Assembly Bill A8839

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8839
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               June 9, 2025
                                ___________
 
 Introduced  by M. of A. SIMON -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance law, in relation to  preventing  discrimi-
   nation by insurers based on an individual's mental health or substance
   use disorder
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 3216 of the insurance law is amended  by  adding  a
 new subsection (n) to read as follows:
   (N)  (1) EVERY INSURER ISSUING A POLICY DELIVERED OR ISSUED FOR DELIV-
 ERY IN THIS STATE THAT  PROVIDES  COVERAGE  FOR  ANY  MENTAL  HEALTH  OR
 SUBSTANCE USE DISORDER SERVICES SHALL:
   (A) COMPLY WITH THE REQUIREMENTS OF THE PAUL WELLSTONE AND PETE DOMEN-
 ICI MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 AND ITS IMPLE-
 MENTING REGULATIONS; AND
   (B) NOT DISCRIMINATE IN ITS PLAN BENEFIT DESIGN OR APPLICATION AGAINST
 INDIVIDUALS  BECAUSE  OF  THEIR  HISTORY OF PRESENT, OR PREDICTED MENTAL
 HEALTH OR SUBSTANCE USE DISORDER.
   (2) THE COMMISSIONER OF MENTAL HEALTH SHALL PROMULGATE RULES AND REGU-
 LATIONS TO INCORPORATE THE REGULATORY REQUIREMENTS RELATED TO THE MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT AT 89 FED. REG. 77735 THROUGH  89
 FED.  REG. 77751, AS FOUND ON SEPTEMBER TWENTY-THIRD, TWO THOUSAND TWEN-
 TY-FOUR, IN THEIR ENTIRETY,  IN  RELATION  TO  THE  PROVISIONS  OF  THIS
 SUBSECTION.
   (3)  DATA  COLLECTED  PURSUANT TO SECTION THREE HUNDRED FORTY-THREE OF
 THIS CHAPTER, AND ANY OTHER DATA REQUESTED BY THE SUPERINTENDENT, MAY BE
 USED TO ASSESS COMPLIANCE WITH THE REQUIREMENTS OF PARAGRAPH ONE OF THIS
 SUBSECTION.
   (4) IF AN INSURER  PROVIDES  ANY  BENEFITS  FOR  A  MENTAL  HEALTH  OR
 SUBSTANCE  USE  DISORDER  IN  ANY  CLASSIFICATION  OF BENEFITS, IT SHALL
 PROVIDE MEANINGFUL BENEFITS FOR SUCH  MENTAL  HEALTH  OR  SUBSTANCE  USE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13210-01-5
              

 A. 8839                             2
 
 DISORDER  IN  EVERY CLASSIFICATION IN WHICH MEDICAL OR SURGICAL BENEFITS
 ARE PROVIDED.  "CORE TREATMENTS" MEANS STANDARD TREATMENTS OR COURSES OF
 TREATMENT, THERAPY, SERVICE,  OR  INTERVENTION  INDICATED  BY  GENERALLY
 ACCEPTED  STANDARDS OF MENTAL HEALTH OR SUBSTANCE USE DISORDER CARE. FOR
 PURPOSES OF THIS PARAGRAPH, WHETHER THE BENEFITS PROVIDED ARE CONSIDERED
 "MEANINGFUL BENEFITS" SHALL BE DETERMINED IN COMPARISON TO THE  BENEFITS
 PROVIDED  FOR  MEDICAL CONDITIONS AND SURGICAL PROCEDURES IN THE CLASSI-
 FICATION AND SHALL REQUIRE, AT A MINIMUM, COVERAGE OF BENEFITS FOR  THAT
 CONDITION  OR  DISORDER  IN  EACH  CLASSIFICATION  IN  WHICH THE INSURER
 PROVIDES BENEFITS FOR ONE OR MORE MEDICAL CONDITIONS OR SURGICAL  PROCE-
 DURES.  AN  INSURER  DOES  NOT  PROVIDE  MEANINGFUL  BENEFITS UNDER THIS
 SUBSECTION UNLESS IT PROVIDES BENEFITS  FOR  CORE  TREATMENTS  FOR  THAT
 CONDITION  OR  DISORDER  IN  EACH  CLASSIFICATION  IN  WHICH THE INSURER
 PROVIDES BENEFITS FOR CORE TREATMENTS FOR ONE OR MORE MEDICAL CONDITIONS
 OR SURGICAL PROCEDURES. IF THERE IS NO  CORE  TREATMENT  FOR  A  COVERED
 MENTAL  HEALTH  OR  SUBSTANCE USE DISORDER WITH RESPECT TO A CLASSIFICA-
 TION, THE INSURER SHALL NOT BE REQUIRED TO  PROVIDE  BENEFITS  FOR  CORE
 TREATMENTS  FOR  SUCH  CONDITION OR DISORDER IN THAT CLASSIFICATION, BUT
 SHALL PROVIDE BENEFITS FOR SUCH CONDITION OR DISORDER IN  EVERY  CLASSI-
 FICATION IN WHICH MEDICAL OR SURGICAL BENEFITS ARE PROVIDED.
   (5)  FOR  THE PURPOSES OF DETERMINING COMPARABILITY AND STRINGENCY FOR
 NONQUANTITATIVE TREATMENT LIMITATIONS, AN INSURER SHALL  NOT  RELY  UPON
 DISCRIMINATORY FACTORS OR EVIDENTIARY STANDARDS TO DESIGN A NONQUANTITA-
 TIVE  TREATMENT  LIMITATION  TO BE IMPOSED ON MENTAL HEALTH OR SUBSTANCE
 USE DISORDER BENEFITS. A FACTOR OR EVIDENTIARY STANDARD IS DISCRIMINATO-
 RY IF THE INFORMATION, EVIDENCE, SOURCES,  OR  STANDARDS  ON  WHICH  THE
 FACTOR  OR EVIDENTIARY STANDARD ARE BASED ARE BIASED OR NOT OBJECTIVE IN
 A MANNER THAT DISCRIMINATES  AGAINST  MENTAL  HEALTH  OR  SUBSTANCE  USE
 DISORDER BENEFITS AS COMPARED TO MEDICAL OR SURGICAL BENEFITS.
   (6) A NONQUANTITATIVE TREATMENT LIMITATION APPLICABLE TO MENTAL HEALTH
 OR  SUBSTANCE  USE  DISORDER  BENEFITS IN A CLASSIFICATION SHALL NOT, IN
 OPERATION, BE MORE  RESTRICTIVE  THAN  THE  PREDOMINANT  NONQUANTITATIVE
 TREATMENT  LIMITATION  APPLIED TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL
 BENEFITS IN THE CLASSIFICATION. TO TEST COMPLIANCE WITH THIS  PARAGRAPH,
 AN  INSURER SHALL COLLECT AND EVALUATE RELEVANT DATA IN A MANNER REASON-
 ABLY DESIGNED TO ASSESS THE  IMPACT  OF  THE  NONQUANTITATIVE  TREATMENT
 LIMITATION  ON  RELEVANT  OUTCOMES RELATED TO ACCESS TO MENTAL HEALTH OR
 SUBSTANCE USE DISORDER BENEFITS AND MEDICAL AND  SURGICAL  BENEFITS  AND
 CAREFULLY  CONSIDER THE IMPACT AS PART OF THE PLAN'S EVALUATION. AS PART
 OF ITS EVALUATION, THE INSURER MAY NOT DISREGARD RELEVANT OUTCOMES  DATA
 THAT  IT  KNOWS OR REASONABLY SHOULD KNOW SUGGEST THAT A NONQUANTITATIVE
 TREATMENT LIMITATION IS ASSOCIATED WITH MATERIAL DIFFERENCES  IN  ACCESS
 TO  MENTAL  HEALTH  OR  SUBSTANCE  USE  DISORDER BENEFITS AS COMPARED TO
 MEDICAL AND SURGICAL BENEFITS. TO THE EXTENT THE RELEVANT DATA EVALUATED
 SUGGESTS THAT THE NONQUANTITATIVE TREATMENT  LIMITATION  CONTRIBUTES  TO
 MATERIAL  DIFFERENCES IN ACCESS TO MENTAL HEALTH OR SUBSTANCE USE DISOR-
 DER BENEFITS AS COMPARED TO MEDICAL OR SURGICAL BENEFITS  IN  A  CLASSI-
 FICATION,  SUCH  DIFFERENCES SHALL BE CONSIDERED A STRONG INDICATOR OF A
 NONCOMPLIANT NONQUANTITATIVE TREATMENT LIMITATION.  WHERE  THE  RELEVANT
 DATA  SUGGEST  THAT THE NONQUANTITATIVE TREATMENT LIMITATION CONTRIBUTES
 TO MATERIAL DIFFERENCES IN ACCESS TO  MENTAL  HEALTH  OR  SUBSTANCE  USE
 DISORDER  BENEFITS  AS  COMPARED  TO  MEDICAL AND SURGICAL BENEFITS IN A
 CLASSIFICATION, THE INSURER SHALL TAKE REASONABLE ACTION, AS  NECESSARY,
 TO  ADDRESS THE MATERIAL DIFFERENCES TO ENSURE COMPLIANCE, IN OPERATION,
 AND SHALL DOCUMENT THE ACTIONS THAT HAVE BEEN OR ARE BEING TAKEN BY  THE
 INSURER  TO  ADDRESS  MATERIAL DIFFERENCES IN ACCESS TO MENTAL HEALTH OR
 A. 8839                             3
 
 SUBSTANCE USE DISORDER BENEFITS, AS COMPARED  TO  MEDICAL  AND  SURGICAL
 BENEFITS.
   (7)  AN  INSURER PROVIDING COVERAGE FOR MENTAL HEALTH OR SUBSTANCE USE
 DISORDER BENEFITS SHALL SUBMIT AN  ANNUAL  REPORT  STARTING  ON  JANUARY
 FIRST,  TWO  THOUSAND  TWENTY-SIX AND ANNUALLY THEREAFTER, THAT CONTAINS
 THE  INFORMATION  DESCRIBED  IN  29  USC  1185A(A)(8)(A)  AND   42   USC
 300GG-26(A)(8)(A).  THE  REPORT  REQUIRED  SHALL BE POSTED ON A PUBLICLY
 AVAILABLE WEBSITE WHOSE WEB ADDRESS IS  PROMINENTLY  DISPLAYED  IN  PLAN
 INFORMATIONAL AND MARKETING MATERIALS.
   (8) IF A HEALTH CARE PROVIDER, A CURRENT OR PROSPECTIVE ENROLLEE OR AN
 EMPLOYER REQUESTS ONE OR MORE NONQUANTITATIVE TREATMENT LIMITATION PARI-
 TY  COMPLIANCE  ANALYSES  THAT THE INSURER IS REQUIRED TO HAVE COMPLETED
 PURSUANT TO 29 U.S.C. SEC. 1185A OR 42 U.S.C. SEC. 300GG-26, THE INSURER
 SHALL PROVIDE THE REQUESTED ANALYSES FREE OF CHARGE WITHIN THIRTY  DAYS.
 THE  INSURER  SHALL  INCLUDE  IN  EACH OF THEIR HEALTH PLAN POLICIES AND
 MENTAL HEALTH AND SUBSTANCE USE DISORDER PROVIDER CONTRACTS A  NOTIFICA-
 TION  OF  THE  RIGHT  TO  REQUEST  NONQUANTITATIVE  TREATMENT LIMITATION
 ANALYSES FREE OF CHARGE. THE NOTIFICATION SHALL INCLUDE  INFORMATION  ON
 HOW  TO REQUEST THE ANALYSES. IN ADDITION TO ANY OTHER ACTION AUTHORIZED
 UNDER THIS CHAPTER, FAILURE BY AN INSURER TO PROVIDE THE FULL  REQUESTED
 ANALYSES SHALL RESULT IN A PENALTY OF ONE HUNDRED DOLLARS PER DAY, WHICH
 SHALL  BE COLLECTED BY THE SUPERINTENDENT AND REMITTED TO THE REQUESTOR.
 IF THE REQUEST UNDER THIS  PARAGRAPH  IS  MADE  IN  CONNECTION  WITH  AN
 ADVERSE  BENEFIT  DETERMINATION  AND  THE  INSURER  FAILS TO PROVIDE THE
 REQUIRED ANALYSES AS REQUIRED BY THIS  PARAGRAPH,  THE  ADVERSE  BENEFIT
 DETERMINATION SHALL BE AUTOMATICALLY REVERSED.
   (9)  THE  SUPERINTENDENT  MAY  ADOPT RULES OR GUIDANCE AS NECESSARY TO
 IMPLEMENT AND ADMINISTER THE PROVISIONS OF PARAGRAPHS ONE THROUGH  SEVEN
 OF  THIS  SUBSECTION, AND SUCH RULES OR GUIDANCE SHALL HAVE THE FORCE OF
 LAW AND SHALL INCLUDE:
   (A) SPECIFYING DATA TESTING REQUIREMENTS TO DETERMINE PLAN DESIGN  AND
 APPLICATION PARITY AND NONDISCRIMINATION COMPLIANCE USING OUTCOMES DATA;
   (B) SETTING STANDARD DEFINITIONS; AND
   (C)  ESTABLISHING  SPECIFIC  TIMELINES FOR INSURER COMPLIANCE WITH THE
 REQUIREMENTS OF THIS SUBSECTION, INCLUDING THE EFFECT  OF  AN  INSURER'S
 LACK  OF  SUFFICIENT  COMPARATIVE ANALYSES OR OTHER REQUIRED INFORMATION
 NECESSARY TO DEMONSTRATE COMPLIANCE.
   § 2. Section 3221 of the insurance law is  amended  by  adding  a  new
 subsection (v) to read as follows:
   (V)  (1) EVERY INSURER ISSUING A POLICY DELIVERED OR ISSUED FOR DELIV-
 ERY IN THIS STATE THAT  PROVIDES  COVERAGE  FOR  ANY  MENTAL  HEALTH  OR
 SUBSTANCE USE DISORDER SERVICES SHALL:
   (A) COMPLY WITH THE REQUIREMENTS OF THE PAUL WELLSTONE AND PETE DOMEN-
 ICI MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 AND ITS IMPLE-
 MENTING REGULATIONS; AND
   (B) NOT DISCRIMINATE IN ITS PLAN BENEFIT DESIGN OR APPLICATION AGAINST
 INDIVIDUALS  BECAUSE  OF  THEIR  HISTORY OF PRESENT, OR PREDICTED MENTAL
 HEALTH OR SUBSTANCE USE DISORDER.
   (2) THE COMMISSIONER OF MENTAL HEALTH SHALL PROMULGATE RULES AND REGU-
 LATIONS TO INCORPORATE THE REGULATORY REQUIREMENTS RELATED TO THE MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT AT 89 FED. REG. 77735 THROUGH  89
 FED.  REG. 77751, AS FOUND ON SEPTEMBER TWENTY-THIRD, TWO THOUSAND TWEN-
 TY-FOUR, IN THEIR ENTIRETY,  IN  RELATION  TO  THE  PROVISIONS  OF  THIS
 SUBSECTION.
   (3)  DATA  COLLECTED  PURSUANT TO SECTION THREE HUNDRED FORTY-THREE OF
 THIS CHAPTER, AND ANY OTHER DATA REQUESTED BY THE SUPERINTENDENT, MAY BE
 A. 8839                             4
 
 USED TO ASSESS COMPLIANCE WITH THE REQUIREMENTS OF PARAGRAPH ONE OF THIS
 SUBSECTION.
   (4)  IF  AN  INSURER  PROVIDES  ANY  BENEFITS  FOR  A MENTAL HEALTH OR
 SUBSTANCE USE DISORDER IN  ANY  CLASSIFICATION  OF  BENEFITS,  IT  SHALL
 PROVIDE  MEANINGFUL  BENEFITS  FOR  SUCH  MENTAL HEALTH OR SUBSTANCE USE
 DISORDER IN EVERY CLASSIFICATION IN WHICH MEDICAL OR  SURGICAL  BENEFITS
 ARE PROVIDED.  "CORE TREATMENTS" MEANS STANDARD TREATMENTS OR COURSES OF
 TREATMENT,  THERAPY,  SERVICE,  OR  INTERVENTION  INDICATED BY GENERALLY
 ACCEPTED STANDARDS OF MENTAL HEALTH OR SUBSTANCE USE DISORDER CARE.  FOR
 PURPOSES OF THIS PARAGRAPH, WHETHER THE BENEFITS PROVIDED ARE CONSIDERED
 "MEANINGFUL  BENEFITS" SHALL BE DETERMINED IN COMPARISON TO THE BENEFITS
 PROVIDED FOR MEDICAL CONDITIONS AND SURGICAL PROCEDURES IN  THE  CLASSI-
 FICATION  AND SHALL REQUIRE, AT A MINIMUM, COVERAGE OF BENEFITS FOR THAT
 CONDITION OR DISORDER  IN  EACH  CLASSIFICATION  IN  WHICH  THE  INSURER
 PROVIDES  BENEFITS FOR ONE OR MORE MEDICAL CONDITIONS OR SURGICAL PROCE-
 DURES. AN INSURER  DOES  NOT  PROVIDE  MEANINGFUL  BENEFITS  UNDER  THIS
 SUBSECTION  UNLESS  IT  PROVIDES  BENEFITS  FOR CORE TREATMENTS FOR THAT
 CONDITION OR DISORDER  IN  EACH  CLASSIFICATION  IN  WHICH  THE  INSURER
 PROVIDES BENEFITS FOR CORE TREATMENTS FOR ONE OR MORE MEDICAL CONDITIONS
 OR  SURGICAL  PROCEDURES.  IF  THERE  IS NO CORE TREATMENT FOR A COVERED
 MENTAL HEALTH OR SUBSTANCE USE DISORDER WITH RESPECT  TO  A  CLASSIFICA-
 TION,  THE  INSURER  SHALL  NOT BE REQUIRED TO PROVIDE BENEFITS FOR CORE
 TREATMENTS FOR SUCH CONDITION OR DISORDER IN  THAT  CLASSIFICATION,  BUT
 SHALL  PROVIDE  BENEFITS FOR SUCH CONDITION OR DISORDER IN EVERY CLASSI-
 FICATION IN WHICH MEDICAL OR SURGICAL BENEFITS ARE PROVIDED.
   (5) FOR THE PURPOSES OF DETERMINING COMPARABILITY AND  STRINGENCY  FOR
 NONQUANTITATIVE  TREATMENT  LIMITATIONS,  AN INSURER SHALL NOT RELY UPON
 DISCRIMINATORY FACTORS OR EVIDENTIARY STANDARDS TO DESIGN A NONQUANTITA-
 TIVE TREATMENT LIMITATION TO BE IMPOSED ON MENTAL  HEALTH  OR  SUBSTANCE
 USE DISORDER BENEFITS. A FACTOR OR EVIDENTIARY STANDARD IS DISCRIMINATO-
 RY  IF  THE  INFORMATION,  EVIDENCE,  SOURCES, OR STANDARDS ON WHICH THE
 FACTOR OR EVIDENTIARY STANDARD ARE BASED ARE BIASED OR NOT OBJECTIVE  IN
 A  MANNER  THAT  DISCRIMINATES  AGAINST  MENTAL  HEALTH OR SUBSTANCE USE
 DISORDER BENEFITS AS COMPARED TO MEDICAL OR SURGICAL BENEFITS.
   (6) A NONQUANTITATIVE TREATMENT LIMITATION APPLICABLE TO MENTAL HEALTH
 OR SUBSTANCE USE DISORDER BENEFITS IN A  CLASSIFICATION  SHALL  NOT,  IN
 OPERATION,  BE  MORE  RESTRICTIVE  THAN  THE PREDOMINANT NONQUANTITATIVE
 TREATMENT LIMITATION APPLIED TO SUBSTANTIALLY ALL MEDICAL  AND  SURGICAL
 BENEFITS  IN THE CLASSIFICATION. TO TEST COMPLIANCE WITH THIS PARAGRAPH,
 AN INSURER SHALL COLLECT AND EVALUATE RELEVANT DATA IN A MANNER  REASON-
 ABLY  DESIGNED  TO  ASSESS  THE  IMPACT OF THE NONQUANTITATIVE TREATMENT
 LIMITATION ON RELEVANT OUTCOMES RELATED TO ACCESS TO  MENTAL  HEALTH  OR
 SUBSTANCE  USE  DISORDER  BENEFITS AND MEDICAL AND SURGICAL BENEFITS AND
 CAREFULLY CONSIDER THE IMPACT AS PART OF THE PLAN'S EVALUATION. AS  PART
 OF  ITS EVALUATION, THE INSURER MAY NOT DISREGARD RELEVANT OUTCOMES DATA
 THAT IT KNOWS OR REASONABLY SHOULD KNOW SUGGEST THAT  A  NONQUANTITATIVE
 TREATMENT  LIMITATION  IS ASSOCIATED WITH MATERIAL DIFFERENCES IN ACCESS
 TO MENTAL HEALTH OR SUBSTANCE  USE  DISORDER  BENEFITS  AS  COMPARED  TO
 MEDICAL AND SURGICAL BENEFITS. TO THE EXTENT THE RELEVANT DATA EVALUATED
 SUGGESTS  THAT  THE  NONQUANTITATIVE TREATMENT LIMITATION CONTRIBUTES TO
 MATERIAL DIFFERENCES IN ACCESS TO MENTAL HEALTH OR SUBSTANCE USE  DISOR-
 DER  BENEFITS  AS  COMPARED TO MEDICAL OR SURGICAL BENEFITS IN A CLASSI-
 FICATION, SUCH DIFFERENCES SHALL BE CONSIDERED A STRONG INDICATOR  OF  A
 NONCOMPLIANT  NONQUANTITATIVE  TREATMENT  LIMITATION. WHERE THE RELEVANT
 DATA SUGGEST THAT THE NONQUANTITATIVE TREATMENT  LIMITATION  CONTRIBUTES
 TO  MATERIAL  DIFFERENCES  IN  ACCESS  TO MENTAL HEALTH OR SUBSTANCE USE
 A. 8839                             5
 
 DISORDER BENEFITS AS COMPARED TO MEDICAL  AND  SURGICAL  BENEFITS  IN  A
 CLASSIFICATION,  THE INSURER SHALL TAKE REASONABLE ACTION, AS NECESSARY,
 TO ADDRESS THE MATERIAL DIFFERENCES TO ENSURE COMPLIANCE, IN  OPERATION,
 AND  SHALL DOCUMENT THE ACTIONS THAT HAVE BEEN OR ARE BEING TAKEN BY THE
 INSURER TO ADDRESS MATERIAL DIFFERENCES IN ACCESS TO  MENTAL  HEALTH  OR
 SUBSTANCE  USE  DISORDER  BENEFITS,  AS COMPARED TO MEDICAL AND SURGICAL
 BENEFITS.
   (7) AN INSURER PROVIDING COVERAGE FOR MENTAL HEALTH OR  SUBSTANCE  USE
 DISORDER  BENEFITS  SHALL  SUBMIT  AN  ANNUAL REPORT STARTING ON JANUARY
 FIRST, TWO THOUSAND TWENTY-SIX AND ANNUALLY  THEREAFTER,  THAT  CONTAINS
 THE   INFORMATION   DESCRIBED  IN  29  USC  1185A(A)(8)(A)  AND  42  USC
 300GG-26(A)(8)(A). THE REPORT REQUIRED SHALL BE  POSTED  ON  A  PUBLICLY
 AVAILABLE  WEBSITE  WHOSE  WEB  ADDRESS IS PROMINENTLY DISPLAYED IN PLAN
 INFORMATIONAL AND MARKETING MATERIALS.
   (8) IF A HEALTH CARE PROVIDER, A CURRENT OR PROSPECTIVE ENROLLEE OR AN
 EMPLOYER REQUESTS ONE OR MORE NONQUANTITATIVE TREATMENT LIMITATION PARI-
 TY COMPLIANCE ANALYSES THAT THE INSURER IS REQUIRED  TO  HAVE  COMPLETED
 PURSUANT TO 29 U.S.C. SEC. 1185A OR 42 U.S.C. SEC. 300GG-26, THE INSURER
 SHALL  PROVIDE THE REQUESTED ANALYSES FREE OF CHARGE WITHIN THIRTY DAYS.
 THE INSURER SHALL INCLUDE IN EACH OF  THEIR  HEALTH  PLAN  POLICIES  AND
 MENTAL  HEALTH AND SUBSTANCE USE DISORDER PROVIDER CONTRACTS A NOTIFICA-
 TION OF  THE  RIGHT  TO  REQUEST  NONQUANTITATIVE  TREATMENT  LIMITATION
 ANALYSES  FREE  OF CHARGE. THE NOTIFICATION SHALL INCLUDE INFORMATION ON
 HOW TO REQUEST THE ANALYSES. IN ADDITION TO ANY OTHER ACTION  AUTHORIZED
 UNDER  THIS CHAPTER, FAILURE BY AN INSURER TO PROVIDE THE FULL REQUESTED
 ANALYSES SHALL RESULT IN A PENALTY OF ONE HUNDRED DOLLARS PER DAY, WHICH
 SHALL BE COLLECTED BY THE SUPERINTENDENT AND REMITTED TO THE  REQUESTOR.
 IF  THE  REQUEST  UNDER  THIS  PARAGRAPH  IS  MADE IN CONNECTION WITH AN
 ADVERSE BENEFIT DETERMINATION AND  THE  INSURER  FAILS  TO  PROVIDE  THE
 REQUIRED  ANALYSES  AS  REQUIRED  BY THIS PARAGRAPH, THE ADVERSE BENEFIT
 DETERMINATION SHALL BE AUTOMATICALLY REVERSED.
   (9) THE SUPERINTENDENT MAY ADOPT RULES OR  GUIDANCE  AS  NECESSARY  TO
 IMPLEMENT  AND ADMINISTER THE PROVISIONS OF PARAGRAPHS ONE THROUGH SEVEN
 OF THIS SUBSECTION, AND SUCH RULES OR GUIDANCE SHALL HAVE THE  FORCE  OF
 LAW AND SHALL INCLUDE:
   (A)  SPECIFYING DATA TESTING REQUIREMENTS TO DETERMINE PLAN DESIGN AND
 APPLICATION PARITY AND NONDISCRIMINATION COMPLIANCE USING OUTCOMES DATA;
   (B) SETTING STANDARD DEFINITIONS; AND
   (C) ESTABLISHING SPECIFIC TIMELINES FOR INSURER  COMPLIANCE  WITH  THE
 REQUIREMENTS  OF  THIS  SUBSECTION, INCLUDING THE EFFECT OF AN INSURER'S
 LACK OF SUFFICIENT COMPARATIVE ANALYSES OR  OTHER  REQUIRED  INFORMATION
 NECESSARY TO DEMONSTRATE COMPLIANCE.
   §  3.  Section  4303  of  the insurance law is amended by adding a new
 subsection (ww) to read as follows:
   (WW) (1) EVERY CORPORATION ISSUING A CONTRACT DELIVERED OR ISSUED  FOR
 DELIVERY  IN  THIS STATE THAT PROVIDES COVERAGE FOR ANY MENTAL HEALTH OR
 SUBSTANCE USE DISORDER SERVICES SHALL:
   (A) COMPLY WITH THE REQUIREMENTS OF THE PAUL WELLSTONE AND PETE DOMEN-
 ICI MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 AND ITS IMPLE-
 MENTING REGULATIONS; AND
   (B) NOT DISCRIMINATE IN ITS PLAN BENEFIT DESIGN OR APPLICATION AGAINST
 INDIVIDUALS BECAUSE OF THEIR HISTORY OF  PRESENT,  OR  PREDICTED  MENTAL
 HEALTH OR SUBSTANCE USE DISORDER.
   (2) THE COMMISSIONER OF MENTAL HEALTH SHALL PROMULGATE RULES AND REGU-
 LATIONS TO INCORPORATE THE REGULATORY REQUIREMENTS RELATED TO THE MENTAL
 HEALTH  PARITY AND ADDICTION EQUITY ACT AT 89 FED. REG. 77735 THROUGH 89
 A. 8839                             6
 
 FED. REG. 77751, AS FOUND ON SEPTEMBER TWENTY-THIRD, TWO THOUSAND  TWEN-
 TY-FOUR,  IN  THEIR  ENTIRETY,  IN  RELATION  TO  THE PROVISIONS OF THIS
 SUBSECTION.
   (3)  DATA  COLLECTED  PURSUANT TO SECTION THREE HUNDRED FORTY-THREE OF
 THIS CHAPTER, AND ANY OTHER DATA REQUESTED BY THE SUPERINTENDENT, MAY BE
 USED TO ASSESS COMPLIANCE WITH THE REQUIREMENTS OF PARAGRAPH ONE OF THIS
 SUBSECTION.
   (4) IF AN INSURER  PROVIDES  ANY  BENEFITS  FOR  A  MENTAL  HEALTH  OR
 SUBSTANCE  USE  DISORDER  IN  ANY  CLASSIFICATION  OF BENEFITS, IT SHALL
 PROVIDE MEANINGFUL BENEFITS FOR SUCH  MENTAL  HEALTH  OR  SUBSTANCE  USE
 DISORDER  IN  EVERY CLASSIFICATION IN WHICH MEDICAL OR SURGICAL BENEFITS
 ARE PROVIDED.  "CORE TREATMENTS" MEANS STANDARD TREATMENTS OR COURSES OF
 TREATMENT, THERAPY, SERVICE,  OR  INTERVENTION  INDICATED  BY  GENERALLY
 ACCEPTED  STANDARDS OF MENTAL HEALTH OR SUBSTANCE USE DISORDER CARE. FOR
 PURPOSES OF THIS PARAGRAPH, WHETHER THE BENEFITS PROVIDED ARE CONSIDERED
 "MEANINGFUL BENEFITS" SHALL BE DETERMINED IN COMPARISON TO THE  BENEFITS
 PROVIDED  FOR  MEDICAL CONDITIONS AND SURGICAL PROCEDURES IN THE CLASSI-
 FICATION AND SHALL REQUIRE, AT A MINIMUM, COVERAGE OF BENEFITS FOR  THAT
 CONDITION  OR  DISORDER  IN  EACH  CLASSIFICATION  IN  WHICH THE INSURER
 PROVIDES BENEFITS FOR ONE OR MORE MEDICAL CONDITIONS OR SURGICAL  PROCE-
 DURES.  AN  INSURER  DOES  NOT  PROVIDE  MEANINGFUL  BENEFITS UNDER THIS
 SUBSECTION UNLESS IT PROVIDES BENEFITS  FOR  CORE  TREATMENTS  FOR  THAT
 CONDITION  OR  DISORDER  IN  EACH  CLASSIFICATION  IN  WHICH THE INSURER
 PROVIDES BENEFITS FOR CORE TREATMENTS FOR ONE OR MORE MEDICAL CONDITIONS
 OR SURGICAL PROCEDURES. IF THERE IS NO  CORE  TREATMENT  FOR  A  COVERED
 MENTAL  HEALTH  OR  SUBSTANCE USE DISORDER WITH RESPECT TO A CLASSIFICA-
 TION, THE INSURER SHALL NOT BE REQUIRED TO  PROVIDE  BENEFITS  FOR  CORE
 TREATMENTS  FOR  SUCH  CONDITION OR DISORDER IN THAT CLASSIFICATION, BUT
 SHALL PROVIDE BENEFITS FOR SUCH CONDITION OR DISORDER IN  EVERY  CLASSI-
 FICATION IN WHICH MEDICAL OR SURGICAL BENEFITS ARE PROVIDED.
   (5)  FOR  THE PURPOSES OF DETERMINING COMPARABILITY AND STRINGENCY FOR
 NONQUANTITATIVE TREATMENT LIMITATIONS, AN INSURER SHALL  NOT  RELY  UPON
 DISCRIMINATORY FACTORS OR EVIDENTIARY STANDARDS TO DESIGN A NONQUANTITA-
 TIVE  TREATMENT  LIMITATION  TO BE IMPOSED ON MENTAL HEALTH OR SUBSTANCE
 USE DISORDER BENEFITS. A FACTOR OR EVIDENTIARY STANDARD IS DISCRIMINATO-
 RY IF THE INFORMATION, EVIDENCE, SOURCES,  OR  STANDARDS  ON  WHICH  THE
 FACTOR  OR EVIDENTIARY STANDARD ARE BASED ARE BIASED OR NOT OBJECTIVE IN
 A MANNER THAT DISCRIMINATES  AGAINST  MENTAL  HEALTH  OR  SUBSTANCE  USE
 DISORDER BENEFITS AS COMPARED TO MEDICAL OR SURGICAL BENEFITS.
   (6) A NONQUANTITATIVE TREATMENT LIMITATION APPLICABLE TO MENTAL HEALTH
 OR  SUBSTANCE  USE  DISORDER  BENEFITS IN A CLASSIFICATION SHALL NOT, IN
 OPERATION, BE MORE  RESTRICTIVE  THAN  THE  PREDOMINANT  NONQUANTITATIVE
 TREATMENT  LIMITATION  APPLIED TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL
 BENEFITS IN THE CLASSIFICATION. TO TEST COMPLIANCE WITH THIS  PARAGRAPH,
 AN  INSURER SHALL COLLECT AND EVALUATE RELEVANT DATA IN A MANNER REASON-
 ABLY DESIGNED TO ASSESS THE  IMPACT  OF  THE  NONQUANTITATIVE  TREATMENT
 LIMITATION  ON  RELEVANT  OUTCOMES RELATED TO ACCESS TO MENTAL HEALTH OR
 SUBSTANCE USE DISORDER BENEFITS AND MEDICAL AND  SURGICAL  BENEFITS  AND
 CAREFULLY  CONSIDER THE IMPACT AS PART OF THE PLAN'S EVALUATION. AS PART
 OF ITS EVALUATION, THE INSURER MAY NOT DISREGARD RELEVANT OUTCOMES  DATA
 THAT  IT  KNOWS OR REASONABLY SHOULD KNOW SUGGEST THAT A NONQUANTITATIVE
 TREATMENT LIMITATION IS ASSOCIATED WITH MATERIAL DIFFERENCES  IN  ACCESS
 TO  MENTAL  HEALTH  OR  SUBSTANCE  USE  DISORDER BENEFITS AS COMPARED TO
 MEDICAL AND SURGICAL BENEFITS. TO THE EXTENT THE RELEVANT DATA EVALUATED
 SUGGESTS THAT THE NONQUANTITATIVE TREATMENT  LIMITATION  CONTRIBUTES  TO
 MATERIAL  DIFFERENCES IN ACCESS TO MENTAL HEALTH OR SUBSTANCE USE DISOR-
 A. 8839                             7

 DER BENEFITS AS COMPARED TO MEDICAL OR SURGICAL BENEFITS  IN  A  CLASSI-
 FICATION,  SUCH  DIFFERENCES SHALL BE CONSIDERED A STRONG INDICATOR OF A
 NONCOMPLIANT NONQUANTITATIVE TREATMENT LIMITATION.  WHERE  THE  RELEVANT
 DATA  SUGGEST  THAT THE NONQUANTITATIVE TREATMENT LIMITATION CONTRIBUTES
 TO MATERIAL DIFFERENCES IN ACCESS TO  MENTAL  HEALTH  OR  SUBSTANCE  USE
 DISORDER  BENEFITS  AS  COMPARED  TO  MEDICAL AND SURGICAL BENEFITS IN A
 CLASSIFICATION, THE INSURER SHALL TAKE REASONABLE ACTION, AS  NECESSARY,
 TO  ADDRESS THE MATERIAL DIFFERENCES TO ENSURE COMPLIANCE, IN OPERATION,
 AND SHALL DOCUMENT THE ACTIONS THAT HAVE BEEN OR ARE BEING TAKEN BY  THE
 INSURER  TO  ADDRESS  MATERIAL DIFFERENCES IN ACCESS TO MENTAL HEALTH OR
 SUBSTANCE USE DISORDER BENEFITS, AS COMPARED  TO  MEDICAL  AND  SURGICAL
 BENEFITS.
   (7)  AN  INSURER PROVIDING COVERAGE FOR MENTAL HEALTH OR SUBSTANCE USE
 DISORDER BENEFITS SHALL SUBMIT AN  ANNUAL  REPORT  STARTING  ON  JANUARY
 FIRST,  TWO  THOUSAND  TWENTY-SIX AND ANNUALLY THEREAFTER, THAT CONTAINS
 THE  INFORMATION  DESCRIBED  IN  29  USC  1185A(A)(8)(A)  AND   42   USC
 300GG-26(A)(8)(A).  THE  REPORT  REQUIRED  SHALL BE POSTED ON A PUBLICLY
 AVAILABLE WEBSITE WHOSE WEB ADDRESS IS  PROMINENTLY  DISPLAYED  IN  PLAN
 INFORMATIONAL AND MARKETING MATERIALS.
   (8) IF A HEALTH CARE PROVIDER, A CURRENT OR PROSPECTIVE ENROLLEE OR AN
 EMPLOYER REQUESTS ONE OR MORE NONQUANTITATIVE TREATMENT LIMITATION PARI-
 TY  COMPLIANCE  ANALYSES  THAT THE INSURER IS REQUIRED TO HAVE COMPLETED
 PURSUANT TO 29 U.S.C. SEC. 1185A OR 42 U.S.C. SEC. 300GG-26, THE INSURER
 SHALL PROVIDE THE REQUESTED ANALYSES FREE OF CHARGE WITHIN THIRTY  DAYS.
 THE  INSURER  SHALL  INCLUDE  IN  EACH OF THEIR HEALTH PLAN POLICIES AND
 MENTAL HEALTH AND SUBSTANCE USE DISORDER PROVIDER CONTRACTS A  NOTIFICA-
 TION  OF  THE  RIGHT  TO  REQUEST  NONQUANTITATIVE  TREATMENT LIMITATION
 ANALYSES FREE OF CHARGE. THE NOTIFICATION SHALL INCLUDE  INFORMATION  ON
 HOW  TO REQUEST THE ANALYSES. IN ADDITION TO ANY OTHER ACTION AUTHORIZED
 UNDER THIS CHAPTER, FAILURE BY AN INSURER TO PROVIDE THE FULL  REQUESTED
 ANALYSES SHALL RESULT IN A PENALTY OF ONE HUNDRED DOLLARS PER DAY, WHICH
 SHALL  BE COLLECTED BY THE SUPERINTENDENT AND REMITTED TO THE REQUESTOR.
 IF THE REQUEST UNDER THIS  PARAGRAPH  IS  MADE  IN  CONNECTION  WITH  AN
 ADVERSE  BENEFIT  DETERMINATION  AND  THE  INSURER  FAILS TO PROVIDE THE
 REQUIRED ANALYSES AS REQUIRED BY THIS  PARAGRAPH,  THE  ADVERSE  BENEFIT
 DETERMINATION SHALL BE AUTOMATICALLY REVERSED.
   (9)  THE  SUPERINTENDENT  MAY  ADOPT RULES OR GUIDANCE AS NECESSARY TO
 IMPLEMENT AND ADMINISTER THE PROVISIONS OF PARAGRAPHS ONE THROUGH  SEVEN
 OF  THIS  SUBSECTION, AND SUCH RULES OR GUIDANCE SHALL HAVE THE FORCE OF
 LAW AND SHALL INCLUDE:
   (A) SPECIFYING DATA TESTING REQUIREMENTS TO DETERMINE PLAN DESIGN  AND
 APPLICATION PARITY AND NONDISCRIMINATION COMPLIANCE USING OUTCOMES DATA;
   (B) SETTING STANDARD DEFINITIONS; AND
   (C)  ESTABLISHING  SPECIFIC  TIMELINES FOR INSURER COMPLIANCE WITH THE
 REQUIREMENTS OF THIS SUBSECTION, INCLUDING THE EFFECT  OF  AN  INSURER'S
 LACK  OF  SUFFICIENT  COMPARATIVE ANALYSES OR OTHER REQUIRED INFORMATION
 NECESSARY TO DEMONSTRATE COMPLIANCE.
   § 4. This act shall take effect immediately.