

DFS Superintendent Adrienne A. Harris Announces Proposed Regulation Requiring Insurers To Provide Increased Access For Mental Health And Substance Use Disorder Services
New York State Department of Financial Services (DFS) Superintendent Adrienne A. Harris today announced a proposed regulation to establish network adequacy standards for behavioral health services, including the establishment of appointment wait times for behavioral health care for the first time in New York history for commercial insurance coverage.
“This proposed regulation will improve access to desperately needed mental health and substance use treatment for all New Yorkers,” said Superintendent Harris. “The Department is committed to breaking down barriers to critical care and today's proposal continues our efforts to build a more equitable, transparent, and resilient health care system in New York."
Today’s announcement builds upon Governor Hochul’s commitment to increase access to mental health care by making provider directories easier to navigate and provider network adequacy requirements relating to appointment wait times. If an appointment with an in-network provider is not available within the established appointment wait times, New Yorkers will be able to access treatment from an out-of-network provider who is able to meet the appointment wait times, at the in-network cost-sharing.
The regulation proposed today establishes important consumer protections including:
- appointment wait time standards for insurers for behavioral health services;
- 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 no additional cost;
- 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
- insurers must now submit to DFS an annual certification regarding an insurer’s access plan that must include collection of data and monitoring of its behavioral health network.
The proposed regulation is subject to a 60-day comment period upon publication in the State Register. DFS looks forward to and appreciates receiving feedback on the proposed regulation during the comment period. For more information, a copy of the proposed regulation can be found on the DFS website. While the DFS regulation is specific to commercial health insurance plans, the New York State Department of Health (DOH) has proposed an identical regulation for health maintenance organizations (HMOs), including Medicaid managed care plans, child health plus, and the essential plan. Interested parties can comment on the DOH regulation here.
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