NY State Senate Bill 2025-S8426A

Senate Bill S8426A

2025-2026 Legislative Session

Prevents discrimination by insurers based on an individual's mental health or substance use disorder

download bill text pdf

Current Bill Status - In Senate Committee Rules Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 10, 2025	print number 8426a
Jun 10, 2025	amend (t) and recommit to rules referred to rules

Bill Amendments

Original

A (Active)

2025-S8426 - Details

See Assembly Version of this Bill:: A8839
Current Committee:: Senate Rules
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L

2025-S8426 - Summary

Prevents discrimination by insurers based on an individual's mental health or substance use disorder; incorporates into law federal enforcement rules set forth in the federal mental health parity and addiction equity act of 2008.

2025-S8426 - Sponsor Memo

                                 
BILL NUMBER: S8426

SPONSOR: BROUK
 
TITLE OF BILL:

An act to amend the insurance law, in relation to requiring health
insurance policies conform to the requirements of the federal Paul Well-
stone and Pete Domenici Mental Health Parity and Addiction Equity Act of
2008

 
PURPOSE:

To amend the insurance law in relation to preventing discrimination by
insurers based on an individual's mental health or substance use disor-
der

 
SUMMARY OF PROVISIONS:

Section 3216 of the insurance law is amended by adding a new subsection
(n) § 2. Section 3221 of the insurance law is amended by adding a new
subsection (v) § 3. Section 4303 of the insurance law is amended by
adding a new subsection (ww).

 
JUSTIFICATION:

New York State and federal law require health insurance plans to cover
mental health and substance use disorder treatment the same way they
cover physical health treatment. In 2008 the Mental Health Parity and
Addiction Equity Act was passed to prevent private insurance companies
from instituting unequal coverage for mental health and substance disor-
ders insurance plans. Nevertheless, insurance carriers circumvented the
2008 law by creating their own formulae for mental health and substance
abuse disorder coverage exploiting loopholes in the law and virtually
eliminating parity with physical health insurance coverage. Health
insurance plans are not meeting the legal mandate for patients. This
persistent problem must be addressed.

New York State and our nation is facing a mental health crisis and
insurance companies are failing patients in need despite the 2008 parity
act. Many obstacles prevent our state's citizens from accessing the
mental health care they need, and the demand for mental health services
in recent years has exacerbated longstanding network inadequacy due to
the lower rates insurance companies are willing to pay for this care.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2025-S8426 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8426
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               June 10, 2025
                                ___________
 
 Introduced  by  Sen.  BROUK  -- read twice and ordered printed, and when
   printed to be committed to the Committee on Rules
 
 AN ACT to amend the insurance  law,  in  relation  to  requiring  health
   insurance  policies  conform  to  the requirements of the federal Paul
   Wellstone and Pete Domenici Mental Health Parity and Addiction  Equity
   Act of 2008

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. 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 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 PLAN 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  SUBSECTION  IN  THEIR  ENTIRETY AND SHALL APPLY AS STATE LAW. SUCH
 INCORPORATION SHALL REMAIN  IN  EFFECT  NOTWITHSTANDING  ANY  SUBSEQUENT
 AMENDMENT,   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
 PROVIDE  MEANINGFUL  BENEFITS  FOR  THAT  MENTAL HEALTH OR SUBSTANCE USE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13343-01-5

 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.

2025-S8426A (ACTIVE) - Details

See Assembly Version of this Bill:: A8839
Current Committee:: Senate Rules
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L

2025-S8426A (ACTIVE) - Summary

2025-S8426A (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S8426A

SPONSOR: BROUK
 
TITLE OF BILL:

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

 
PURPOSE:

To amend the insurance law in relation to preventing discrimination by
insurers based on an individual's mental health or substance use disor-
der

 
SUMMARY OF PROVISIONS:

Section 3216 of the insurance law is amended by adding a new subsection
(n) § 2. Section 3221 of the insurance law is amended by adding a new
subsection (v) § 3. Section 4303 of the insurance law is amended by
adding a new subsection (ww).

 
JUSTIFICATION:

New York State and federal law require health insurance plans to cover
mental health and substance use disorder treatment the same way they
cover physical health treatment. In 2008 the Mental Health Parity and
Addiction Equity Act was passed to prevent private insurance companies
from instituting unequal coverage for mental health and substance disor-
ders insurance plans. Nevertheless, insurance carriers circumvented the
2008 law by creating their own formulae for mental health and substance
abuse disorder coverage exploiting loopholes in the law and virtually
eliminating parity with physical health insurance coverage. Health
insurance plans are not meeting the legal mandate for patients. This
persistent problem must be addressed.

New York State and our nation is facing a mental health crisis and
insurance companies are failing patients in need despite the 2008 parity
act. Many obstacles prevent our state's citizens from accessing the
mental health care they need, and the demand for mental health services
in recent years has exacerbated longstanding network inadequacy due to
the lower rates insurance companies are willing to pay for this care.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2025-S8426A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  8426--A
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               June 10, 2025
                                ___________
 
 Introduced  by  Sen.  BROUK  -- read twice and ordered printed, and when
   printed to be  committed  to  the  Committee  on  Rules  --  committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee
 
 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.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13343-02-5
 S. 8426--A                          2

 
   (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
 DISORDER BENEFITS AS COMPARED TO MEDICAL  AND  SURGICAL  BENEFITS  IN  A
 CLASSIFICATION,  THE INSURER SHALL TAKE REASONABLE ACTION, AS NECESSARY,
 S. 8426--A                          3

 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.
   §  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-
 S. 8426--A                          4
 
 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-
 DER BENEFITS AS COMPARED TO MEDICAL OR SURGICAL BENEFITS  IN  A  CLASSI-
 S. 8426--A                          5
 
 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.
   §  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
 S. 8426--A                          6
 
   (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
 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
 S. 8426--A                          7
 
 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
 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.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.