Insights

Bulletin on Coverage for Peer Support Services Provided as Part of a Substance Use Disorder Outpatient Program


On December 20, 2019, the Department of Financial Services (DFS) published Circular Letter No. 14 (2019). As background, New York law requires every policy or contract that provides medical, major medical, or similar comprehensive-type coverage to provide outpatient coverage for the diagnosis and treatment of substance use disorder, including detoxification and rehabilitation services. Coverage may be limited to facilities in New York that are licensed, certified, or otherwise authorized by the Office of Addiction Services and Supports (OASAS) to provide outpatient substance use disorder services and, in other states, to those facilities that are accredited by the Joint Commission as alcoholism or chemical dependence substance abuse treatment programs and are similarly licensed, certified, or otherwise authorized in the state in which the facility is located.

According to the letter, carriers may not deny as a non-covered benefit medically necessary peer support services provided as part of an outpatient substance use disorder program by a facility licensed, certified, or otherwise authorized by OASAS to provide outpatient substance use disorder services if all the other terms and conditions of the policy or contract are met.

The letter contains no new specific compliance requirements for employers. But employers with fully insured plans in New York should be aware of the coverage as outlined in the letter.

Circular Letter No. 14 (2019) »