Hochul expands access to mental health & substance use disorder treatment

New network adequacy standards designed to reduce appointment wait times and make provider directories easier to navigate

Submitted by the Office of Gov. Kathy Hochul

Gov. Kathy Hochul announced new network adequacy regulations for behavioral health services will now entitle New Yorkers to an initial appointment for behavioral health care within 10 business days of the request, or seven calendar days following hospital discharge. Under the regulations adopted by the New York State Department of Financial Services and state Department of Health, insurers unable to meet these time frames will have to offer out-of-network mental health or substance use disorder coverage without increasing the cost for the consumer.

“New Yorkers deserve a speedy and effective process to receive the services they need,” Hochul said. “The regulations established by the Department of Financial Services and Department of Health will standardize wait times, allow for same cost-sharing and update directories – providing individuals more access to mental health and substance use disorder care statewide.”

Additionally, insurers are required to update their provider directories to include clearer details on the availability of behavioral health services, including provider locations (city/town and ZIP code), telehealth availability and languages spoken by the provider.

New York State Department of Financial Services Superintendent Adrienne Harris said, “This regulation helps New Yorkers to get mental health and substance use disorder treatments more quickly. The department is dedicated to eliminating obstacles to care, and this initiative furthers our mission to create a more inclusive, transparent and resilient health care system across the state.”

New York State Health Commissioner Dr. James McDonald said, “Network adequacy is about making sure third-party payers have enough health care providers to meet their patient’s needs. These regulations will help New Yorkers who too often wait weeks or even months for an initial appointment for mental health or substance use disorder treatment.”

Office of Mental Health Commissioner Dr. Ann Sullivan said, “New Yorkers should be able to access high-quality behavioral health care services whenever and wherever they are in need. These new network adequacy regulations will ensure that commercial insurance carriers provide this coverage in a timely manner by setting a standard, and so that people needing this care can easily access it when they need it. These changes highlight Gov. Hochul’s continued focus on strengthening our mental health care system and expanding access statewide.”

The regulation establishes important consumer protections including:

•Standard wait times: Initial appointment time of 10 business days or less, and other appointment wait time standards for insurers for behavioral health services;

•Same cost-sharing: 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 the in-network cost-sharing rate;

•Updated directories: 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

•Insurer compliance: Insurers and managed care organizations must now submit to DFS and DOH an annual certification regarding an insurer’s access plan that must include collection of data and monitoring of its behavioral health network.

The DFS regulation, which applies to commercial health insurance plans, takes effect July 1. A copy is available on the DFS website.

Additionally, DOH has proposed an identical regulation for HMOs – including Medicaid managed care plans, child health plus and the essential plan. This regulation goes into effect on July 1, and is available on the DOH website.

Today’s announcement builds upon Hochul’s ongoing efforts to expand access to critical health services. Over the past two years, she has made multibillion-dollar investments in safety-net hospitals, passed the largest Medicaid rate increases in more than a decade, and announced $2.6 billion in capital transformation funding to help transform and modernize New York’s health care facilities. Additionally, Hochul signed legislation to prevent medical debt from negatively impacting New Yorkers’ access to credit in 2023.

Hochul has made strengthening mental health care statewide a priority of her administration. Adopted in FY 2024, her landmark $1 billion multi-year plan has bolstered prevention efforts, greatly expanded community access to mental health supports, and has developed supports for New Yorkers with the highest needs.

This investment is tripling the number of Certified Community Behavioral Health Clinics statewide, adding 42 new assertive community treatment teams and creating 50 critical time intervention teams. The governor’s plan has also created nearly 1,300 new units of specialized housing for individuals living with mental illness, with about 2,200 units in the pipeline to be developed.

Hochul has also added 325 inpatient beds at state-operated psychiatric centers and restored 550 beds that were offline at community-based hospitals. Under the governor’s direction, the state also established new hospital admission and discharge regulations to ensure quality care and safe, thoughtful discharge plans to help connect individuals leaving emergency and inpatient care with community-based support.

New York State Sen. Samra G. Brouk said, “We must ensure that those suffering through a mental health or substance use crisis can get the care they need quickly. I applaud Gov. Hochul’s plan to adopt new network adequacy regulations for behavioral health services, as it will reduce wait times and open doors to care for New Yorkers in need.”