On Feb. 21, NYDFS proposed rules on network adequacy and access.
NYDFS proposed adding Part 38 to NYCRR, NY INS 11-III-A to improve network adequacy standards, access for mental health and substance use disorder services.
Network Adequacy
Established appointment wait time standards for behavioral health care for commercial insurance coverage, builds on legislation to improve provider directories, see #199236.
Also required insurers to assist consumers in accessing in-network providers within those standards, and requires that certain data be included in provider directories.
Insurers required to submit an annual certification to NYDFS re insurer’s access plan.
Certification must include collection of data, monitoring of behavioral health network.
Health care plan must submit the certification by Dec. 31, 2025, annually thereafter.
Consultation
Proposal subject to a 60-day comment period upon publication in the State register.
Effectiveness
From Jan. 1, 2025, Part 38 (Reg 230) will apply to health care plan that delivers a policy or contract with network of health care providers for behavioral health services.
Feb. 21, 2024 NYDFS Rule Publication
On Feb. 21, 2024, NYDFS published proposal in State register, comments due Apr. 21.
Nov. 2024 NYDFS Revised Proposal
On Nov. 20, 2024, NYDFS published revised proposal for network adequacy and access standards, after considering comments received on the initial Feb. 2024 proposal.
NYDFS also published assessment of public comments, revised regulatory impact statement, notice of revised rulemaking, and text of the revised proposal.
The public comment period for the revised proposal ends on Jan. 6, 2025.
Feb. 2025 NYDFS Rule Adoption
On Feb. 4, 2025, NYDFS adopted the proposed rule to improve network adequacy standards, and access for mental health and substance use disorder services.
Health care plans must comply with the regulation, effective Jul. 1,2025, for policies and contracts issued, renewed, modified, or amended on or after such date.
Also must submit their first annual compliance certifications by Dec. 31, 2026.
Adopted rule re network adequacy standards becomes effective as of Jul. 1, 2025 and will apply to all policies issued, renewed, modified, or amended on or after that date.
