NY A03104

Changes insurance law to require inpatient coverage for substance use disorder treatment to include "clinically necessary" treatment (not just "medically necessary") at the discretion of the service provider, including residential settings.

Renames the "office of alcoholism and substance abuse" to the "office of addiction services and supports" throughout the statute.

Defines "clinical necessity" to include both an individual's medical needs and social determinants of health that promote stability following discharge from treatment.

Requires insurers to deny coverage for the first 28 days of inpatient treatment only if treatment was not indicated by the office-designated clinical review tool, and any denial must specifically explain how the tool was applied and compare application to outpatient medical/surgical benefits.

Establishes that concurrent and retrospective utilization review must comply with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and applicable regulations.