NY| The new regulation 11 NYCRR 38 (Insurance Regulation 230) for network adequacy and access standards for mental health and substance use disorder treatment services in New York State will be effective July 1, 2025. These regulations aim to improve access to behavioral health services by establishing standards for health care plans.
Key points:
- Health care plans must ensure adequate provider networks to meet insureds’ behavioral health needs, including specific provider types like residential facilities for sub-acute care and mobile crisis intervention services.
- Appointment wait time standards are set, requiring initial appointments within 10 business days for outpatient facilities or health care professionals, and within 7 calendar days following hospital discharge.
- If appointment wait times cannot be met, health care plans must approve referrals to non-participating providers at in-network cost-sharing rates.
- Provider directories must include detailed information about behavioral health providers, including services offered, languages spoken, and telehealth availability.
- Health care plans must submit annual certifications confirming compliance with access plans, appointment wait time standards, and provider directory verification requirements.