New State regulations speed up access to behavioral health care

ALBANY | Gov. Kathy Hochul has announced that new network adequacy regulations give New Yorkers with qualifying health insurance plans access to an initial outpatient appointment for behavioral health care within 10 business days of the request. These new consumer protections also require these plans to post up-to-date and accurate lists of in-network providers on their websites, which will help to eliminate inaccurate or misleading directories. "New Yorkers in need of mental health or substance use disorder treatment should not be forced to wait months for essential care or to cover these costs themselves when their plan doesn't include any available providers," Gov. Hochul said. "These new regulations will help remove barriers that often force individuals and families to pay out-of-pocket for care or forgo treatment altogether." As of July 1, New Yorkers covered by Medicaid Managed Care, Child Health Plus, and the Essential Plan are entitled to these important consumer protections for appointment wait times. For New Yorkers covered by commercial health insurance plans, these wait time standards will take effect on a rolling basis as their policies are renewed, modified, or purchased on and after July 1. The regulations also require plans to have dedicated employees who can help their members find an in-network provider. Additionally, the plans must provide a list of available in-network providers within three business days, following a member's request. New Yorkers unsure of their coverage should contact their insurer or employer. Those needing mental health or substance use disorder services should also check their health insurance policies for a list of what is covered. Plans must post an accurate and up-to-date directory of their provider network, including health care professionals or facilities, the provider's location, telehealth options, languages spoken, any restrictions concerning the conditions treated or ages served, and facility affiliations, among other information. Accurate directories will help to eliminate so-called 'ghost networks' –ones that give the appearance of offering in-network options, but instead list inaccurate information or providers that aren't taking appointments. New York State Department of Financial Services Superintendent Adrienne Harris said, "This regulation is a significant step toward getting New Yorkers the critical care they need, when they need it. From banking, to insurance, to cryptocurrency, the Department will continue working to build a more equitable, transparent, and resilient financial system for all New Yorkers." The new regulations also provide avenues for consumers to file a complaint against plans or insurers not in compliance. New Yorkers covered by Medicaid, Essential Plan, or Child Health Plus can contact DOH; those with state-regulated commercial insurance coverage may contact DFS. For more information about mental health and substance use disorder treatment coverage requirements and protections, visit here. The Community Health Access to Addiction & Mental Healthcare Project, or 'CHAMP,' is a resource available to help people with insurance issues related to substance use disorder and mental health care. CHAMP can answer questions, help file complaints against insurance companies, and assist with insurance denial appeals. Gov. Hochul also secured $1 million in the FY 2026 Enacted State Budget to help enforce state regulations so that insurers provide the mental health care and substance use disorder coverage their members deserve. This includes new resources to strengthen compliance and oversight, educate consumers and providers, and investigate and mediate complaints.

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New State regulations speed up access to behavioral health care

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