January 9, 2024
As we shared yesterday, the NYS Council recently submitted legislative language that would ensure adequate commercial rates on par with Medicaid rates for services provided to New Yorkers with commercial insurance. This dovetails NYS Council advocacy efforts that have spanned over a decade. We have continuously pressed the Department of Financial Services, the Executive and DOB and lawmakers to end rate discrimination that fosters disparate access to care for New Yorkers with commercial insurance.
We have also been relentless in our pursuit of strong Network Adequacy standards that will ensure improved access to services for any New Yorker who needs care through the public mental hygiene system. See below from the State of the State proposals book. Remember: This is a proposal in the SOS Book and is not yet the law of the land.
Lots of ground to cover before this happens, but here’s what’s in the SOS Book:
Require Increased Commercial Insurance Reimbursement Rates for Mental Health Services Despite laws requiring parity, many commercial plans pay for mental health services at levels that do not adequately compensate providers for the costs incurred to deliver services.
A national study revealed that in 2017 reimbursement rates for primary care were 23.8% higher than for behavioral health care. Low reimbursements drive providers to remain out-of-network and require insureds to pay higher rates to access care. The same study found that in New York, behavioral health visits were over ten times more likely to be out-of-network than primary care visits – among the largest disparities in the country. When an insured goes out of network, they may face higher cost sharing responsibilities and receive only modest payment from their plan to offset the provider’s charges.
Building on action taken last year to increase rates for school-based mental health clinics, and with the aim of improving access to mental health providers, Governor Hochul will pursue legislation to require adequate reimbursement of OMH- and OASAS-licensed outpatient services at least at the Medicaid rate for comparable services.
Increase Access to Care Through Network Adequacy Regulations:
New Yorkers all too often struggle to find a mental health provider that is covered by their insurance, having to seek care out of network or wait a long time to be seen. No New Yorker, having identified a mental health need, should have to wait months for an 2024 State of the State 27 appointment. To address barriers to accessing care, New York is promulgating network adequacy regulations for both commercial and Medicaid insurers that will set standards related to access to mental health and substance use disorder services, including appointment wait times. If insurers cannot provide appointments for behavioral health services within a specific number of days, they will have to provide out-of-network coverage at no additional cost. The regulations will also require plans to maintain transparent and accurate network provider directories