State leaders said Wednesday they have struck a deal on bills aimed at countering a sharp rise in heroin and opioid overdoses across New York and are poised to enact a measure touted by Sen. James Seward, R-Milford, that would expand insurance coverage for addiction services.

The multi-pronged package of legislation is slated to be passed before New York’s 213 lawmakers return home at the end of this week, with the closure of the 2014 session.

In outlining the agreement after marathon negotiations with the Senate and the Assembly, Gov. Andrew Cuomo highlighted the insurance coverage expansion as the first item from the laundry list of measures upon which there is now agreement between legislative leaders and his office.

The initiative would require insurers to rely on health care professionals specializing in substance abuse to make coverage decisions. It would also speed up the appeals process for those who are rejected for coverage and requires health plans to reimburse for treatment while a denial is under appeal.

Said Seward: “When a heroin addict decides to seek help, it is crucial that services are made available. It may be the turning point in someone’s life, and I don’t want that moment to pass because of insurance paperwork, the denial of services by a bureaucrat who isn’t medically qualified to make such a decision, or drawn-out appeals.”

In a session marked by political battles and overshadowed by Cuomo’s efforts to withstand this year’s election challenge from Republican hopeful Rob Astorino, the heroin legislation was one of the most significant measures to break through the Albany gridlock so far this year. 

The legislation will likely have a “negligible impact” on the insurance industry, said Seward, the chairman of the Senate Insurance Committee. Because the expansion does not kick in until next April 1, when the next state fiscal year begins, it will not be known until that time what the financial impact will be on state insurance plans provided to public sector workers, he added.

The New York Health Plan Association, an umbrella organization for major health insurers, welcomed the effort to bring greater clarity to regulations governing substance abuse treatment But the group’s president, Paul Macielak, said because the way the rules were formulated, the health plans would have to pay for “unwarranted and potentially inappropriate care” in as many as 80 percent of cases.

Treatment experts have long argued that insurance companies have posed a formidable barrier to ensuring addicted people get effective medical services.

Cuomo alluded to that argument when he stated at a press briefing streamed on the internet from the state Capitol that the new legislation creates new checks on the insurance industry and makes sure it “can’t play games and decide who gets treatment and who doesn’t .”

The new legislation also seeks to crack down on doctors and pharmacists who make illegal sales to controlled substances, by boosting the maximum prison sentence for that offense from 2½ years to 5½ years. It would also allow police to get wiretaps when they have evidence implicating a health care professional in the illicit sale of pharmaceutical drugs.

There would also be new public awareness campaigns to educate New Yorkers about the danger of addiction and counter the stigma associated with substance abuse.

Seward said he had hoped there would be even greater emphasis on tougher penalties in the legislation Cuomo is expected to sign.

At the same time, he acknowledged, “we’re not going to arrest our way out of this problem.”

Cuomo said he and legislative leaders had not worked out on agreement on a proposal that would make New York the 23rd state in the nation to legalize medicinal marijuana. Cuomo has been opposed to proposals that would allow marijuana to be smoked by patients, preferring other ways of administering the drug. He said he was continuing discussions with lawmakers, and wanted to see legislation with tight controls.

“It’s very hard to put that genie back into the bottle,” Cuomo said.

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