State access to mental health treatment expanded

Gov. Kathy Hochul announced that new network adequacy regulations for behavioral health services will now entitle New Yorkers to an initial appointment for behavioral health care within 10 business days of the request, or seven calendar days following hospital discharge.

Under the regulations adopted by the New York State Department of Financial Services and State Department of Health, insurers unable to meet these timeframes will have to offer out-of-network mental health or substance use disorder coverage without increasing the cost for the consumer.

"New Yorkers deserve a speedy and effective process to receive the services they need," Hochul said. "The regulations established by the Department of Financial Services and Department of Health will standardize wait times, allow for same cost-sharing and update directories - providing individuals more access to mental health and substance use disorder care statewide."

Additionally, insurers are required to update their provider directories to include clearer details on the availability of behavioral health services, including provider locations (city/town and zip code), telehealth availability and languages spoken by the provider.

"This regulation helps New Yorkers to get mental health and substance use disorder treatments more quickly," New York State Department of Financial Services Superintendent Adrienne Harris said.

"The department is dedicated to eliminating obstacles to care, and this initiative furthers our mission to create a more inclusive, transparent, and resilient health care system across the state."

"New Yorkers should be able to access high-quality behavioral health care services whenever and wherever they are in need," New York State Office of Mental Health Commissioner Dr. Ann Sullivan said. "These new network adequacy regulations will ensure that commercial insurance carriers provide this coverage in a timely manner by setting a standard and so that people needing this care can easily access it when they need it. These changes highlight Governor Hochul's continued focus on strengthening our mental health care system and expanding access statewide."

The regulation establishes important consumer protections including:

Standard wait times: Initial appointment time of 10 business days or less, and other appointment wait time standards for insurers for behavioral health services;

Same cost-sharing: Requirements for insurers to assist consumers in accessing in-network providers within those standards. When an in-network provider is not available within those standards, the regulation will require insurers to allow access to an out-of-network provider who can meet those standards, at the in-network cost-sharing rate;

Updated directories: Specific information to be included in provider directories, including provider affiliations with facilities and restrictions on a provider's scope of services, such as age of patients or mental health conditions treated; and

Insurer compliance: Insurers and managed care organizations must now submit to DFS and DOH an annual certification regarding an insurer's access plan that must include collection of data and monitoring of its behavioral health network.

The DFS regulation, which applies to commercial health insurance plans, takes effect on July 1. A copy is available on the DFS website.

Additionally, DOH has proposed an identical regulation for HMOs - including Medicaid managed care plans, child health plus and the essential plan. This regulation goes into effect on July 1 and is available on the DOH website.

This investment is tripling the number of Certified Community Behavioral Health Clinics statewide, adding 42 new Assertive Community Treatment teams and creating 50 Critical Time Intervention teams - all crucial to providing outpatient care to help individuals live in their community. The Governor's plan has also created nearly 1,300 new units of specialized housing for individuals living with mental illness, with about 2,200 units in the pipeline to be developed.