S. 8426 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 SUBSECTION, WHETHER THE BENEFITS PROVIDED ARE CONSID-
ERED "MEANINGFUL BENEFITS" IS DETERMINED IN COMPARISON TO THE BENEFITS
PROVIDED FOR MEDICAL CONDITIONS AND SURGICAL PROCEDURES IN THE CLASSI-
FICATION AND REQUIRES, 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 SHALL NOT BE DEEMED TO 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 CLAS-
SIFICATION, THE INSURER IS NOT 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/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/SURGICAL BENE-
FITS IN THE CLASSIFICATION. TO TEST COMPLIANCE WITH THIS PARAGRAPH, AN
INSURER SHALL COLLECT AND EVALUATE RELEVANT DATA IN A MANNER REASONABLY
DESIGNED TO ASSESS THE IMPACT OF THE NONQUANTITATIVE TREATMENT LIMITA-
TION ON RELEVANT OUTCOMES RELATED TO ACCESS TO MENTAL HEALTH OR
SUBSTANCE USE DISORDER BENEFITS AND MEDICAL/SURGICAL BENEFITS AND CARE-
FULLY 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/SURGICAL BENEFITS. TO THE EXTENT THE RELEVANT DATA EVALUATED
SUGGEST THAT THE NONQUANTITATIVE TREATMENT LIMITATION CONTRIBUTES TO
MATERIAL DIFFERENCES IN ACCESS TO MENTAL HEALTH OR SUBSTANCE USE DISOR-
DER BENEFITS AS COMPARED TO MEDICAL/SURGICAL BENEFITS IN A CLASSIFICA-
TION, SUCH DIFFERENCES WILL BE CONSIDERED A STRONG INDICATOR OF A
NONCOMPLIANT NONQUANTITATIVE TREATMENT LIMITATION. WHERE THE RELEVANT
DATA SUGGEST THAT THE NONQUANTITATIVE TREATMENT LIMITATION PER EXAMINER
CONTRIBUTES PER EXAMINED TO MATERIAL DIFFERENCES IN ACCESS TO MENTAL
HEALTH OR SUBSTANCE USE DISORDER BENEFITS AS COMPARED TO
MEDICAL/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 DIFFER-
S. 8426 3
ENCES IN ACCESS TO MENTAL HEALTH OR SUBSTANCE USE DISORDER BENEFITS, AS
COMPARED TO MEDICAL/SURGICAL BENEFITS.
(7) AN INSURER PROVIDING COVERAGE FOR MENTAL HEALTH OR SUBSTANCE USE
DISORDER BENEFITS SHALL SUBMIT AN ANNUAL REPORT BEGINNING JANUARY FIRST,
TWO THOUSAND TWENTY-SIX AND ANNUALLY THEREAFTER, THAT CONTAINS THE
INFORMATION DESCRIBED IN 29 U.S.C. § 1185A(A)(8)(A) OR 42 U.S.C. §
300GG-26(A)(8)(A), AS APPLICABLE, AND ANY OTHER INFORMATION DETERMINED
NECESSARY TO ASSESS COMPLIANCE WITH THIS SUBSECTION. SUCH REPORT SHALL
BE POSTED ON A PUBLICLY AVAILABLE WEBSITE WHOSE WEB ADDRESS IS PROMI-
NENTLY DISPLAYED IN PLAN INFORMATIONAL AND MARKETING MATERIALS.
(8) IF A HEALTH CARE PROVIDER OR A CURRENT OR PROSPECTIVE ENROLLEE OR
AN EMPLOYER REQUESTS, ONE OR MORE NONQUANTITATIVE TREATMENT LIMITATION
PARITY COMPLIANCE ANALYSES THAT THE INSURER IS REQUIRED TO HAVE
COMPLETED BY THIS SUBSECTION, 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 NOTIFICATION 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 TEN DOLLARS PER DAY. IF THE REQUEST UNDER THIS
PARAGRAPH IS MADE IN CONNECTION WITH AN ADVERSE BENEFIT DETERMINATION
AND THE INSURER FAILS TO PROVIDE THE REQUESTED ANALYSES AS REQUIRED BY
THIS SUBSECTION, THE ADVERSE BENEFIT DETERMINATION IS AUTOMATICALLY
REVERSED.
(9) THE SUPERINTENDENT MAY ADOPT RULES OR GUIDANCE AS NECESSARY TO
IMPLEMENT AND ADMINISTER THIS SUBSECTION, AND SUCH RULES OR GUIDANCE
SHALL HAVE THE FORCE OF LAW, INCLUDING:
(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 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 FEDERAL PAUL WELLSTONE AND
PETE DOMENICI MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 AND
ITS IMPLEMENTING REGULATIONS; AND
(B) NOT DISCRIMINATE IN ITS CONTRACT BENEFIT DESIGN OR APPLICATION
AGAINST INDIVIDUALS BECAUSE OF THEIR HISTORY OF, PRESENT, OR PREDICTED
MENTAL HEALTH OR SUBSTANCE USE DISORDER.
(2) THE PROVISIONS PUBLISHED AT 89 FEDERAL REGISTER 77586 ET SEQ. ON
SEPTEMBER TWENTY-THIRD TWO THOUSAND TWENTY-THREE, ARE INCORPORATED INTO
THIS SECTION IN THEIR ENTIRETY AND SHALL APPLY AS STATE LAW. SUCH INCOR-
PORATION SHALL REMAIN IN EFFECT NOTWITHSTANDING ANY SUBSEQUENT AMEND-
MENT, REPEAL, OR NONENFORCEMENT OF THE REFERENCED FEDERAL PROVISIONS.
(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 THIS SUBSECTION.
S. 8426 4
(4) IF A CORPORATION PROVIDES ANY BENEFITS FOR A MENTAL HEALTH OR
SUBSTANCE USE DISORDER IN ANY CLASSIFICATION OF BENEFITS, IT SHALL
PROVIDE MEANINGFUL BENEFITS FOR THAT 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 SUBSECTION, WHETHER THE BENEFITS PROVIDED ARE CONSID-
ERED "MEANINGFUL BENEFITS" IS DETERMINED IN COMPARISON TO THE BENEFITS
PROVIDED FOR MEDICAL CONDITIONS AND SURGICAL PROCEDURES IN THE CLASSI-
FICATION AND REQUIRES, AT A MINIMUM, COVERAGE OF BENEFITS FOR THAT
CONDITION OR DISORDER IN EACH CLASSIFICATION IN WHICH THE CORPORATION
PROVIDES BENEFITS FOR ONE OR MORE MEDICAL CONDITIONS OR SURGICAL PROCE-
DURES. A CORPORATION SHALL NOT BE DEEMED TO PROVIDE MEANINGFUL BENEFITS
UNDER THIS SUBSECTION UNLESS IT PROVIDES BENEFITS FOR CORE TREATMENTS
FOR THAT CONDITION OR DISORDER IN EACH CLASSIFICATION IN WHICH THE
CORPORATION 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
CLASSIFICATION, THE CORPORATION IS NOT 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 CLAS-
SIFICATION IN WHICH MEDICAL OR SURGICAL BENEFITS ARE PROVIDED.
(5) FOR THE PURPOSES OF DETERMINING COMPARABILITY AND STRINGENCY FOR
NONQUANTITATIVE TREATMENT LIMITATIONS, A CORPORATION 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 OR SURGICAL
BENEFITS IN THE CLASSIFICATION. TO TEST COMPLIANCE WITH THIS PARAGRAPH,
A CORPORATION SHALL COLLECT AND EVALUATE RELEVANT DATA IN A MANNER
REASONABLY DESIGNED TO ASSESS THE IMPACT OF THE NONQUANTITATIVE TREAT-
MENT LIMITATION ON RELEVANT OUTCOMES RELATED TO ACCESS TO MENTAL HEALTH
OR SUBSTANCE USE DISORDER BENEFITS AND MEDICAL OR SURGICAL BENEFITS, AND
CAREFULLY CONSIDER THE IMPACT AS PART OF THE CONTRACT'S EVALUATION. AS
PART OF ITS EVALUATION, THE CORPORATION MAY NOT DISREGARD RELEVANT
OUTCOMES DATA THAT IT KNOWS OR REASONABLY SHOULD KNOW SUGGEST THAT A
NONQUANTITATIVE TREATMENT LIMITATION IS ASSOCIATED WITH MATERIAL DIFFER-
ENCES IN ACCESS TO MENTAL HEALTH OR SUBSTANCE USE DISORDER BENEFITS AS
COMPARED TO MEDICAL OR SURGICAL BENEFITS. TO THE EXTENT THE RELEVANT
DATA EVALUATED SUGGEST THAT THE NONQUANTITATIVE TREATMENT LIMITATION
CONTRIBUTES TO MATERIAL DIFFERENCES IN ACCESS TO MENTAL HEALTH OR
SUBSTANCE USE DISORDER BENEFITS AS COMPARED TO MEDICAL OR SURGICAL BENE-
FITS IN A CLASSIFICATION, 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, THE CORPORATION SHALL TAKE REASONABLE
S. 8426 5
ACTION, AS NECESSARY, TO ADDRESS SUCH DIFFERENCES TO ENSURE OPERATIONAL
COMPLIANCE, AND SHALL DOCUMENT THE ACTIONS TAKEN TO DO SO.
(7) A CORPORATION PROVIDING COVERAGE FOR MENTAL HEALTH OR SUBSTANCE
USE DISORDER BENEFITS SHALL SUBMIT AN ANNUAL REPORT BEGINNING JANUARY
FIRST, TWO THOUSAND TWENTY-SIX AND ANNUALLY THEREAFTER THAT CONTAINS THE
INFORMATION DESCRIBED IN 29 U.S.C. § 1185A(A)(8)(A) OR 42 U.S.C. §
300GG-26(A)(8)(A), AS APPLICABLE, AND ANY OTHER INFORMATION DETERMINED
NECESSARY TO ASSESS COMPLIANCE WITH THIS SUBSECTION. SUCH REPORT SHALL
BE POSTED ON A PUBLICLY AVAILABLE WEBSITE WHOSE WEB ADDRESS IS PROMI-
NENTLY DISPLAYED IN CONTRACT INFORMATIONAL AND MARKETING MATERIALS.
(8) IF A HEALTH CARE PROVIDER OR A CURRENT OR PROSPECTIVE ENROLLEE OR
AN EMPLOYER REQUESTS ONE OR MORE NONQUANTITATIVE TREATMENT LIMITATION
PARITY COMPLIANCE ANALYSES THAT THE CORPORATION IS REQUIRED TO HAVE
COMPLETED BY THIS SUBSECTION, THE CORPORATION SHALL PROVIDE THE
REQUESTED ANALYSES FREE OF CHARGE WITHIN THIRTY DAYS. THE CORPORATION
SHALL INCLUDE IN EACH OF ITS HEALTH CARE CONTRACTS AND PROVIDER AGREE-
MENTS FOR MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES A NOTIFICA-
TION OF THE RIGHT TO REQUEST SUCH ANALYSES FREE OF CHARGE. SUCH NOTIFI-
CATION SHALL INCLUDE INFORMATION ON HOW TO REQUEST THE ANALYSES. IN
ADDITION TO ANY OTHER ACTION AUTHORIZED UNDER THIS CHAPTER, FAILURE BY A
CORPORATION TO PROVIDE THE FULL REQUESTED ANALYSES SHALL RESULT IN A
PENALTY OF ONE HUNDRED TEN DOLLARS PER DAY. IF THE REQUEST UNDER THIS
PARAGRAPH IS MADE IN CONNECTION WITH AN ADVERSE BENEFIT DETERMINATION
AND THE CORPORATION FAILS TO PROVIDE THE REQUESTED ANALYSES AS REQUIRED
BY THIS SUBSECTION, THE ADVERSE BENEFIT DETERMINATION SHALL BE AUTOMAT-
ICALLY REVERSED.
(9) THE SUPERINTENDENT MAY ADOPT RULES OR GUIDANCE AS NECESSARY TO
IMPLEMENT AND ADMINISTER THIS SUBSECTION, AND SUCH RULES OR GUIDANCE
SHALL HAVE THE FORCE OF LAW, INCLUDING:
(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 CORPORATION COMPLIANCE WITH
THE REQUIREMENTS OF THIS SUBSECTION, INCLUDING THE EFFECT OF A CORPO-
RATION'S LACK OF SUFFICIENT COMPARATIVE ANALYSES OR OTHER REQUIRED
INFORMATION NECESSARY TO DEMONSTRATE COMPLIANCE.
§ 3. 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 ALL APPLICABLE REQUIREMENTS OF STATE AND FEDERAL LAW
REGARDING COVERAGE OF SUCH SERVICES; AND
(B) NOT DISCRIMINATE IN ITS POLICY BENEFIT DESIGN OR ADMINISTRATION
AGAINST INDIVIDUALS BECAUSE OF THEIR HISTORY OF, PRESENT, OR PREDICTED
MENTAL HEALTH OR SUBSTANCE USE DISORDER.
(2) THE PROVISIONS PUBLISHED AT 89 FEDERAL REGISTER 77586 ET SEQ. ON
SEPTEMBER TWENTY-THIRD, TWO THOUSAND TWENTY-THREE, ARE INCORPORATED INTO
THIS SECTION IN THEIR ENTIRETY AND SHALL APPLY AS STATE LAW. SUCH INCOR-
PORATION SHALL REMAIN IN EFFECT NOTWITHSTANDING ANY SUBSEQUENT AMEND-
MENT, REPEAL, OR NONENFORCEMENT OF THE REFERENCED FEDERAL PROVISIONS.
(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 THIS SUBSECTION.
(4) IF AN INSURER PROVIDES ANY BENEFITS FOR A MENTAL HEALTH OR
SUBSTANCE USE DISORDER IN ANY CLASSIFICATION OF BENEFITS, IT SHALL
S. 8426 6
PROVIDE MEANINGFUL BENEFITS FOR THAT 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 SUBSECTION, WHETHER THE BENEFITS PROVIDED ARE CONSID-
ERED "MEANINGFUL BENEFITS" IS DETERMINED IN COMPARISON TO THE BENEFITS
PROVIDED FOR MEDICAL CONDITIONS AND SURGICAL PROCEDURES IN THE CLASSI-
FICATION AND REQUIRES, 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 SHALL NOT BE DEEMED TO 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 CLAS-
SIFICATION, THE INSURER IS NOT 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 OR 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 OR SURGICAL BENEFITS, AND
CAREFULLY CONSIDER THE IMPACT AS PART OF THE POLICY'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 NONQUANTITA-
TIVE TREATMENT LIMITATION IS ASSOCIATED WITH MATERIAL DIFFERENCES IN
ACCESS TO MENTAL HEALTH OR SUBSTANCE USE DISORDER BENEFITS AS COMPARED
TO MEDICAL OR SURGICAL BENEFITS. TO THE EXTENT THE RELEVANT DATA EVALU-
ATED SUGGEST THAT THE NONQUANTITATIVE TREATMENT LIMITATION CONTRIBUTES
PER EXAMINER TO MATERIAL DIFFERENCES IN ACCESS TO MENTAL HEALTH OR
SUBSTANCE USE DISORDER BENEFITS AS COMPARED TO MEDICAL OR SURGICAL BENE-
FITS IN A CLASSIFICATION, 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, THE INSURER SHALL TAKE REASONABLE
ACTION, AS NECESSARY, TO ADDRESS SUCH DIFFERENCES TO ENSURE OPERATIONAL
COMPLIANCE, AND SHALL DOCUMENT THE ACTIONS TAKEN TO DO SO.
S. 8426 7
(7) AN INSURER PROVIDING COVERAGE FOR MENTAL HEALTH OR SUBSTANCE USE
DISORDER BENEFITS SHALL SUBMIT AN ANNUAL REPORT BEGINNING JANUARY FIRST,
TWO THOUSAND TWENTY-SIX AND ANNUALLY THEREAFTER THAT CONTAINS THE INFOR-
MATION DESCRIBED IN 29 U.S.C. § 1185A(A)(8)(A) OR 42 U.S.C. §
300GG-26(A)(8)(A), AS APPLICABLE, AND ANY OTHER INFORMATION DETERMINED
NECESSARY TO ASSESS COMPLIANCE WITH THIS SUBSECTION. THE REPORT SHALL BE
POSTED ON A PUBLICLY AVAILABLE WEBSITE WHOSE WEB ADDRESS IS PROMINENTLY
DISPLAYED IN POLICY INFORMATIONAL AND MARKETING MATERIALS.
(8) IF A HEALTH CARE PROVIDER OR A CURRENT OR PROSPECTIVE INSURED OR
AN EMPLOYER REQUESTS ONE OR MORE NONQUANTITATIVE TREATMENT LIMITATION
PARITY COMPLIANCE ANALYSES THAT THE INSURER IS REQUIRED TO HAVE
COMPLETED BY THIS SUBSECTION, THE INSURER SHALL PROVIDE THE REQUESTED
ANALYSES FREE OF CHARGE WITHIN THIRTY DAYS. THE INSURER SHALL INCLUDE IN
EACH OF ITS HEALTH INSURANCE POLICIES AND PROVIDER AGREEMENTS FOR MENTAL
HEALTH AND SUBSTANCE USE DISORDER SERVICES A NOTIFICATION OF THE RIGHT
TO REQUEST SUCH ANALYSES FREE OF CHARGE. SUCH 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 TEN
DOLLARS PER DAY. IF THE REQUEST UNDER THIS PARAGRAPH IS MADE IN
CONNECTION WITH AN ADVERSE BENEFIT DETERMINATION AND THE INSURER FAILS
TO PROVIDE THE REQUESTED ANALYSES AS REQUIRED BY THIS SUBSECTION, THE
ADVERSE BENEFIT DETERMINATION SHALL BE AUTOMATICALLY REVERSED.
(9) THE SUPERINTENDENT MAY ADOPT RULES OR GUIDANCE AS NECESSARY TO
IMPLEMENT AND ADMINISTER THIS SUBSECTION, AND SUCH RULES OR GUIDANCE
SHALL HAVE THE FORCE OF LAW, INCLUDING:
(A) SPECIFYING DATA TESTING REQUIREMENTS TO DETERMINE POLICY 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 SECTION, INCLUDING THE EFFECT OF AN INSURER'S LACK
OF SUFFICIENT COMPARATIVE ANALYSES OR OTHER REQUIRED INFORMATION NECES-
SARY TO DEMONSTRATE COMPLIANCE.
§ 4. This act shall take effect on the one hundred twentieth day after
it shall have become a law and shall apply to all policies issued,
renewed, modified, altered or amended on or after such date. Effectively
immediately, the addition, amendment and/or repeal of any rule or regu-
lation necessary for the implementation of this act on its effective
date are authorized to be made and completed on or before such date.
