§ 343. Mental health and substance use disorder parity report. (a)
Beginning July first, two thousand nineteen and every two years
thereafter, each insurer providing managed care products, individual
comprehensive accident and health insurance or group or blanket
comprehensive accident and health insurance, each corporation organized
pursuant to article forty-three of this chapter providing comprehensive
health insurance and each entity licensed pursuant to article forty-four
of the public health law providing comprehensive health service plans
shall submit to the superintendent, in a form and manner prescribed by
the superintendent, a report detailing the entity's compliance with
federal and state mental health and substance use disorder parity laws
based on the entity's record during the preceding two calendar years.
The superintendent shall publish on the department's website on or
before October first, two thousand nineteen, and every two years
thereafter, the reports submitted pursuant to this section.

(b) Each person required to submit a report under this section shall
include in the report the following information:

(1) Rates of utilization review for mental health and substance use
disorder claims as compared to medical and surgical claims, including
rates of approval and denial, categorized by benefits provided under the
following classifications: inpatient in-network, inpatient
out-of-network, outpatient in-network, outpatient out-of-network,
emergency care, and prescription drugs;

(2) The number of prior or concurrent authorization requests for
mental health services and for substance use disorder services and the
number of denials for such requests, compared with the number of prior
or concurrent authorization requests for medical and surgical services
and the number of denials for such requests, categorized by the same
classifications identified in paragraph one of this subsection;

(3) The rates of appeals of adverse determinations, including the
rates of adverse determinations upheld and overturned, for mental health
claims and substance use disorder claims compared with the rates of
appeals of adverse determinations, including the rates of adverse
determinations upheld and overturned, for medical and surgical claims;

(4) The percentage of claims paid for in-network mental health
services and for substance use disorder services compared with the
percentage of claims paid for in-network medical and surgical services
and the percentage of claims paid for out-of-network mental health
services and substance use disorder services compared with the
percentage of claims paid for out-of-network medical and surgical
services;

(5) The number of behavioral health advocates, pursuant to an
agreement with the office of the attorney general if applicable, or
staff available to assist policyholders with mental health benefits and
substance use disorder benefits;

(6) A comparison of the cost sharing requirements including but not
limited to co-pays and coinsurance, and the benefit limitations
including limitations on the scope and duration of coverage, for medical
and surgical services, and mental health services and substance use
disorder services for coverage in the individual, small group, and large
group markets, provided that the comparison captures at least
seventy-five percent of a company's enrollees in each market;

(7) The number by type of providers licensed to practice in this state
that provide services for the treatment and diagnosis of substance use
disorder who are in-network, and the number by type of providers
licensed to practice in this state that provide services for the
diagnosis and treatment of mental, nervous or emotional disorders and
ailments, however defined in a company's policy, who are in-network;

(8) The percentage of providers of services for the treatment and
diagnosis of substance use disorder who remained participating
providers, and the percentage of providers of services for the diagnosis
and treatment of mental, nervous or emotional disorders and ailments,
however defined in a company's policy, who remained participating
providers; and

(9) Any other data, information, or metric the superintendent deems
necessary or useful to measure compliance with mental health and
substance use disorder parity including, but not limited to an
evaluation and assessment of: (i) the adequacy of the company's
in-network mental health services and substance use disorder provider
panels pursuant to provisions of the insurance law and public health
law; and (ii) the company's reimbursement for in-network and
out-of-network mental health services and substance use disorder
services as compared to the reimbursement for in-network and
out-of-network medical and surgical services.