February 21, 2024
Good afternoon,
1) OMH is working to codify regulations that would guide the discharge of individuals from inpatient and emergency psychiatric settings. Likewise, the Department of Health drafted similar regulation changes for admissions and discharges from emergency room settings, which were posted today. Comments are due by April 21.
Here’s the link: NYS Register, pg. 17: https://dos.ny.gov/system/files/documents/2024/02/022124.pdf
(From today’s NYS Register – linked above):
“Needs and Benefits: The proposed rule will require general hospital emergency services to develop policies and procedures for intake and discharge of patients with behavioral health presentations. The proposed rule will also add new screening requirements for risk of suicide and violence. In addition, emergency departments in hospitals with inpatient psychiatric units must follow a more person-centered discharge plan for patients with complex needs. To accomplish adequate discharge planning for these individuals, general hospitals with inpatient psychiatric units must create and implement a discharge plan that addresses the patient’s complex needs. These changes ensure that discharge plans will address the post-emergency needs of the patient, including confirmation of appointments for psychiatric follow-up after a hospital visit, moving clinicians away from treating only the medical emergency…”
2) Also today the Department of Financial Services (DFS) proposed regulations to establish (updated) network adequacy standards for behavioral health services for commercial insurers. The regulations establish appointment wait times for mental health and substance use disorder services, and when an in-network provider is not available within those standards, the regulations will require insurers to allow access to an out-of-network provider who can meet those standards, at no additional cost.
The Department of Health (DoH) has proposed similar behavioral health network adequacy standards that will apply to the Medicaid program. The proposed regulations are subject to a 60-day comment period upon publication in the State Register.
You may recall that last month both DoH and DFS pre-publicized their proposed (updated) standards for Network Adequacy in order to gather initial feedback from stakeholders. The NYS Council weighed in according (see our attached pre-comments). Today both Departments published their (official) proposed Regulations related to Network Adequacy standards.
Here’s the link to the NYS register where the proposed Network Adequacy standards are posted:
NYS Register, page 14 https://dos.ny.gov/system/files/documents/2024/02/022124.pdf
Comments due by April 21 (60 days).
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February 21, 2024 05:07 PM 9 MINUTES AGO
State seeks to set 10-day maximum wait time for mental health care visits
AMANDA D’AMBROSIO, CRAIN’S NY
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.