State Seeks To Set 10-Day Maximum Wait Time For Mental Health Care Visits
By Amanda D’Ambrosio Crain’s Health Pulse February 22, 2024
State officials proposed new rules Wednesday that aim to establish better network adequacy for behavioral health providers, imposing maximum wait times for visits and requiring private insurers to take on a bigger role in helping patients secure an appointment.
The draft rules, which were published by the Department of Financial Services, would mark the first time in history that New York established a maximum wait time for behavioral health appointments for patients with commercial insurance.
The rules require health plans to help patients secure a behavioral health visit within 10 days of their initial request for an appointment. The proposed maximum wait time for people leaving hospital settings is seven days after discharge.
State officials also proposed ways to ensure that insurance companies help New Yorkers get timely care. If a patient is unable to secure an in-network visit within the standard wait time, the state would require health plans to find an out-of-network provider at no additional cost to the patient.
The proposed rules aim to make sure that insurers’ behavioral health provider directories are up-to-date and adequate – an attempt to safeguard patients’ ability to get care. DFS is seeking to require health plans to list contact information and descriptions for each provider on their directories, including the specific age groups and mental health conditions that each provider treats.
DFS Superintendent Adrienne Harris said in a statement that the proposed rules will improve access to “desperately needed mental health and substance use treatment for all New Yorkers.”
The proposed DFS regulation would only cover commercial health plans, but the Department of Health proposed an identical regulation for health maintenance organizations, including Medicaid managed care plans, Child Health Plus, and the Essential Plan.
The rules come on the heels of a report released by Attorney General Letitia James last December which showed that health insurers made it harder for patients to access mental health care. The report found that 86% of providers listed on health plan directories were “ghosts” – meaning that they were out-of-network, not accepting new patients, or just nonexistent.
Gov. Kathy Hochul has since proposed efforts to improve access to behavioral health care, including commitments to boost network adequacy regulations and require insurers to provide timely, in-network care in her executive budget.
The health insurance industry has expressed concerns that the proposed rules would not be attainable for insurers in a health care staffing crisis. Eric Linzer, president and CEO of the New York Health Plan Association, said that the organization’s members “take seriously their obligation to provide comprehensive behavioral health benefits.”
“The major challenge facing the behavioral health care system — in New York and across the country — is a provider shortage,” Linzer said. “New York does not currently have enough behavioral health providers to meet the proposed appointment wait time standards, and mandating health plans to either meet the standards or pay out-of-network rates for the services will not create behavioral health provider capacity.”
The proposed DFS and DOH network adequacy regulations will go up for a 60-day comment period. The comment period will expire on April 22.