DE SB100

Extends mental health parity and addiction equity protections to Medicaid health plans, ensuring the same substance use disorder treatment coverage as private insurance plans.

Requires carriers to provide unlimited medically necessary treatment for drug and alcohol dependencies using the full set of American Society of Addiction Medicine (ASAM) criteria in residential settings, intensive outpatient programs, and inpatient withdrawal management.

Prohibits concurrent utilization review during the first 14 days of inpatient admission, 30 days of intensive outpatient program treatment, or 5 days of inpatient withdrawal management, provided facilities notify carriers within 48 hours of admission.

Permits carriers to deny coverage only if treatment contradicts evidence-based ASAM clinical review tools, and allows retrospective review of services provided during the protected treatment periods.

Adds ASAM criteria definition to both insurance statutes (§3343 for private insurance and §3578 for Medicaid) to standardize medical necessity determinations for addiction treatment across all health benefit plans.