fifth in a series of settlement agreements (known as Assurances of Discontinuance) with health insurance plans that were found to have violated the federal Mental Health Parity and Addiction Equity Act (MHPAEA).  The federal parity law requires insurers that offer mental health and substance use disorder (MH/SUD) benefits to provide those benefits in no more restrictive way than other covered medical and surgical benefits.

In January 2014, New York Attorney General Eric Schneiderman announced the first of five settlement agreements with health insurers providing MH/SUD coverage in New York.  The NY Attorney General’s office found that Cigna, EmblemHealth, MVP Health Care, ValueOptions (now known as Beacon Health), and Excellus had violated various provisions of the federal mental health and addiction parity law.

Violations of the federal MH/SUD parity law identified by the New York Attorney General’s office included:

  • More rigorous and frequent utilization review being applied to MH/SUD benefits
  • Lack of coverage for or more restrictive management of inpatient or residential MH and SUD treatment
  • Higher denial rates for outpatient MH/SUD services than for outpatient medical/surgical services
  • Higher co-pays for outpatient MH/SUD treatment than outpatient medical/surgical benefits
  • MH/SUD coverage denial letters that were so generic that they blocked meaningful appeal

Through the Assurances of Discontinuance between New York State and the insurers, the plans agreed to pay penalties, to reimburse beneficiaries for out of pocket costs incurred for wrongfully denied MH/SUD service claims, and to make a number of changes to their systems used to evaluate MH/SUD treatment claims.  Links to the Assurances of Discontinuance and summaries of the agreements can be found here.

In addition to the oversight and enforcement responsibilities of the state insurance commissioners and the state Medicaid directors, state Attorneys General can play a critically important role in ensuring that the requirements of the federal MH/SUD parity law are being met.  In New York, a number of consumer complaints helped to prompt the Attorney General’s investigation of MH/SUD coverage and whether plans were fully complying with the federal parity law.  Increasing the quantity and volume of complaints about health insurance coverage that doesn’t appear to comply with the federal MH/SUD parity law and sharing those complaints with all of the state and federal regulators responsible for parity oversight will be extremely important to realize the true promise of the law.