A 8839: 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.

  
  STATE OF NEW YORK ________________________________________________________________________ 8839 2025-2026 Regular Sessions  IN ASSEMBLY 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: 1 Section 1. Section 3216 of the insurance law is amended by adding a 2 new subsection (n) to read as follows: 3 (n) (1) Every insurer issuing a policy delivered or issued for deliv- 4 ery in this state that provides coverage for any mental health or 5 substance use disorder services shall: 6 (A) comply with the requirements of the Paul Wellstone and Pete Domen- 7 ici Mental Health Parity and Addiction Equity Act of 2008 and its imple- 8 menting regulations; and 9 (B) not discriminate in its plan benefit design or application against 10 individuals because of their history of present, or predicted mental 11 health or substance use disorder. 12 (2) The commissioner of mental health shall promulgate rules and regu- 13 lations to incorporate the regulatory requirements related to the Mental 14 Health Parity and Addiction Equity Act at 89 Fed. Reg. 77735 through 89 15 Fed. Reg. 77751, as found on September twenty-third, two thousand twen- 16 ty-four, in their entirety, in relation to the provisions of this 17 subsection. 18 (3) Data collected pursuant to section three hundred forty-three of 19 this chapter, and any other data requested by the superintendent, may be 20 used to assess compliance with the requirements of paragraph one of this 21 subsection. 22 (4) If an insurer provides any benefits for a mental health or 23 substance use disorder in any classification of benefits, it shall 24 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 1 disorder in every classification in which medical or surgical benefits 2 are provided. "Core treatments" means standard treatments or courses of 3 treatment, therapy, service, or intervention indicated by generally 4 accepted standards of mental health or substance use disorder care. For 5 purposes of this paragraph, whether the benefits provided are considered 6 "meaningful benefits" shall be determined in comparison to the benefits 7 provided for medical conditions and surgical procedures in the classi- 8 fication and shall require, at a minimum, coverage of benefits for that 9 condition or disorder in each classification in which the insurer 10 provides benefits for one or more medical conditions or surgical proce- 11 dures. An insurer does not provide meaningful benefits under this 12 subsection unless it provides benefits for core treatments for that 13 condition or disorder in each classification in which the insurer 14 provides benefits for core treatments for one or more medical conditions 15 or surgical procedures. If there is no core treatment for a covered 16 mental health or substance use disorder with respect to a classifica- 17 tion, the insurer shall not be required to provide benefits for core 18 treatments for such condition or disorder in that classification, but 19 shall provide benefits for such condition or disorder in every classi- 20 fication in which medical or surgical benefits are provided. 21 (5) For the purposes of determining comparability and stringency for 22 nonquantitative treatment limitations, an insurer shall not rely upon 23 discriminatory factors or evidentiary standards to design a nonquantita- 24 tive treatment limitation to be imposed on mental health or substance 25 use disorder benefits. A factor or evidentiary standard is discriminato- 26 ry if the information, evidence, sources, or standards on which the 27 factor or evidentiary standard are based are biased or not objective in 28 a manner that discriminates against mental health or substance use 29 disorder benefits as compared to medical or surgical benefits. 30 (6) A nonquantitative treatment limitation applicable to mental health 31 or substance use disorder benefits in a classification shall not, in 32 operation, be more restrictive than the predominant nonquantitative 33 treatment limitation applied to substantially all medical and surgical 34 benefits in the classification. To test compliance with this paragraph, 35 an insurer shall collect and evaluate relevant data in a manner reason- 36 ably designed to assess the impact of the nonquantitative treatment 37 limitation on relevant outcomes related to access to mental health or 38 substance use disorder benefits and medical and surgical benefits and 39 carefully consider the impact as part of the plan's evaluation. As part 40 of its evaluation, the insurer may not disregard relevant outcomes data 41 that it knows or reasonably should know suggest that a nonquantitative 42 treatment limitation is associated with material differences in access 43 to mental health or substance use disorder benefits as compared to 44 medical and surgical benefits. To the extent the relevant data evaluated 45 suggests that the nonquantitative treatment limitation contributes to 46 material differences in access to mental health or substance use disor- 47 der benefits as compared to medical or surgical benefits in a classi- 48 fication, such differences shall be considered a strong indicator of a 49 noncompliant nonquantitative treatment limitation. Where the relevant 50 data suggest that the nonquantitative treatment limitation contributes 51 to material differences in access to mental health or substance use 52 disorder benefits as compared to medical and surgical benefits in a 53 classification, the insurer shall take reasonable action, as necessary, 54 to address the material differences to ensure compliance, in operation, 55 and shall document the actions that have been or are being taken by the 56 insurer to address material differences in access to mental health or 
 A. 8839 3 1 substance use disorder benefits, as compared to medical and surgical 2 benefits. 3 (7) An insurer providing coverage for mental health or substance use 4 disorder benefits shall submit an annual report starting on January 5 first, two thousand twenty-six and annually thereafter, that contains 6 the information described in 29 USC 1185a(a)(8)(A) and 42 USC 7 300gg-26(a)(8)(A). The report required shall be posted on a publicly 8 available website whose web address is prominently displayed in plan 9 informational and marketing materials. 10 (8) If a health care provider, a current or prospective enrollee or an 11 employer requests one or more nonquantitative treatment limitation pari- 12 ty compliance analyses that the insurer is required to have completed 13 pursuant to 29 U.S.C. Sec. 1185a or 42 U.S.C. Sec. 300gg-26, the insurer 14 shall provide the requested analyses free of charge within thirty days. 15 The insurer shall include in each of their health plan policies and 16 mental health and substance use disorder provider contracts a notifica- 17 tion of the right to request nonquantitative treatment limitation 18 analyses free of charge. The notification shall include information on 19 how to request the analyses. In addition to any other action authorized 20 under this chapter, failure by an insurer to provide the full requested 21 analyses shall result in a penalty of one hundred dollars per day, which 22 shall be collected by the superintendent and remitted to the requestor. 23 If the request under this paragraph is made in connection with an 24 adverse benefit determination and the insurer fails to provide the 25 required analyses as required by this paragraph, the adverse benefit 26 determination shall be automatically reversed. 27 (9) The superintendent may adopt rules or guidance as necessary to 28 implement and administer the provisions of paragraphs one through seven 29 of this subsection, and such rules or guidance shall have the force of 30 law and shall include: 31 (A) specifying data testing requirements to determine plan design and 32 application parity and nondiscrimination compliance using outcomes data; 33 (B) setting standard definitions; and 34 (C) establishing specific timelines for insurer compliance with the 35 requirements of this subsection, including the effect of an insurer's 36 lack of sufficient comparative analyses or other required information 37 necessary to demonstrate compliance. 38 § 2. Section 3221 of the insurance law is amended by adding a new 39 subsection (v) to read as follows: 40 (v) (1) Every insurer issuing a policy delivered or issued for deliv- 41 ery in this state that provides coverage for any mental health or 42 substance use disorder services shall: 43 (A) comply with the requirements of the Paul Wellstone and Pete Domen- 44 ici Mental Health Parity and Addiction Equity Act of 2008 and its imple- 45 menting regulations; and 46 (B) not discriminate in its plan benefit design or application against 47 individuals because of their history of present, or predicted mental 48 health or substance use disorder. 49 (2) The commissioner of mental health shall promulgate rules and regu- 50 lations to incorporate the regulatory requirements related to the Mental 51 Health Parity and Addiction Equity Act at 89 Fed. Reg. 77735 through 89 52 Fed. Reg. 77751, as found on September twenty-third, two thousand twen- 53 ty-four, in their entirety, in relation to the provisions of this 54 subsection. 55 (3) Data collected pursuant to section three hundred forty-three of 56 this chapter, and any other data requested by the superintendent, may be 
 A. 8839 4 1 used to assess compliance with the requirements of paragraph one of this 2 subsection. 3 (4) If an insurer provides any benefits for a mental health or 4 substance use disorder in any classification of benefits, it shall 5 provide meaningful benefits for such mental health or substance use 6 disorder in every classification in which medical or surgical benefits 7 are provided. "Core treatments" means standard treatments or courses of 8 treatment, therapy, service, or intervention indicated by generally 9 accepted standards of mental health or substance use disorder care. For 10 purposes of this paragraph, whether the benefits provided are considered 11 "meaningful benefits" shall be determined in comparison to the benefits 12 provided for medical conditions and surgical procedures in the classi- 13 fication and shall require, at a minimum, coverage of benefits for that 14 condition or disorder in each classification in which the insurer 15 provides benefits for one or more medical conditions or surgical proce- 16 dures. An insurer does not provide meaningful benefits under this 17 subsection unless it provides benefits for core treatments for that 18 condition or disorder in each classification in which the insurer 19 provides benefits for core treatments for one or more medical conditions 20 or surgical procedures. If there is no core treatment for a covered 21 mental health or substance use disorder with respect to a classifica- 22 tion, the insurer shall not be required to provide benefits for core 23 treatments for such condition or disorder in that classification, but 24 shall provide benefits for such condition or disorder in every classi- 25 fication in which medical or surgical benefits are provided. 26 (5) For the purposes of determining comparability and stringency for 27 nonquantitative treatment limitations, an insurer shall not rely upon 28 discriminatory factors or evidentiary standards to design a nonquantita- 29 tive treatment limitation to be imposed on mental health or substance 30 use disorder benefits. A factor or evidentiary standard is discriminato- 31 ry if the information, evidence, sources, or standards on which the 32 factor or evidentiary standard are based are biased or not objective in 33 a manner that discriminates against mental health or substance use 34 disorder benefits as compared to medical or surgical benefits. 35 (6) A nonquantitative treatment limitation applicable to mental health 36 or substance use disorder benefits in a classification shall not, in 37 operation, be more restrictive than the predominant nonquantitative 38 treatment limitation applied to substantially all medical and surgical 39 benefits in the classification. To test compliance with this paragraph, 40 an insurer shall collect and evaluate relevant data in a manner reason- 41 ably designed to assess the impact of the nonquantitative treatment 42 limitation on relevant outcomes related to access to mental health or 43 substance use disorder benefits and medical and surgical benefits and 44 carefully consider the impact as part of the plan's evaluation. As part 45 of its evaluation, the insurer may not disregard relevant outcomes data 46 that it knows or reasonably should know suggest that a nonquantitative 47 treatment limitation is associated with material differences in access 48 to mental health or substance use disorder benefits as compared to 49 medical and surgical benefits. To the extent the relevant data evaluated 50 suggests that the nonquantitative treatment limitation contributes to 51 material differences in access to mental health or substance use disor- 52 der benefits as compared to medical or surgical benefits in a classi- 53 fication, such differences shall be considered a strong indicator of a 54 noncompliant nonquantitative treatment limitation. Where the relevant 55 data suggest that the nonquantitative treatment limitation contributes 56 to material differences in access to mental health or substance use 
 A. 8839 5 1 disorder benefits as compared to medical and surgical benefits in a 2 classification, the insurer shall take reasonable action, as necessary, 3 to address the material differences to ensure compliance, in operation, 4 and shall document the actions that have been or are being taken by the 5 insurer to address material differences in access to mental health or 6 substance use disorder benefits, as compared to medical and surgical 7 benefits. 8 (7) An insurer providing coverage for mental health or substance use 9 disorder benefits shall submit an annual report starting on January 10 first, two thousand twenty-six and annually thereafter, that contains 11 the information described in 29 USC 1185a(a)(8)(A) and 42 USC 12 300gg-26(a)(8)(A). The report required shall be posted on a publicly 13 available website whose web address is prominently displayed in plan 14 informational and marketing materials. 15 (8) If a health care provider, a current or prospective enrollee or an 16 employer requests one or more nonquantitative treatment limitation pari- 17 ty compliance analyses that the insurer is required to have completed 18 pursuant to 29 U.S.C. Sec. 1185a or 42 U.S.C. Sec. 300gg-26, the insurer 19 shall provide the requested analyses free of charge within thirty days. 20 The insurer shall include in each of their health plan policies and 21 mental health and substance use disorder provider contracts a notifica- 22 tion of the right to request nonquantitative treatment limitation 23 analyses free of charge. The notification shall include information on 24 how to request the analyses. In addition to any other action authorized 25 under this chapter, failure by an insurer to provide the full requested 26 analyses shall result in a penalty of one hundred dollars per day, which 27 shall be collected by the superintendent and remitted to the requestor. 28 If the request under this paragraph is made in connection with an 29 adverse benefit determination and the insurer fails to provide the 30 required analyses as required by this paragraph, the adverse benefit 31 determination shall be automatically reversed. 32 (9) The superintendent may adopt rules or guidance as necessary to 33 implement and administer the provisions of paragraphs one through seven 34 of this subsection, and such rules or guidance shall have the force of 35 law and shall include: 36 (A) specifying data testing requirements to determine plan design and 37 application parity and nondiscrimination compliance using outcomes data; 38 (B) setting standard definitions; and 39 (C) establishing specific timelines for insurer compliance with the 40 requirements of this subsection, including the effect of an insurer's 41 lack of sufficient comparative analyses or other required information 42 necessary to demonstrate compliance. 43 § 3. Section 4303 of the insurance law is amended by adding a new 44 subsection (ww) to read as follows: 45 (ww) (1) Every corporation issuing a contract delivered or issued for 46 delivery in this state that provides coverage for any mental health or 47 substance use disorder services shall: 48 (A) comply with the requirements of the Paul Wellstone and Pete Domen- 49 ici Mental Health Parity and Addiction Equity Act of 2008 and its imple- 50 menting regulations; and 51 (B) not discriminate in its plan benefit design or application against 52 individuals because of their history of present, or predicted mental 53 health or substance use disorder. 54 (2) The commissioner of mental health shall promulgate rules and regu- 55 lations to incorporate the regulatory requirements related to the Mental 56 Health Parity and Addiction Equity Act at 89 Fed. Reg. 77735 through 89 
 A. 8839 6 1 Fed. Reg. 77751, as found on September twenty-third, two thousand twen- 2 ty-four, in their entirety, in relation to the provisions of this 3 subsection. 4 (3) Data collected pursuant to section three hundred forty-three of 5 this chapter, and any other data requested by the superintendent, may be 6 used to assess compliance with the requirements of paragraph one of this 7 subsection. 8 (4) If an insurer provides any benefits for a mental health or 9 substance use disorder in any classification of benefits, it shall 10 provide meaningful benefits for such mental health or substance use 11 disorder in every classification in which medical or surgical benefits 12 are provided. "Core treatments" means standard treatments or courses of 13 treatment, therapy, service, or intervention indicated by generally 14 accepted standards of mental health or substance use disorder care. For 15 purposes of this paragraph, whether the benefits provided are considered 16 "meaningful benefits" shall be determined in comparison to the benefits 17 provided for medical conditions and surgical procedures in the classi- 18 fication and shall require, at a minimum, coverage of benefits for that 19 condition or disorder in each classification in which the insurer 20 provides benefits for one or more medical conditions or surgical proce- 21 dures. An insurer does not provide meaningful benefits under this 22 subsection unless it provides benefits for core treatments for that 23 condition or disorder in each classification in which the insurer 24 provides benefits for core treatments for one or more medical conditions 25 or surgical procedures. If there is no core treatment for a covered 26 mental health or substance use disorder with respect to a classifica- 27 tion, the insurer shall not be required to provide benefits for core 28 treatments for such condition or disorder in that classification, but 29 shall provide benefits for such condition or disorder in every classi- 30 fication in which medical or surgical benefits are provided. 31 (5) For the purposes of determining comparability and stringency for 32 nonquantitative treatment limitations, an insurer shall not rely upon 33 discriminatory factors or evidentiary standards to design a nonquantita- 34 tive treatment limitation to be imposed on mental health or substance 35 use disorder benefits. A factor or evidentiary standard is discriminato- 36 ry if the information, evidence, sources, or standards on which the 37 factor or evidentiary standard are based are biased or not objective in 38 a manner that discriminates against mental health or substance use 39 disorder benefits as compared to medical or surgical benefits. 40 (6) A nonquantitative treatment limitation applicable to mental health 41 or substance use disorder benefits in a classification shall not, in 42 operation, be more restrictive than the predominant nonquantitative 43 treatment limitation applied to substantially all medical and surgical 44 benefits in the classification. To test compliance with this paragraph, 45 an insurer shall collect and evaluate relevant data in a manner reason- 46 ably designed to assess the impact of the nonquantitative treatment 47 limitation on relevant outcomes related to access to mental health or 48 substance use disorder benefits and medical and surgical benefits and 49 carefully consider the impact as part of the plan's evaluation. As part 50 of its evaluation, the insurer may not disregard relevant outcomes data 51 that it knows or reasonably should know suggest that a nonquantitative 52 treatment limitation is associated with material differences in access 53 to mental health or substance use disorder benefits as compared to 54 medical and surgical benefits. To the extent the relevant data evaluated 55 suggests that the nonquantitative treatment limitation contributes to 56 material differences in access to mental health or substance use disor- 
 A. 8839 7 1 der benefits as compared to medical or surgical benefits in a classi- 2 fication, such differences shall be considered a strong indicator of a 3 noncompliant nonquantitative treatment limitation. Where the relevant 4 data suggest that the nonquantitative treatment limitation contributes 5 to material differences in access to mental health or substance use 6 disorder benefits as compared to medical and surgical benefits in a 7 classification, the insurer shall take reasonable action, as necessary, 8 to address the material differences to ensure compliance, in operation, 9 and shall document the actions that have been or are being taken by the 10 insurer to address material differences in access to mental health or 11 substance use disorder benefits, as compared to medical and surgical 12 benefits. 13 (7) An insurer providing coverage for mental health or substance use 14 disorder benefits shall submit an annual report starting on January 15 first, two thousand twenty-six and annually thereafter, that contains 16 the information described in 29 USC 1185a(a)(8)(A) and 42 USC 17 300gg-26(a)(8)(A). The report required shall be posted on a publicly 18 available website whose web address is prominently displayed in plan 19 informational and marketing materials. 20 (8) If a health care provider, a current or prospective enrollee or an 21 employer requests one or more nonquantitative treatment limitation pari- 22 ty compliance analyses that the insurer is required to have completed 23 pursuant to 29 U.S.C. Sec. 1185a or 42 U.S.C. Sec. 300gg-26, the insurer 24 shall provide the requested analyses free of charge within thirty days. 25 The insurer shall include in each of their health plan policies and 26 mental health and substance use disorder provider contracts a notifica- 27 tion of the right to request nonquantitative treatment limitation 28 analyses free of charge. The notification shall include information on 29 how to request the analyses. In addition to any other action authorized 30 under this chapter, failure by an insurer to provide the full requested 31 analyses shall result in a penalty of one hundred dollars per day, which 32 shall be collected by the superintendent and remitted to the requestor. 33 If the request under this paragraph is made in connection with an 34 adverse benefit determination and the insurer fails to provide the 35 required analyses as required by this paragraph, the adverse benefit 36 determination shall be automatically reversed. 37 (9) The superintendent may adopt rules or guidance as necessary to 38 implement and administer the provisions of paragraphs one through seven 39 of this subsection, and such rules or guidance shall have the force of 40 law and shall include: 41 (A) specifying data testing requirements to determine plan design and 42 application parity and nondiscrimination compliance using outcomes data; 43 (B) setting standard definitions; and 44 (C) establishing specific timelines for insurer compliance with the 45 requirements of this subsection, including the effect of an insurer's 46 lack of sufficient comparative analyses or other required information 47 necessary to demonstrate compliance. 48 § 4. This act shall take effect immediately.