Mental Health and Substance Use Disorder 

Access to treatment for mental health and substance use disorders (MH/SUD) is essential to the health and well-being of all New Yorkers. MH/SUD services must be covered in health insurance policies sold in New York. In order to help you understand your insurance coverage for MH/SUD treatment, please click here to read the DFS consumer brochure.


For Additional Information on MH/SUD Benefits and Services, See the Links Below:

New York State Office of Addiction Services and Supports

New York State Office of Mental Health

New York State Department of Health


For Questions and Complaints About Health Insurance Coverage of Mental Health and Substance Use Disorder Treatment:

Questions.  If you have questions about your health insurance coverage, call DFS at (800) 342-3736 (available Monday through Friday, 8:30 AM to 4:30 PM). Local calls can be made to (212) 480-6400 or (518) 474-6600.

Complaints.  You can file a complaint with DFS, with the Department of Health (DOH) or with an independent ombudsman program, depending on the type of coverage you have.

  • If you are covered by an insurer or HMO.  File a complaint with DFS online at www.dfs.ny.gov/Complaint.  We will investigate your complaint.  We may share a copy of your complaint with your insurer or refer it to another state agency, if applicable.
  • If you have Medicaid, Essential Plan, or Child Health Plus coverage.  File a complaint with DOH.  For more information: 
    • Medicaid:  (800) 541-2831
    • Medicaid Managed Care:  (800) 206-8125 or [email protected]
    • Child Health Plus:  (800) 698-4543 or locally at (518) 473-0566
    • Essential Plan:  (855) 355-5777   
  • If you are covered by an insurer or HMO or you have Medicaid, Essential Plan, or Child Health Plus.  You may also ask for help from New York’s independent Behavioral Health Ombudsman Program if you have questions or a complaint, or want to file an appeal for denied treatment with your insurer or HMO.  The Community Health Access to Addiction & Mental Healthcare Project (“CHAMP”) helpline can be reached by calling 888-614-5400 Monday-Friday, 9:00 AM-4:00 PM or by sending an email to: [email protected].

For Information About MH/SUD Parity Laws:

What is parity?

MH/SUD parity means that your MH/SUD benefits must be comparable to the medical/surgical (M/S) benefits in your insurance policy.

What federal laws govern parity?

The federal Mental Health Parity Act of 1996 required that large group health plans could not impose lifetime dollar limits on mental health benefits that were less favorable than the limits imposed on medical and surgical benefits. Since then, additional federal parity laws related to mental health have been passed.

The federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) ensures that group health insurance plans treat MH/SUD and M/S benefits similarly by preventing health insurance plans from imposing less favorable benefit limitations on MH/SUD than on M/S benefits. An Amendment to the Affordable Care Act (ACA) added this coverage requirement to individual health plans as well.

The following  links provide additional information on federal MHPAEA and parity requirements:

What state laws govern parity?

New York Insurance Law requires insurance coverage to be consistent with MHPAEA and imposes additional MH/SUD coverage requirements. The following New York laws, regulations, and industry guidance provide information on MH/SUD requirements.

Laws

MH/SUD

GROUP COMMERCIAL HEALTH INSURANCE POLICIES

INDIVIDUAL COMMERCIAL HEALTH INSURANCE POLICIES

HMO/ARTICLE 43 HEALTH INSURANCE POLICIES

Inpatient SUD Services

§3221(l)(6)

§3216(i)(30)

§4303(k)

Outpatient SUD Services

§3221(l)(7)

§3216(i)(31)

§4303(l)

Inpatient and Outpatient MH Services

§3221(l)(5)

§3216(i)(35)

§4303(g)

Prescription Medications to Treat SUD

§3221(l)(7-b)

§3216(i)(31-a)

§4303(l-2)

SUD Clinical Review Criteria

§4902(a)(9)

 §4902(a)(9)

§4902(a)(9)

MH Clinical Review Criteria

§4902(a)(12)

§4902(a)(12)

§4902(a)(12)

Participating Provider Directory

§§3217-a(a)(17)

§§3217-a(a)(17)

§4324(a)(17)

Disclosure of Comparative Analysis

§3217-a(a)(21)

§3217-a(a)(21)

§4324(a)(22)

Regulations

Circular Letters

FAQs

  • Mental Health and Substance Use Disorder (MH/SUD) FAQs
  • Mental Health Services for Essential Workers FAQs

For Information About MH/SUD Parity Reporting Requirements


Additional Resources

New York State Office of Mental Health