NY Governor moves to guarantee ACA protections

New York Governor Andrew M. Cuomo has taken action to ensure that essential health services are protected and covered for all New Yorkers despite what he sees as federal-level efforts to strip millions of Americans of healthcare provided under the Patient Protection and Affordable Care Act. On June 5, he directed the New York State Department of Financial Services (DFS) to promulgate new emergency regulations mandating that health insurance providers may not discriminate against New Yorkers with preexisting conditions or based on age or gender, in addition to safeguarding the 10 categories of protections guaranteed under the ACA.
The administration also finalized regulations to ensure that contraceptive drugs and devices are covered by commercial health insurance policies without copays, coinsurance, or deductibles no matter what federal action may be taken, according to the governor’s press release. Cuomo took these “aggressive actions [so that] no matter what happens in Congress, the people of New York will not have to worry about losing access to the quality medical care they need and deserve.”
The regulations also ensure all medically necessary abortion services are covered by commercial health insurance policies without copays, coinsurance, or deductibles.

Essential health benefits.

Under the new regulations, individual and small group accident and health insurance policies, which provide hospital, surgical, or medical expense coverage, as well as student accident and health insurance policies, will be required to cover the same 10 categories of essential health benefits and be subject to the same benchmark plan rules currently applied under the ACA:

  • Ambulatory patient services, such as office visits, ambulatory surgical services, dialysis, radiology services, chemotherapy, infertility treatment, abortion services, hospice care, and diabetic equipment, supplies and self-management education;
  • Emergency services, such as emergency room, urgent care services, and ambulance services;
  • Hospitalization, such as preadmission testing, inpatient physician and surgical services, hospital care, skilled nursing facility care, and hospice care;
  • Maternity and newborn care, such as delivery, prenatal and postnatal care, and breastfeeding education and equipment;
  • Mental health and substance use disorder services, including behavioral health treatment, such as inpatient and outpatient services for the diagnosis and treatment of mental, nervous and emotional disorders, screening, diagnosis and treatment for autism spectrum disorder, and inpatient and outpatient services for the diagnosis and treatment of substance use disorder;
  • Prescription drugs, such as coverage for generic, brand name and specialty drugs, enteral formulas, contraceptive drugs and devices, abortifacient drugs, and orally administered anti-cancer medication;
  • Rehabilitative and habilitative services and devices, such as durable medical equipment, medical supplies, prosthetic devices, hearing aids, chiropractic care, physical therapy, occupational therapy, speech therapy, and home health care;
  • Laboratory services, such as diagnostic testing;
  • Preventive and wellness services and chronic disease management, such as well child visits, immunizations, mammography, gynecological exams including cervical cytology screening, bone density measurements or testing, and prostate cancer screening; and
  • Pediatric services, including oral and vision care, such as preventive and routine vision and dental care, and prescription lenses and frames.

Insurers must comply with the new regulations as a requirement of their license in New York. The Superintendent of DFS may issue model contract language identifying these coverage requirements.

Contraception and abortion services.

DFS will also mandate under existing New York law that health insurers provide coverage for all contraceptive drugs and devices and cover at least one form of contraception in each of the FDA-approved contraceptive delivery methods without copays, coinsurance, or deductibles, regardless of the future of the ACA. Health insurers will also be required to provide coverage for an initial three-month supply of a contraceptive to an insured person. For subsequent dispensing of the same contraceptive covered under the same policy or renewal, an insurer must allow coverage for the entire prescribed contraceptive supply, up to 12 months, at the same time. Health insurers will also be required to cover abortion services that are medically necessary without copays, coinsurance, or deductibles (unless the plan is a high deductible plan).
Cuomo also ordered the Department of Health to ban insurers who withdraw from the state health insurance exchange from future participation in any program that interacts with the marketplace (Medicaid, Child Health Plus, and the Essential Plan).
Full and accurate information about coverage, enforced in a letter (available at www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/ContraceptiveLetter.pdf), must be provided.

Marketplace withdrawals.

The Department of Health will ban all insurers that withdraw from offering Qualified Health Plans on the State Health Marketplace from future participation in any program that interacts with the marketplace, including Medicaid, Child Health Plus, and the Essential Plan. In addition, insurers that withdraw from the State Health Marketplace will be banned from contracting with the state.
“We will not stand idly by as ultra-conservatives in Washington try to roll back the progress we have made to expand access quality, affordable health care, putting our most vulnerable New Yorkers at risk,” Cuomo said.

SOURCE: New York Governor’s press release, June 5, 2017
Visit our News Library to read more news stories.