Mental Health and Substance Use Disorder Health Insurance Coverage Parity
Many New Yorkers struggle to find in-network mental health and substance use disorder (MH/SUD) providers. Along with costly premiums and co-pays, they may also be at risk of not getting life-saving care. These barriers can raise concerns if the health insurance plan treats access to similar medical or surgical services differently than access to MH/SUD services.
New York State (NYS) is overseeing and enforcing parity laws to ensure MH/SUD services are accessible to the people who need them, when they need them.
Learn more about state and federal parity laws
RESOURCES FOR NEW YORKERS
Mental Health Parity: Ending Discrimination in Health Insurance Coverage Webinar
Commissioner Sullivan discusses how NYS is leading the way in enforcing mental health parity with The Kennedy Forum.
Mental Health Parity Information from NYS Office of the Attorney General (AG)
Learn more about mental health parity laws and the resources available to ensure equal access to treatment coverage.
Parity Red Flags for Health Insurance Plan Members
List of “red flags” that your health plan may not be complying with federal or NYS parity laws.
Medical Necessity Criteria: Notification for Health Insurance Plan Members
Health insurance plan members in NYS are entitled to request and receive copies of medical necessity criteria used by health plans to make determinations regarding behavioral health benefits.
You or your provider can use the form letters from the Parity Enforcement Project Initiative to request this information.
Health plan members are also entitled to request and receive a copy of the most recent comparative analysis performed by their health insurance plan to assess compliance with federal parity laws and regulations.
If your health insurance plan refuses to provide this information to you, contact the Consumer Assistance Unit of the NYS Department of Financial Services (DFS) at 1-800-342-3736.
CHAMP – Behavioral Health Ombudsman Program
The Community Health Access to Addiction and Mental Health Care Project, "CHAMP," fights for New Yorkers facing insurance obstacles to treatment. Anyone who seeks treatment should get it, regardless of their ability to pay.
CHAMP Email: firstname.lastname@example.org
CHAMP Helpline: 888-614-5400
RESOURCES FOR HEALTH INSURERS
NYS OMH Parity Compliance Toolkit
The toolkit is a collection of information and resources to support insurers, providers, and health plan members in understanding parity and NYS’ efforts toward achieving MH/SUD parity compliance.
Medical Necessity Criteria for NYS Regulated Health Insurers
Important information for health insurers conducing utilization review of MH services.
REPORTS AND OVERSIGHT
Mental Health SUD Parity Data 2019-2020
Insurance Law § 343 requires commercial insurers to submit a biennial MH/SUD Parity Report to the DFS to help measure compliance with federal and state parity laws for MH/SUD treatment. The 2019-2020 Parity Reports submitted by insurers are posted on the DFS website.
NYS Mental Health Parity and Addiction Equity Act Report - March 2022
The Department of Health, Office of Mental Health, and Office of Addiction Services and Supports review of Medicaid Managed Care Plans, Alternative Benefit Plans, and Children’s Health Insurance Program (CHIP) Plans for mental health and substance use treatment benefit coverage.
NYS Mental Health Parity Report - May 2018
Report from the NYS Office of the Attorney General stemming from an industry-wide investigation of health plans’ compliance with state and federal mental health and addiction parity laws.
Citations and Findings
Oversight findings and citations issued to Medicaid Managed Care Plans for noncompliance with behavioral health laws and regulations.
To report a disparity in MH/SUD benefits, please contact:
New York Department of Financial Services Online Complaint Form
Consumer Assistance Unit: 1-800-342-3736
New York Department of Health
New York Attorney General Health Care Bureau Online Complaint Form
If you have any questions about Mental Health Parity in NYS, you can email OMH.Parity@omh.ny.gov.