New York: Circular Letter Addresses Reimbursement for Treatment by School-Based Mental Health Clinics

January 03, 2024

On December 21, 2023, the Department of Financial Services (DFS) issued a circular letter to advise health insurers of the coverage reimbursement requirements for treatment provided by school-based mental health clinics. 

Specifically, for comprehensive health insurance policies and contracts issued, renewed, amended, modified, or altered on or after January 1, 2024, insurers must provide reimbursement for covered outpatient care when provided by a school-based mental health clinic licensed at a pre-school, elementary school, or secondary school, regardless of whether the school-based mental health clinic furnishing such services is a participating provider with respect to such services. Such reimbursement must be at either the negotiated rate or a rate that is no less than the Medicaid rate. 

Although the letter is directed at insurers, sponsors of insured plans with policies issued in the state may want to be aware of this coverage requirement. 

Insurance Circular Letter No. 9 (2023): Reimbursement for Treatment Provided by School-Based Mental Health Clinics