New York

Note: All of the sections of the law summarized below are located within New York’s Insurance Law. It is not possible to link to specific articles and sections of New York’s consolidated laws due to the construction of the website that hosts them. Please send an email to info@paritytrack.org to receive the actual text of these sections of New York’s Insurance Law.

New York state law, known as “Timothy’s Law” has sections that address insurance coverage for behavioral health services.

There are several layers to New York’s law. Different sections of the law apply to different groups of behavioral health conditions:

1. Mental health conditions in general
2. “Biologically-based mental illnesses”
3. Substance use disorders
4. Autism

The section of the law that applies to mental health conditions in general requires small employer fully-insured plans, and large employer fully-insured plans to cover “mental, nervous or emotional disorders or ailments, however defined in such policy, at least equal to the coverage provided for other health conditions.” The law does not go into any further detail about how these conditions are defined or reference any outside classification material such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). This section of the law includes the following coverage requirements:

1. 30 days of inpatient treatment
2. 20 outpatient visits
3. 60 days of partial hospitalization (but each day subtracts half a day from inpatient days)

This section of the law also states that deductibles, copays, and coinsurance must be “consistent with those imposed on” other medical services.

The section of the law that applies to “biologically-based mental illnesses” states that coverage must be provided on the “same terms and conditions” as coverage for other medical services. large employer fully-insured plans must provide this coverage while small employer fully-insured plans must only offer this coverage, but it may be rejected by the small employer. “Biologically-based mental illnesses” are defined as:

1. Schizophrenia/psychotic disorders
2. Major depression
3. Bipolar disorder
4. Delusional disorders
5. Panic disorder
6. Obsessive compulsive disorders
7. Anorexia
8. Bulimia

This section of the law also applies to children with “serious emotional disturbances.” These are defined as attention deficit disorders, disruptive behavior disorders, or pervasive development disorders with any one of the following symptoms:

1. Thoughts of suicide or self-harm
2. Psychosis
3. Behavior that could cause injury or property damage
4. Behavior that could result in child’s removal from home

Small employer plans are not required to abide by this section.

This section of the law requires individual plans, small employer fully-insured plans, and large to cover substance use disorder treatment services and that treatment limitations and financial requirements cannot be different than those in place for other medical services. It also states that coverage in general must follow the Federal Parity Law.

This section of the law requires individual plans, small employer fully-insured plans, and large to cover screening, diagnosis, and treatment of autism spectrum disorders. It defines autism spectrum disorder as any condition in the DSM that is considered a pervasive developmental disorder. Additionally, it specifically mentions autistic disorder, asperger’s disorder, Rhett’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified as conditions that must be covered.

This section states that the following are treatments that must be covered:

1. Behavioral health treatment (includes applied behavior analysis)
2. Psychiatric care;
3. Psychological care
4. Medical care provided by a licensed health care provider
5. Therapeutic care
6. Pharmacy care in the event that the policy provides coverage for prescription drugs

Plans must only cover 680 hours per year of applied behavior analysis but must use deductibles, copays, and coinsurance that are “consistent” with those in place for other medical care.

Plans may use utilization review and other managed care practices.