Mental Health and Substance Use Disorder Parity and Reporting Information

Access to treatment for mental health and substance use disorders (MH/SUD) is essential to the health and well-being of all New Yorkers. MH/SUD services must be covered in health insurance policies sold in New York. If you are a consumer looking for information about your insurance coverage for MH/SUD treatment, please visit our MH/SUD consumer information page.


Federal Laws Governing Parity

The federal Mental Health Parity Act of 1996 required that large group health plans could not impose lifetime dollar limits on mental health benefits that were less favorable than the limits imposed on medical and surgical benefits. Since then, additional federal parity laws related to mental health have been passed.

The federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) ensures that group health insurance plans treat MH/SUD and M/S benefits similarly by preventing health insurance plans from imposing less favorable benefit limitations on MH/SUD than on M/S benefits. An Amendment to the Affordable Care Act (ACA) added this coverage requirement to individual health plans as well.

The following links provide additional information on federal MHPAEA and parity requirements:

State Laws Governing Parity?

New York Insurance Law requires insurance coverage to be consistent with MHPAEA and imposes additional MH/SUD coverage requirements. The following New York laws, regulations, and industry guidance provide information on MH/SUD requirements.

Laws

MH/SUD

GROUP COMMERCIAL HEALTH INSURANCE POLICIES

INDIVIDUAL COMMERCIAL HEALTH INSURANCE POLICIES

HMO/ARTICLE 43 HEALTH INSURANCE POLICIES

Inpatient SUD Services

§3221(l)(6)

§3216(i)(30)

§4303(k)

Outpatient SUD Services

§3221(l)(7)

§3216(i)(31)

§4303(l)

Inpatient and Outpatient MH Services

§3221(l)(5)

§3216(i)(35)

§4303(g)

Prescription Medications to Treat SUD

§3221(l)(7-b)

§3216(i)(31-a)

§4303(l-2)

SUD Clinical Review Criteria

§4902(a)(9)

 §4902(a)(9)

§4902(a)(9)

MH Clinical Review Criteria

§4902(a)(12)

§4902(a)(12)

§4902(a)(12)

Participating Provider Directory

§§3217-a(a)(17)

§§3217-a(a)(17)

§4324(a)(17)

Disclosure of Comparative Analysis

§3217-a(a)(21)

§3217-a(a)(21)

§4324(a)(22)

Regulations

Circular Letters

Industry FAQs

  • Mental Health and Substance Use Disorder (MH/SUD) FAQs
  • Mental Health Services for Essential Workers FAQs

MH/SUD Parity Reporting Requirements


Additional Outside Resources

New York State Office of Mental Health