As a member of the Senate’s Joint Task Force on Heroin and Opioid Addiction I have worked to enact new laws to fight the heroin and opioid abuse crisis. The laws focus on a number of key areas including initiatives to increase access to treatment and support those who are in recovery.
Several changes in our laws are now in effect and just recently the Department of Financial Services (DFS), the agency that oversees and regulates insurance companies in New York State, outlined the revisions in a special guidance letter to health insurers.
The guidance issued by DFS outlines the new requirements insurers must adhere to in regard to medication, inpatient and outpatient treatment, and other vital addiction recovery services.
Here are some of the key changes that I have fought to enact.
Ending Prior Insurance Authorization for Immediate Access to Inpatient Treatment Services: Requires up to a minimum of 14 days of coverage for necessary inpatient treatment of substance use disorder (SUD) without prior approval or concurrent utilization review (UR) during those 14 days for in-network providers.
Lengthening the Amount of Time Families Can Seek Emergency Drug Treatment: Extends the amount of time a person can be held to receive emergency services related to substance use from 48 hours to 72 hours. This bill also ensures the provision of adequate discharge planning from treatment facilities, provides individuals with the opportunity to seek further substance use treatment, and requires the dissemination of information on the dangers of long-term substance use and treatment resources.
Using Consistent Criteria to Determine the Medical Necessity of Treatments: Allows providers to determine the most appropriate level of care for a client with a substance abuse disorder, regardless of what diagnostic tool is used to determine treatment service levels. Providers could use either OASAS’s Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) or any other diagnostic tool approved by OASAS – increasing the ability of providers to make sure that patients are able to receive the treatment they need.
Authorizing Emergency Substance Use Disorder Medication Coverage: Requires insurance coverage, without prior authorization, for an emergency five-day supply of medications for treating a substance use disorder when emergency conditions exist. Any copayments or coinsurance collected for the emergency supply must not exceed the copayment or coinsurance otherwise applicable to a 30-day supply of such medication.
Expanding Access to Naloxone/Opioid Reversal Medication Coverage: Requires insurance coverage for Naloxone or other overdose reversal medication, whether it is prescribed to a person who is addicted to opioids or their family member covered under the same insurance plan.
DFS will review health insurers’ compliance with requirements for coverage during market conduct exams and will take action against any insurers found to have failed to meet all statutory and regulatory requirements for coverage of substance use disorder treatment.
The full guidance letter can be found on the DFS website at http://www.dfs.ny.gov/insurance/circltr/2016/cl2016_06.pdf.
Going forward, we must also take additional steps to target drug kingpins who prey on the addiction of others. One piece of legislation that would help, known as Laree’s Law, would establish the crime of homicide by sale of an opioid controlled substance. The bill (S.4163) would allow law enforcement officials to charge a dealer with homicide if heroin or an opiate-controlled substance they sell causes an overdose death. The senate has passed the bill in each of the last three years, but the assembly has failed to consider the measure. Those who prey on the addiction of others are abhorrent and should be dealt with severely.
Heroin and opioid addiction is a public health crisis and no one is immune to the crippling effects of this epidemic. I will continue to work closely with community agencies, healthcare professionals, and local law enforcement to assess the effectiveness of these new laws and take additional actions as needed.