NY S07882

Requires all health insurance policies providing medical or comprehensive coverage to include diagnosis and treatment of substance use disorder benefits, including both inpatient and outpatient treatment, detoxification, and rehabilitation services, in compliance with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

Mandates that health plans continue coverage and reimbursement for substance use disorder treatment services during all internal and external appeals of adverse determinations, with no greater out-of-pocket costs to the insured than if the services were initially approved.

Requires utilization review agents conducting reviews for substance use disorder treatment to be healthcare providers specializing in behavioral health with experience in addiction treatment, and mandates use of evidence-based clinical review criteria approved by the Office of Alcoholism and Substance Abuse Services.

Establishes expedited appeal processes for substance use disorder treatment determinations, including expedited external appeals when delay would pose serious threat to the patient's health or safety.

Creates a workgroup chaired by the commissioners of health and alcoholism/substance abuse services and the superintendent of financial services to study barriers to treatment access, best practices, insurance coverage improvements, and quality standards, with findings due December 31, 2015.