Governor Cuomo Announces New Health Insurance Reforms to Combat Heroin and Opioid ABuse to Take Effect January 1

Press Release

Governor Andrew M. Cuomo today announced that new health insurance reforms aimed at combatting New York State's heroin and opioid crisis will go into effect January 1, 2017. These reforms were part of the landmark legislative package that the Governor signed earlier this year. Once in effect, health insurance plans will be required to cover treatment services provided to New Yorkers suffering from opioid addiction, increase access to treatment, expand community prevention strategies, and limit the over-prescription of opioids in New York.

"With these landmark reforms fully enacted, we have removed artificial barriers that prevented New Yorkers from receiving the help they need and put into place new safeguards to get these drugs off the street," Governor Cuomo said. "As families and communities across the nation grapple with the devastating effects of this heroin and opioid crisis, New York is leading the fight to stamp out this disease once and for all."

The legislative package included several best practices and recommendations identified by the Governor's Heroin and Opioid Task Force, and builds on New York's aggressive efforts to break the cycle of heroin and opioid addiction . These new insurance-related protections are the final components of the package to take effect and include four measures to remove burdensome access barriers for inpatient treatment and medication. These measures:

End Prior Insurance Authorization to Allow for Immediate Access to Inpatient Treatment as Long as Such Treatment is Needed: Insurers must cover necessary inpatient services for the treatment of substance use disorders for as long as an individual needs them. In addition, the legislation establishes that utilization review by insurers can begin only after the first 14 days of treatment, ensuring that every patient receives at least two weeks of uninterrupted care before the insurance company becomes involved.
End Prior Insurance Authorization to Allow for Greater Access to Drug Treatment Medications: Insurers cannot require prior approval for emergency supplies of drug treatment medications. Similar provisions that also apply to managed care providers treating Medicaid recipients who seek access to buprenorphine and injectable naltrexone took effect in June.
Require All Insurance Companies Use Objective State-Approved Criteria to Determine the Level of Care for Individuals Suffering from Substance Abuse: All insurers operating in New York State must use objective, state-approved criteria when making coverage determinations for all substance use disorder treatment in order to make sure individuals get the treatment they need.
Mandate Insurance Coverage for Opioid Overdose-Reversal Medication: Insurance companies must cover the costs of naloxone when prescribed to a person who is addicted to opioids and to his/her family member/s on the same insurance plan.

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