NY A10164

Requires all health insurance policies providing hospital, major medical, or comprehensive coverage to include inpatient coverage for substance use disorder diagnosis and treatment, including detoxification and rehabilitation services, without more restrictive financial requirements or treatment limitations than applied to medical and surgical benefits.

Requires all health insurance policies to provide outpatient coverage for substance use disorder treatment and allows up to 20 outpatient visits per year for family members of persons with substance use disorder seeking treatment.

Mandates that utilization review determinations for substance use disorder treatment be conducted by physicians specializing in behavioral health or licensed health care professionals with substance use disorder treatment experience, and establishes expedited 24-hour appeal processes for inpatient substance use disorder treatment denials.

Requires utilization review agents to use evidence-based and peer-reviewed clinical review criteria approved by the Office of Alcoholism and Substance Abuse Services when evaluating substance use disorder treatment coverage.

Creates a workgroup to study and report by December 31, 2015 on barriers to substance use disorder treatment access, clinical best practices, insurance coverage improvements, and quality standards for treatment facilities.