Mental Health and Substance Use Disorder Parity Reports

Insurance Law § 343 requires insurers to submit a biennial Mental Health and Substance Use Disorder Parity Report to the Department of Financial Services to help measure compliance with federal and state parity laws for mental health and substance use disorder treatment.

Each Parity Report spans a two year period and includes the following information:

1. Total number of insureds who received mental health and substance use disorder services and medical or surgical services;
2. Total number of claims received for mental health and substance use disorder services and medical or surgical services;
3. Rates of approvals and denials for inpatient and outpatient mental health and substance use disorder services, including emergency care and prescription drugs;
4. Number of retrospective, prior authorization and continuing care medical necessity reviews for mental health and substance use disorder treatment compared to the rates for medical and surgical services;
5. (Rates of appeals and denials for mental health and substance use disorder treatment compared to the rates for medical and surgical services;
6. Percentage of claims paid for mental health and substance use disorder services compared to the rates for medical and surgical services;
7. Number of staff available to help members with mental health and substance use disorder benefits compared to the number of staff available to help members with medical or surgical benefits;
8. Cost-sharing requirements and benefit limitations for mental health and substance use disorder treatment as compared to medical and surgical services;
9. Number of mental health and substance use disorder providers in the provider network at the start of the reporting period;
10. Number of mental health and substance use disorder providers at the end of the reporting period;
11. Number of mental health and substance use disorder providers who joined the provider network during the reporting period;
12. Number of mental health and substance use disorder providers who left the provider network during the reporting period;
13. Number of mental health and substance use disorder providers who remained in the provider network at the end of the reporting period;
14. Percentage of mental health and substance use disorder providers who did not remain participating providers at the end of the reporting period;
15. (Number of external appeals filed and closed for mental health and substance use disorder treatment compared to medical and surgical treatment;
16. Number and percentage of denials upheld on external appeal.

Questions?

Parity Reports submitted by insurers are posted below in the form in which they were received. If you have questions about these reports or are seeking to access previously published reports, email [email protected].

The Office of Mental Health has also posted portions of Parity Reports on its website.

NOTE: The reports available on this page are in Excel format.