S 8426: 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 ________________________________________________________________________ 8426 2025-2026 Regular Sessions  IN SENATE 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: 1 Section 1. Section 3221 of the insurance law is amended by adding a 2 new subsection (v) to read as follows: 3 (v) (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 federal Paul Wellstone and 7 Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and 8 its implementing 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 provisions published at 89 Federal Register 77586 et seq. on 13 September twenty-third, two thousand twenty-three, are incorporated into 14 this subsection in their entirety and shall apply as state law. Such 15 incorporation shall remain in effect notwithstanding any subsequent 16 amendment, repeal, or nonenforcement of the referenced federal 17 provisions. 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 this subsection. 21 (4) If an insurer provides any benefits for a mental health or 22 substance use disorder in any classification of benefits, it shall 23 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 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 subsection, whether the benefits provided are consid- 6 ered "meaningful benefits" is determined in comparison to the benefits 7 provided for medical conditions and surgical procedures in the classi- 8 fication and requires, 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 shall not be deemed to provide meaningful benefits 12 under this subsection unless it provides benefits for core treatments 13 for that condition or disorder in each classification in which the 14 insurer provides benefits for core treatments for one or more medical 15 conditions or surgical procedures. If there is no core treatment for a 16 covered mental health or substance use disorder with respect to a clas- 17 sification, the insurer is not 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/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/surgical bene- 34 fits in the classification. To test compliance with this paragraph, an 35 insurer shall collect and evaluate relevant data in a manner reasonably 36 designed to assess the impact of the nonquantitative treatment limita- 37 tion on relevant outcomes related to access to mental health or 38 substance use disorder benefits and medical/surgical benefits and care- 39 fully consider the impact as part of the plan's evaluation. As part of 40 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/surgical benefits. To the extent the relevant data evaluated 45 suggest 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/surgical benefits in a classifica- 48 tion, such differences will be considered a strong indicator of a 49 noncompliant nonquantitative treatment limitation. Where the relevant 50 data suggest that the nonquantitative treatment limitation per examiner 51 contributes per examined to material differences in access to mental 52 health or substance use disorder benefits as compared to 53 medical/surgical benefits in a classification, the insurer shall take 54 reasonable action, as necessary, to address the material differences to 55 ensure compliance, in operation, and shall document the actions that 56 have been or are being taken by the insurer to address material differ- 
 S. 8426 3 1 ences in access to mental health or substance use disorder benefits, as 2 compared to medical/surgical benefits. 3 (7) An insurer providing coverage for mental health or substance use 4 disorder benefits shall submit an annual report beginning January first, 5 two thousand twenty-six and annually thereafter, that contains the 6 information described in 29 U.S.C. § 1185a(a)(8)(A) or 42 U.S.C. § 7 300gg-26(a)(8)(A), as applicable, and any other information determined 8 necessary to assess compliance with this subsection. Such report shall 9 be posted on a publicly available website whose web address is promi- 10 nently displayed in plan informational and marketing materials. 11 (8) If a health care provider or a current or prospective enrollee or 12 an employer requests, one or more nonquantitative treatment limitation 13 parity compliance analyses that the insurer is required to have 14 completed by this subsection, the insurer shall provide the requested 15 analyses free of charge within thirty days. The insurer shall include in 16 each of their health plan policies and mental health and substance use 17 disorder provider contracts a notification of the right to request 18 nonquantitative treatment limitation analyses free of charge. The 19 notification shall include information on how to request the analyses. 20 In addition to any other action authorized under this chapter, failure 21 by an insurer to provide the full requested analyses shall result in a 22 penalty of one hundred ten dollars per day. If the request under this 23 paragraph is made in connection with an adverse benefit determination 24 and the insurer fails to provide the requested analyses as required by 25 this subsection, the adverse benefit determination is automatically 26 reversed. 27 (9) The superintendent may adopt rules or guidance as necessary to 28 implement and administer this subsection, and such rules or guidance 29 shall have the force of law, including: 30 (A) specifying data testing requirements to determine plan design and 31 application parity and nondiscrimination compliance using outcomes data; 32 (B) setting standard definitions; and 33 (C) establishing specific timelines for insurer compliance with the 34 requirements of this subsection, including the effect of an insurer's 35 lack of sufficient comparative analyses or other required information 36 necessary to demonstrate compliance. 37 § 2. Section 4303 of the insurance law is amended by adding a new 38 subsection (ww) to read as follows: 39 (ww) (1) Every corporation issuing a contract delivered or issued for 40 delivery in this state that provides coverage for any mental health or 41 substance use disorder services shall: 42 (A) comply with the requirements of the federal Paul Wellstone and 43 Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and 44 its implementing regulations; and 45 (B) not discriminate in its contract benefit design or application 46 against individuals because of their history of, present, or predicted 47 mental health or substance use disorder. 48 (2) The provisions published at 89 Federal Register 77586 et seq. on 49 September twenty-third two thousand twenty-three, are incorporated into 50 this section in their entirety and shall apply as state law. Such incor- 51 poration shall remain in effect notwithstanding any subsequent amend- 52 ment, repeal, or nonenforcement of the referenced federal provisions. 53 (3) Data collected pursuant to section three hundred forty-three of 54 this chapter, and any other data requested by the superintendent, may be 55 used to assess compliance with the requirements of this subsection. 
 S. 8426 4 1 (4) If a corporation provides any benefits for a mental health or 2 substance use disorder in any classification of benefits, it shall 3 provide meaningful benefits for that mental health or substance use 4 disorder in every classification in which medical or surgical benefits 5 are provided. "Core treatments" means standard treatments or courses of 6 treatment, therapy, service, or intervention indicated by generally 7 accepted standards of mental health or substance use disorder care. For 8 purposes of this subsection, whether the benefits provided are consid- 9 ered "meaningful benefits" is determined in comparison to the benefits 10 provided for medical conditions and surgical procedures in the classi- 11 fication and requires, at a minimum, coverage of benefits for that 12 condition or disorder in each classification in which the corporation 13 provides benefits for one or more medical conditions or surgical proce- 14 dures. A corporation shall not be deemed to provide meaningful benefits 15 under this subsection unless it provides benefits for core treatments 16 for that condition or disorder in each classification in which the 17 corporation provides benefits for core treatments for one or more 18 medical conditions or surgical procedures. If there is no core treatment 19 for a covered mental health or substance use disorder with respect to a 20 classification, the corporation is not required to provide benefits for 21 core treatments for such condition or disorder in that classification, 22 but shall provide benefits for such condition or disorder in every clas- 23 sification in which medical or surgical benefits are provided. 24 (5) For the purposes of determining comparability and stringency for 25 nonquantitative treatment limitations, a corporation shall not rely upon 26 discriminatory factors or evidentiary standards to design a nonquantita- 27 tive treatment limitation to be imposed on mental health or substance 28 use disorder benefits. A factor or evidentiary standard is discriminato- 29 ry if the information, evidence, sources, or standards on which the 30 factor or evidentiary standard are based are biased or not objective in 31 a manner that discriminates against mental health or substance use 32 disorder benefits as compared to medical or surgical benefits. 33 (6) A nonquantitative treatment limitation applicable to mental health 34 or substance use disorder benefits in a classification shall not, in 35 operation, be more restrictive than the predominant nonquantitative 36 treatment limitation applied to substantially all medical or surgical 37 benefits in the classification. To test compliance with this paragraph, 38 a corporation shall collect and evaluate relevant data in a manner 39 reasonably designed to assess the impact of the nonquantitative treat- 40 ment limitation on relevant outcomes related to access to mental health 41 or substance use disorder benefits and medical or surgical benefits, and 42 carefully consider the impact as part of the contract's evaluation. As 43 part of its evaluation, the corporation may not disregard relevant 44 outcomes data that it knows or reasonably should know suggest that a 45 nonquantitative treatment limitation is associated with material differ- 46 ences in access to mental health or substance use disorder benefits as 47 compared to medical or surgical benefits. To the extent the relevant 48 data evaluated suggest that the nonquantitative treatment limitation 49 contributes to material differences in access to mental health or 50 substance use disorder benefits as compared to medical or surgical bene- 51 fits in a classification, such differences shall be considered a strong 52 indicator of a noncompliant nonquantitative treatment limitation. Where 53 the relevant data suggest that the nonquantitative treatment limitation 54 contributes to material differences in access to mental health or 55 substance use disorder benefits, the corporation shall take reasonable 
 S. 8426 5 1 action, as necessary, to address such differences to ensure operational 2 compliance, and shall document the actions taken to do so. 3 (7) A corporation providing coverage for mental health or substance 4 use disorder benefits shall submit an annual report beginning January 5 first, two thousand twenty-six and annually thereafter that contains the 6 information described in 29 U.S.C. § 1185a(a)(8)(A) or 42 U.S.C. § 7 300gg-26(a)(8)(A), as applicable, and any other information determined 8 necessary to assess compliance with this subsection. Such report shall 9 be posted on a publicly available website whose web address is promi- 10 nently displayed in contract informational and marketing materials. 11 (8) If a health care provider or a current or prospective enrollee or 12 an employer requests one or more nonquantitative treatment limitation 13 parity compliance analyses that the corporation is required to have 14 completed by this subsection, the corporation shall provide the 15 requested analyses free of charge within thirty days. The corporation 16 shall include in each of its health care contracts and provider agree- 17 ments for mental health and substance use disorder services a notifica- 18 tion of the right to request such analyses free of charge. Such notifi- 19 cation shall include information on how to request the analyses. In 20 addition to any other action authorized under this chapter, failure by a 21 corporation to provide the full requested analyses shall result in a 22 penalty of one hundred ten dollars per day. If the request under this 23 paragraph is made in connection with an adverse benefit determination 24 and the corporation fails to provide the requested analyses as required 25 by this subsection, the adverse benefit determination shall be automat- 26 ically reversed. 27 (9) The superintendent may adopt rules or guidance as necessary to 28 implement and administer this subsection, and such rules or guidance 29 shall have the force of law, including: 30 (A) specifying data testing requirements to determine plan design and 31 application parity and nondiscrimination compliance using outcomes data; 32 (B) setting standard definitions; and 33 (C) establishing specific timelines for corporation compliance with 34 the requirements of this subsection, including the effect of a corpo- 35 ration's lack of sufficient comparative analyses or other required 36 information necessary to demonstrate compliance. 37 § 3. Section 3216 of the insurance law is amended by adding a new 38 subsection (n) to read as follows: 39 (n) (1) Every insurer issuing a policy delivered or issued for deliv- 40 ery in this state that provides coverage for any mental health or 41 substance use disorder services shall: 42 (A) comply with all applicable requirements of state and federal law 43 regarding coverage of such services; and 44 (B) not discriminate in its policy benefit design or administration 45 against individuals because of their history of, present, or predicted 46 mental health or substance use disorder. 47 (2) The provisions published at 89 Federal Register 77586 et seq. on 48 September twenty-third, two thousand twenty-three, are incorporated into 49 this section in their entirety and shall apply as state law. Such incor- 50 poration shall remain in effect notwithstanding any subsequent amend- 51 ment, repeal, or nonenforcement of the referenced federal provisions. 52 (3) Data collected pursuant to section three hundred forty-three of 53 this chapter, and any other data requested by the superintendent, may be 54 used to assess compliance with the requirements of this subsection. 55 (4) If an insurer provides any benefits for a mental health or 56 substance use disorder in any classification of benefits, it shall 
 S. 8426 6 1 provide meaningful benefits for that mental health or substance use 2 disorder in every classification in which medical or surgical benefits 3 are provided. "Core treatments" means standard treatments or courses of 4 treatment, therapy, service, or intervention indicated by generally 5 accepted standards of mental health or substance use disorder care. For 6 purposes of this subsection, whether the benefits provided are consid- 7 ered "meaningful benefits" is determined in comparison to the benefits 8 provided for medical conditions and surgical procedures in the classi- 9 fication and requires, at a minimum, coverage of benefits for that 10 condition or disorder in each classification in which the insurer 11 provides benefits for one or more medical conditions or surgical proce- 12 dures. An insurer shall not be deemed to provide meaningful benefits 13 under this subsection unless it provides benefits for core treatments 14 for that condition or disorder in each classification in which the 15 insurer provides benefits for core treatments for one or more medical 16 conditions or surgical procedures. If there is no core treatment for a 17 covered mental health or substance use disorder with respect to a clas- 18 sification, the insurer is not required to provide benefits for core 19 treatments for such condition or disorder in that classification, but 20 shall provide benefits for such condition or disorder in every classi- 21 fication in which medical or surgical benefits are provided. 22 (5) For the purposes of determining comparability and stringency for 23 nonquantitative treatment limitations, an insurer shall not rely upon 24 discriminatory factors or evidentiary standards to design a nonquantita- 25 tive treatment limitation to be imposed on mental health or substance 26 use disorder benefits. A factor or evidentiary standard is discriminato- 27 ry if the information, evidence, sources, or standards on which the 28 factor or evidentiary standard are based are biased or not objective in 29 a manner that discriminates against mental health or substance use 30 disorder benefits as compared to medical or surgical benefits. 31 (6) A nonquantitative treatment limitation applicable to mental health 32 or substance use disorder benefits in a classification shall not, in 33 operation, be more restrictive than the predominant nonquantitative 34 treatment limitation applied to substantially all medical or surgical 35 benefits in the classification. To test compliance with this paragraph, 36 an insurer shall collect and evaluate relevant data in a manner reason- 37 ably designed to assess the impact of the nonquantitative treatment 38 limitation on relevant outcomes related to access to mental health or 39 substance use disorder benefits and medical or surgical benefits, and 40 carefully consider the impact as part of the policy's evaluation. As 41 part of its evaluation, the insurer may not disregard relevant outcomes 42 data that it knows or reasonably should know suggest that a nonquantita- 43 tive treatment limitation is associated with material differences in 44 access to mental health or substance use disorder benefits as compared 45 to medical or surgical benefits. To the extent the relevant data evalu- 46 ated suggest that the nonquantitative treatment limitation contributes 47 per examiner to material differences in access to mental health or 48 substance use disorder benefits as compared to medical or surgical bene- 49 fits in a classification, such differences shall be considered a strong 50 indicator of a noncompliant nonquantitative treatment limitation. Where 51 the relevant data suggest that the nonquantitative treatment limitation 52 contributes to material differences in access to mental health or 53 substance use disorder benefits, the insurer shall take reasonable 54 action, as necessary, to address such differences to ensure operational 55 compliance, and shall document the actions taken to do so. 
 S. 8426 7 1 (7) An insurer providing coverage for mental health or substance use 2 disorder benefits shall submit an annual report beginning January first, 3 two thousand twenty-six and annually thereafter that contains the infor- 4 mation described in 29 U.S.C. § 1185a(a)(8)(A) or 42 U.S.C. § 5 300gg-26(a)(8)(A), as applicable, and any other information determined 6 necessary to assess compliance with this subsection. The report shall be 7 posted on a publicly available website whose web address is prominently 8 displayed in policy informational and marketing materials. 9 (8) If a health care provider or a current or prospective insured or 10 an employer requests one or more nonquantitative treatment limitation 11 parity compliance analyses that the insurer is required to have 12 completed by this subsection, the insurer shall provide the requested 13 analyses free of charge within thirty days. The insurer shall include in 14 each of its health insurance policies and provider agreements for mental 15 health and substance use disorder services a notification of the right 16 to request such analyses free of charge. Such notification shall include 17 information on how to request the analyses. In addition to any other 18 action authorized under this chapter, failure by an insurer to provide 19 the full requested analyses shall result in a penalty of one hundred ten 20 dollars per day. If the request under this paragraph is made in 21 connection with an adverse benefit determination and the insurer fails 22 to provide the requested analyses as required by this subsection, the 23 adverse benefit determination shall be automatically reversed. 24 (9) The superintendent may adopt rules or guidance as necessary to 25 implement and administer this subsection, and such rules or guidance 26 shall have the force of law, including: 27 (A) specifying data testing requirements to determine policy design 28 and application parity and nondiscrimination compliance using outcomes 29 data; 30 (B) setting standard definitions; and 31 (C) establishing specific timelines for insurer compliance with the 32 requirements of this section, including the effect of an insurer's lack 33 of sufficient comparative analyses or other required information neces- 34 sary to demonstrate compliance. 35 § 4. This act shall take effect on the one hundred twentieth day after 36 it shall have become a law and shall apply to all policies issued, 37 renewed, modified, altered or amended on or after such date. Effectively 38 immediately, the addition, amendment and/or repeal of any rule or regu- 39 lation necessary for the implementation of this act on its effective 40 date are authorized to be made and completed on or before such date.