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New York might be setting the parity precedent

October 21, 2016
by Julie Miller, Editor in Chief
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New York has been habitually strict on health insurance regulation. On Wednesday, Gov. Andrew Cuomo and the state finance department sent a letter to health plans, underlining their obligation to follow new state parity legislation and vowing to take action on insurers that fail to meet parity standards.

Then on Thursday, Attorney General Eric Schneiderman separately reached a settlement with insurance giant Cigna that puts the kibosh on the company’s preauthorization rules for medication-assisted treatment. Schneiderman applauded Cigna’s policy change and encouraged other insurers to follow suit.

What’s interesting is that Cigna has actually done some earnest soul searching in addressing the opioid crisis. Clinical leaders aren’t just monitoring physician prescribing practices around opioids—every insurer is doing that now days—but they’ve also started looking into optimal addiction treatment through a partnership with the American Society of Addiction Medicine. There’s a big difference between prodding network doctors to write fewer scripts for pain meds and covering treatment for patients with addiction disorders.

I contacted Cigna, and a spokesperson told me via email: “Under our commercial plans, we have agreed to voluntarily remove prior authorization from all medications used in medication-assisted treatment for opioid use disorder. This will help make it easier for our customers to access coverage for the medications they need.”

Schneiderman has reached other parity settlements with MVP Healthcare, EmblemHealth, Excellus, Beacon Health Options and HealthNow.

New York rules

Providers should be encouraged by the New York parity law.  It includes provisions such as an insurer requirement to cover residential and inpatient services for substance use disorders for as long as necessary and the stipulation that managed care utilization review can begin no sooner than the 14th day of treatment. Additionally, it requires that all insurers operating in New York to use objective, state-approved criteria when making coverage determinations.

Providers should also note, however, that insurers can still deny coverage for services that do not meet the medical necessity criteria—which must be evidence-based, by the way. The law obviously does not open the floodgates for overly generous services at the highest level of care for the highest cost, so providers still need to be methodical in their clinical choices.

Treatment centers in every state would be well advised to study New York’s model because Cuomo might be setting a precedent on parity. I predict the federal government will start angling for every state to follow New York’s example. In fact, we’re due for the parity report from the White House by year end, and it could be an eye opener for state officials.

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Julie Miller

Editor in Chief

Julie Miller

@editor_JMiller

Julie Miller has more than 14 years of experience observing, analyzing and reporting on various...

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