Network Adequacy Standards Aimed at Improving Access to Mental Health and Substance Use Disorder Care
Regulations to Help Millions of New Yorkers Covered by Medicaid Managed Care, Child Health Plus, Essential Plan, and Commercial Health Insurance Plans
Enhanced Regulations to Make Mental Health Care More Affordable by Increasing Access to In-Network Care
Governor Kathy Hochul today 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,” Governor 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.”
New York State Office of Mental Health Commissioner Dr. Ann Sullivan said, “These regulations remove barriers that either slowed or prevented New Yorkers from accessing critical behavioral health care services. Ensuring timely access and adequate networks of providers by plans and commercial insurers, we enable individuals and families to have access to high-quality mental health and substance use services whenever needed. These new regulations reflect Governor Hochul’s commitment to expanding access to behavioral health care statewide.”
New York State Health Commissioner Dr. James McDonald said, “Timely access to behavioral health care can be life-changing, and in many cases, lifesaving. These new regulations help ensure that all New Yorkers, regardless of their type of coverage, can access the mental health and substance use care they need, when they need it. I thank Governor Hochul for her unwavering commitment to protect the health of New Yorkers and advance health equity across the state.”
New York State Office of Addiction Services and Supports Commissioner Dr. Chinazo Cunningham said, “These new regulations will make it easier for people to quickly access the addiction and mental health care and resources they need. By continuing to remove barriers to these services, and strengthening consumer protections for those accessing help, we are continuing to support Governor Hochul’s vision to improve services across the state and help all New Yorkers live healthier lives.”
State Senator Nathalia Fernandez said, “While the federal government pulls back from their responsibility to protect health care, New York is moving forward. These new regulations are about making sure coverage means real, timely care. I thank Governor Hochul for taking action to strengthen access to mental health and substance use care. That’s the kind of leadership this moment demands.”
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.
Governor 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.
Under Governor Hochul’s leadership, New York is leading the nation in requiring health insurers to cover behavioral health services and continues to develop tools to ensure these companies are following all applicable laws. The state now requires commercial insurers to reimburse covered outpatient mental health and substance use disorder services provided by in-network OMH- and OASAS-licensed facilities at no less than the Medicaid rate; and requires commercial and Medicaid health plans to use transparent, nonprofit clinical guidelines and cover all medically necessary treatments.
The 988 Suicide & Crisis Lifeline connects New Yorkers to trained crisis counselors 24/7, who can help anyone thinking about suicide, struggling with substance use, experiencing a mental health crisis, or any other kind of emotional distress. New Yorkers can call, text or chat 988 if they are worried about someone who may need crisis support.
New Yorkers struggling with an addiction, or whose loved ones are struggling, can find help and hope by calling the state’s toll-free, 24-hour, 7-day-a-week HOPEline at 1-877-8-HOPENY (1-877-846-7369) or by texting HOPENY (Short Code 467369).
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