Special State Update – July 28, 2014

Special State Update: Spotlight on…New York

New York:

  • Sends letters to insurers regarding the Mental Health Parity and Addiction Equity Act
  • Passes set of policies related to heroin and prescription drug abuse
  • Develops plan to collaborate with SUNY university system on substance abuse
  • Develops level of care determination tool


New York State sends letters to insurers regarding the Mental Health Parity and Addiction Equity Act

The letter, sent on June 4th, provides guidance to insurers about the impact of the Mental Health Parity and Addiction Equity Act (MHPAEA) on New York’s insurance market. MHPAEA requires that plans that offer coverage for mental health and substance use disorder services provide comparable coverage to other physical health services. The letter references the State law that reinforces MHPAEA, including the requirement that all insurance policies issued in the State offer comparable coverage for mental health, substance abuse, and physical health.  The letter also provides guidance on benefit classifications, financial requirements and quantitative treatment limitations, out-of-network coverage, non-quantitative treatment limitations, and more. Insurers will be required to cover intensive residential, youth residential, methadone clinics, and using Suboxone will be covered as part of the pharmacy benefit. The State also developed model contract language to assist insurers with the new requirements.

New York State passes landmark set of policies related to heroin and prescription drug abuse

On June 24th, NY Governor Andrew Cuomo signed a package of bills responding to the increase in heroin and prescription drug abuse. The new policies are varied and cover a wide range of issues, including access to treatment, the illegal distribution of drugs, overdose reversal, and public education.

The newly enacted policies include:

Improving Addiction Treatment

  • Creates an expedited appeals process for individuals who need substance use disorder treatment.
  • The law also requires that people are not denied care while appeals are pending.
  • Requires that mental health and substance abuse specialists make medical necessity determinations using evidence-based criteria approved by the State Office of Alcoholism and Substance Abuse Services (OASAS).
  • Creates a demonstration program to design and study a new care model that would divert patients who need treatment, but do not need in-hospital detoxification services to community-based, short-term treatment centers like Haven House Detox.
  • Directs OASAS to create a demonstration program to provide wraparound case management services and supports to adolescents and adults for up to 9 months post-treatment.
  • Allows young people who may have a substance use disorder to be assessed by an OASAS certified provider as part of Person In Need of Supervision (PINS) diversion services.

Increasing Access to Overdose Rescue Kits

  • Requires naloxone overdose reversal kits to include information about how to recognize the signs of an overdose, the steps to take (including calling 911), and how to access OASAS services.

Educating the Public about Prescription Opioid and Heroin Use

  • Directs OASAS to create a public awareness and education campaign to educate the general public and health care professionals about the risks of using heroin and misusing prescription opioids. The resources will also contain information about addiction and how to access addiction services.
  • Compels the State Education Commissioner to update the State’s drug abuse curriculum every 3 years to ensure that it is up-to-date with the latest research and drug use trends.

Controlling the Supply of Illegal Substances

  • Creates a new crime in the penal code to address doctor-shopping by criminalizing individuals’ attempts to obtain a controlled substance or prescription by misrepresenting themselves as a prescriber or pharmacist or using a forged prescription.
  • Allows law enforcement to obtain an eavesdropping warrant using the designated offense “criminal sale of a prescription for a controlled substance or of a controlled substance by a practitioner or pharmacist” to better investigate prescription drug trafficking.
  • Grants the Department of Health Bureau of Narcotic Enforcement increased access to criminal histories to better investigate suspect prescribers and dispensers. This Bureau manages the State’s prescription drug monitoring program (PDMP).
  • Makes the criminal sale of a controlled substance a Class C felony.

New York State develops plan to collaborate with SUNY university system on substance abuse

NY Governor Cuomo announced a partnership with the State University of New York (SUNY) System to address prescription opioid and heroin abuse on college campuses. The SUNY System is made up of 64 University centers, colleges, and community college campuses.

The initiative:

  • Incorporates opioid awareness education during new student orientations and during other appropriate settings;
  • Offers training for all staff and resident assistants about the warning signs for substance use disorders, ensuring that students who seek treatment for a substance use disorder have access to all of the services they need;
  • Assists and educates campus law enforcement about use trends and best practices for working with students under the influence of opioids; and
  • Offers training to staff and health centers to administer naloxone.

New York develops level of care determination tool  

To protect the expertise of our clinicians, OASAS is developing a new level-of-care tool called the Level of Care for Alcohol and Drug Referral (LOCATDR3). OASAS will require Medicaid managed care plans to use the web-based LOCATDR 3, so that decisions about medical necessity are driven by clinical judgment.  The tool will ensure that consistent determinations are made by clinicians and managed care plans. Through the use of LOCATDR3 clients will receive the right service, at the right intensity, at the right time.

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Special thanks to Arlene Gonzales-Sanchez, Commissioner of the New York State Office of Alcoholism and Substance Abuse Services (OASAS), who also services on the NASADAD Board of Directors. We also wish to thank Pat Zuber-Wilson and Rob Kent who assisted with this update.