By Karen Rubin, News & Photo Features

As the fate of Americans’ health care falls in the hands of 13 Republican Senators conferring in secret without input from Democrats let alone health care experts or patients, deciding how much of the “harsh” House plan they incorporate into their own bill, it may well fall to states to take matters into their own hands. Indeed, New York State may provide the model for health care, just as California has dictated pollution standards to the auto manufacturing industry, exceeding federal standards.

New York State Governor Andrew M. Cuomo has directed the New York State Department of Financial Services to promulgate new emergency regulations mandating health insurance providers do not discriminate against New Yorkers with preexisting conditions or based on age or gender, in addition to safeguarding the 10 categories of protections guaranteed by the Affordable Care Act. The new first-in-the-nation measures will ensure that essential health services are protected and covered for all New Yorkers regardless of efforts at the federal level to strip millions of Americans of their healthcare.

At the Governor’s direction, the Department of Health will ban all insurers who 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. New York is home to one of the most robust health marketplaces in the country, and insurers who do not comply will lose access to such profitable programs. The Governor will also direct state agencies and authorities to ban insurers who withdraw from the State Health Marketplace from contracting with the state and to consider all available actions to protect New Yorker’s access to quality healthcare.

Furthermore, the administration finalized regulations that will ensure that contraceptive drugs and devices are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles no matter federal action. The regulations also ensure all medically necessary abortion services are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles.

“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,” Governor Cuomo said. “As long as I am Governor, New Yorkers will not be subject to price discrimination based on age, gender, or pre-existing conditions, and essential health benefits will continue to be the rule, not the exception. These aggressive actions will make certain 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.”

Under the new regulations, DFS will require that 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 cover the same categories of essential health benefits and be subject to the same benchmark plan rules that currently apply through the Affordable Care Act. Insurers must comply with the new regulations as a requirement of their license in New York.

1. 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;
2. Emergency services, such as emergency room, urgent care services, and ambulance services;
3. Hospitalization, such as preadmission testing, inpatient physician and surgical services, hospital care, skilled nursing facility care, and hospice care;
4. Maternity and newborn care, such as delivery, prenatal and postnatal care, and breastfeeding education and equipment;
5. 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;
6. 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;
7. 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;
8. Laboratory services, such as diagnostic testing;
9. 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
10. Pediatric services, including oral and vision care, such as preventive and routine vision and dental care, and prescription lenses and frames.

The Superintendent of the Department of Financial Services may issue model contract language identifying the coverage requirements for all individual and small group accident and health insurance policies that provide hospital, surgical, or medical expense coverage and all student accident and health insurance policies delivered or issued for delivery in New York State.

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 co-pays, coinsurance, or deductibles, regardless of the future of the Affordable Care Act.
• Provide coverage for the dispensing of 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 dispensing of the entire prescribed contraceptive supply, up to 12 months, at the same time.
• Provide coverage for abortion services that are medically necessary without co-pays, coinsurance, or deductibles (unless the plan is a high deductible plan).
• Provide full and accurate information about coverage, enforced in a letter available here.

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