The New York State Insurance Department has posted a draft of guidance concerning implementation of the federal Mental Health Parity and Addiction Equity Act of 2008.
In the guidance, officials note that New York already requires state-regulated health insurance policies sold in the state to include outpatient substance use disorder benefits.
Because of that existing state requirement, the federal regulations implementing the MHPAEA will have the effect of requiring New York health policies and contracts to “include substance use disorder benefits in every other classification for which the contract or policy provides medical/surgical benefits, including in the inpatient classification,” officials write in the draft guidance.
It appears that a group health plan can place an annual day limitation on inpatient rehabilitation for substance use disorders only if the plan places the same kind of limit on inpatient care for medical or surgical conditions, officials write in the draft.
A plan might be able to require a specialty care co-payment for use of mental health or substance use disorder services, but, in that case, the insurer will have to make sure that a specialty care co-payment requirement applies to at least two-thirds of comparable medical and surgical benefits, officials write.