New York Regulations Promote Network Adequacy and Access Standards for Mental Health and Substance Use Disorder Treatment Services

June 03, 2025

Both the New York State Department of Financial Services (DFS) and State Department of Health (DOH) recently adopted “network adequacy” regulations that will require healthcare plans in the state to improve access to behavioral health services, including mental health and substance use treatment services. The new regulations take effect on July 1, 2025, and specifically require a covered plan to:

• Provide an initial appointment for behavioral healthcare within 10 business days of a member’s request, or within seven calendar days following a member’s discharge from a hospital or emergency room visit.
  • Where in-network coverage is not available to support these timeframes, the plan must approve a referral to an out-of-network provider, at the in-network cost-sharing rate.
• Update provider directories with detail regarding practice locations, provider affiliations, and any restrictions on scope of services.
• Maintain compliance by establishing and maintaining an “access plan” with protocols for ensuring access to behavioral health services and monitoring provider capacity. Written certification of compliance will be required annually, with the first report due by December 31, 2026.

The DFS regulation applies to commercial health insurance plans and the identical DOH regulations apply to HMOs, including Medicaid managed care plans, child health plus and the essential plan. This regulation does not apply to self-funded plans or plans issued outside of New York.

• NY DFS Insurance Regulation 230
• NY Public Health Law Part 98