NY S07912

Requires all health insurance policies with hospital, major medical, or comprehensive coverage to provide inpatient and outpatient coverage for substance use disorder treatment, including detoxification and rehabilitation services, effective April 1, 2015.

Mandates that substance use disorder coverage cannot have more restrictive financial requirements or treatment limitations than other medical and surgical benefits, and must comply with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

Provides up to 20 annual outpatient visits for family members of individuals with substance use disorder who seek treatment as family members under applicable policies.

Requires utilization review agents to use evidence-based clinical review criteria approved by the Office of Alcoholism and Substance Abuse Services when reviewing substance use disorder treatment coverage, and permits peer reviewers to be physicians or health care professionals specializing in behavioral health and substance use disorder treatment.

Establishes expedited 24-hour appeal and determination processes for inpatient substance use disorder treatment, and directs the Commissioner of Alcoholism and Substance Abuse Services, Superintendent of Financial Services, and Commissioner of Health to form a workgroup by June 17, 2014 to study and recommend improvements to substance use disorder treatment access and insurance coverage by December 31, 2015.