New York State Department of Financial Services adopts behavioral health network adequacy rules with 10-business-day access standard effective July 1 2025

The New York State Department of Financial Services (DFS), alongside the New York State Department of Health (DOH), has adopted network adequacy regulations for behavioral health services that set maximum wait times for accessing care. The rules entitle consumers to an initial behavioral health appointment within 10 business days of a request, or within seven calendar days after hospital discharge, and require insurers that cannot meet these timeframes to provide out-of-network mental health or substance use disorder coverage without higher consumer cost. The framework includes standardized appointment wait-time requirements and “same cost-sharing” protections, requiring insurers to help consumers access in-network providers and, where timely in-network care is unavailable, to permit access to an out-of-network provider at the in-network cost-sharing rate. Insurers must also enhance provider directories with clearer information on provider location, telehealth availability, languages spoken, facility affiliations, and any limits on scope of services, and insurers and managed care organizations must submit an annual certification to DFS and DOH covering the insurer’s access plan, including data collection and monitoring of its behavioral health network. The DFS regulation applies to commercial health insurance plans and takes effect on July 1, 2025. DOH has proposed an identical regulation for health maintenance organizations, including Medicaid managed care plans, Child Health Plus and the Essential Plan, which is set to take effect on July 1, 2025.