“The agreement presented by the governor and legislative leaders that will be adopted this week takes significant steps to expand insurance coverage, treatment options and access to inpatient facilities. Several of the proposals are similar to those proposed by our Assembly Republican Conference at the beginning of this year. However, one glaring issue not addressed in the legislative package is increasing law enforcement efforts, specifically by amending the law to keep drug dealers behind bars where they belong. Earlier this session, I introduced legislation that would adopt reforms to prohibit drug dealers with multiple felony convictions from being eligible for drug diversion programs. Too many drug dealers convicted of drug-related felonies are using the 2009 law as a loophole to get out of jail, and I am disappointed legislation to address this was excluded from the package. Additionally, a measure that would create the assumption of ‘intent to sell’ if someone is found with 40 or more individual packages of heroin was also left out of the package,” said Assemblywoman Nicole Malliotakis (R,C,I-Brooklyn/Staten Island).
“We need to tackle this serious epidemic from every angle. Yes, we must expand insurance coverage and treatment options and increase the number of beds in inpatient facilities. It is critical that when an addict is ready to seek treatment they have immediate access to it. But if we truly want to tackle this epidemic, we need to keep drug dealers off our streets and behind bars where they belong. Unless we change the law, they will continue receiving ‘Get Out of Jail Free’ cards and selling heroin to our kids,” she added.
Here are the details of the plan that will be adopted this week:
ELIMINATES BURDENSOME INSURANCE BARRIERS TO INCREASE ACCESS TO NEEDED ADDICTION TREATMENT
- Ends Prior Insurance Authorization to Allow Immediate Access to Inpatient Treatment as Long as Such Treatment is Needed: People suffering from addiction who seek treatment need immediate access to services, but prior authorization requirements by insurance companies are often a roadblock to admission to inpatient programs. This legislation requires insurers to cover 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 every patient receives at least two weeks of uninterrupted, covered care before the insurance company becomes involved.
- Ends Prior Insurance Authorization to Allow Greater Access to Drug Treatment Medications: People seeking medication to manage withdrawal symptoms or maintain recovery must often request prior approval from their insurance company, which slows or stops the individual from getting needed medication. This legislation prohibits insurers from requiring prior approval for emergency supplies of these medications. Similar provisions will also apply to managed care providers treating individuals on Medicaid who seek access to buprenorphine and injectable naltrexone.
- Requires All Insurance Companies to Use Objective State-Approved Criteria to Determine the Level of Care for Individuals Suffering from Substance Abuse: Insurance companies often use inconsistent criteria to determine the covered level of care for those suffering from substance use disorder, which often creates barriers preventing these individuals from receiving care. This legislation will require all insurers operating in New York State to use objective, state-approved criteria when making coverage determinations for all substance use disorder treatment to make sure individuals get the treatment they need.
- Mandate Insurance Coverage for Opioid Overdose-Reversal Medication: Naloxone is a medication that revives an individual from a heroin or opioid overdose and has saved thousands of New Yorkers’ lives. To expand access to this life-saving medication, the new legislation requires insurance companies to 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.
· Increase Evaluation for Individuals Incapacitated by Drugs from 48 to 72 Hours: Sometimes, individuals suffering from addiction are at risk for overdose and thus pose a threat to themselves. The legislation allows families to seek 72 hours of emergency treatment, an increase from the current 48 hours, for their loved one to stabilize and connect them to longer-term treatment options while also balancing the rights of the incapacitated individuals.
· Require Hospitals to Provide Follow-Up Treatment Service Options to Individuals Upon Hospital Discharge: Hospitals play an important role in caring for individuals suffering from addiction who are often admitted to hospital emergency rooms after an overdose. This legislation requires hospital medical staff to provide discharge-planning services to connect patients who have or are at risk for substance use disorder with nearby treatment options to provide continuous medical care.
· Allow More Trained Professionals to Administer Life-Saving Overdose-Reversal Medication: Overdose-reversal medication such as naloxone saves lives. However, the law does not currently allow certain licensed professionals to administer this medication to individuals overdosing from heroin and opioids. To ensure more people are able to help reverse overdoses, the new legislation authorizes trained professionals to administer naloxone in emergency situations without risk to their professional license.
· Expand Wraparound Services to Support Long-Term Recovery: Individuals leaving treatment are at great risk for relapse. To provide services during this critical period, the legislation extends the wraparound program launched in 2014 to provide services to individuals completing treatment, including education and employment resources; legal services; social services; transportation assistance; childcare services; and peer support groups.
- Reduce Prescription Limits for Opioids from 30 days to Seven Days: There is a well-established link between the rise in opioid prescriptions and the current heroin crisis. To reduce unnecessary access to opioids, the legislation lowers the limit for initial opioid prescriptions for acute pain from 30 days to no more than a 7-day supply, with exceptions for chronic pain and other conditions.
- Require Ongoing Education on Addiction & Pain Management for All Physicians and Prescribers: Physicians and other opioid prescribers are important partners in preventing addiction linked to abuse of prescription opioids. To ensure prescribers understand the risks presented by prescription opioids, the legislation mandates that these health care professionals complete three hours of education every three years on addiction, pain management; and palliative care.
- Mandate Pharmacists to Provide Easy-to-Understand Information on Risks Associated with Drug Addiction and Abuse: Consumers may not understand the addiction and abuse risks posed by prescription opioids. To improve consumer awareness about these risks, the legislation requires pharmacists to provide educational materials to consumers about the risk of addiction, including information about local treatment services.
- Require Data Collection on Overdoses and Prescriptions to Assist the State in Providing Additional Protections to Combat this Epidemic: Current and accurate data is critical to combat the heroin and opioid crisis, yet gaps currently exist in statewide data on overdoses and usage of opioid reversal medication. To fill that gap the legislation requires the State Commissioner of Health to report county-level data on opioid overdoses and usage of overdose-reversal medication on a quarterly basis.
HELP IS JUST A CALL OR CLICK AWAY
- New Yorkers struggling with an addiction, or those who have loved ones struggling, can find help and hope by calling the state’s HOPEline at 1-877-8-HOPENY (1-877-846-7369) or by texting HOPENY (Short Code 467369).
- New Yorkers can find an OASAS-certified substance use disorder treatment provider by using the OASAS Treatment Availability Dashboard.
- For help with accessing care and insurance coverage, visit the Access Treatment page on the OASAS website.
- To find a naloxone overdose reversal medication training near you, visit the OASAS opioid overdose prevention trainingspage.
- Visit www.combatheroin.ny.gov for more information on addressing heroin and prescription opioid abuse, including a Kitchen Table Tool Kit to help start the conversation about the warning signs of addiction and where to get help.
- For additional tools to use in talking to a young person about preventing underage drinking or drug use, visit the State’sTalk2Prevent website.
Assemblywoman, 64th District