New York State Department of Financial Services puts network adequacy rules into effect requiring behavioral health appointments within 10 business days

The New York State Department of Financial Services (DFS) announced that new network adequacy regulations are now in effect to improve access to mental health and substance use disorder treatment for members of qualifying health insurance plans. The rules require access to an initial outpatient behavioral health appointment within 10 business days of a request and mandate that plans maintain accurate, up-to-date online directories of in-network providers. The requirements apply to Medicaid Managed Care, Child Health Plus and the Essential Plan from 1 July, while the commercial insurance wait-time standards apply on a rolling basis as policies are renewed, modified or purchased on and after 1 July. Plans must also designate staff to help members find in-network providers and provide a list of available in-network providers within three business days of a member request. Provider directories must include, among other information, location, telehealth options, languages spoken, restrictions on conditions treated or ages served and facility affiliations, with the stated aim of reducing “ghost networks.” Consumers can file complaints with the New York State Department of Health (DOH) for Medicaid, Essential Plan or Child Health Plus coverage, or with DFS for state-regulated commercial coverage; the announcement also cited the CHAMP resource for help with insurance issues and complaint filing. The state budget includes USD 1 million for enforcement-related activities, including compliance and oversight resources and complaint investigation and mediation, and the release reiterated existing state requirements on reimbursement floors for certain in-network outpatient services and the use of transparent, nonprofit clinical guidelines to support coverage of medically necessary treatments.