New York Mandates 10-Day Wait for Initial Behavioral Health Appointments, Cracks Down on “Ghost Networks”
New regulations signed into law by Governor Kathy Hochul will dramatically improve access to mental health and substance use disorder treatment for millions of New Yorkers, guaranteeing an initial outpatient appointment within 10 business days and tackling the issue of misleading provider directories.
New Yorkers seeking mental health or substance use disorder treatment should no longer face months-long delays or be forced to shoulder the financial burden of out-of-network care, according to Governor Hochul. “These new regulations will help remove barriers that often force individuals and families to pay out-of-pocket for care or forgo treatment altogether,” she stated.
Expanded Protections Take Effect This Summer
As of July 1, individuals covered by Medicaid Managed Care, Child Health Plus, and the Essential Plan are immediately entitled to the new appointment wait time protections. For those with commercial health insurance, the standards will be implemented on a rolling basis as policies are renewed, modified, or purchased. This phased approach ensures a smooth transition for insurers and policyholders alike.
The regulations don’t stop at appointment speed. Insurers are now required to maintain dedicated staff to assist members in finding in-network providers and must provide a list of available options within three business days of a member’s request. This proactive approach aims to streamline the often-complex process of locating appropriate care.
Addressing “Ghost Networks” and Ensuring Transparency
A key component of the new rules focuses on eliminating so-called “ghost networks” – insurance directories that list providers who are not actually accepting new patients or whose information is outdated. Plans must now post accurate and up-to-date provider networks on their websites, including details such as location, telehealth options, languages spoken, and any limitations regarding conditions treated or age groups served.
According to a senior official, the goal is to ensure that New Yorkers can rely on their insurance directories to find genuine, accessible care. This increased transparency will empower consumers and hold insurers accountable.
State Leaders Praise Landmark Regulations
New York State Department of Financial Services Superintendent Adrienne Harris hailed the regulation as “a significant step toward getting New Yorkers the critical care they need, when they need it.” Dr. Ann Sullivan, Commissioner of the New York State Office of Mental Health, emphasized that the regulations “remove barriers that either slowed or prevented New Yorkers from accessing critical behavioral health care services.”
The sentiment was echoed by Dr. James McDonald, New York State Health Commissioner, who stated that timely access to behavioral health care can be “life-changing, and in many cases, lifesaving.” Dr. Chinazo Cunningham, Commissioner of the New York State Office of Addiction Services and Supports, added that the new rules will “make it easier for people to quickly access the addiction and mental health care and resources they need.”
State Senator Nathalia Fernandez underscored the importance of New York’s proactive stance, stating, “While the federal government pulls back from their responsibility to protect health care, New York is moving forward.”
Consumer Recourse and Enforcement
The new regulations also establish clear avenues for consumers to file complaints against non-compliant plans or insurers. Individuals covered by Medicaid, the Essential Plan, or Child Health Plus can contact the Department of Health (DOH), while those with state-regulated commercial insurance can contact the Department of Financial Services (DFS).
Governor Hochul has also secured $1 million in the FY 2026 enacted state budget to bolster enforcement efforts. These funds will be used to strengthen compliance and oversight, educate consumers and providers, and investigate and mediate complaints.
New York Leads the Nation in Behavioral Health Coverage
Under Governor Hochul’s leadership, New York is setting a national standard for behavioral health coverage. The state now mandates that commercial insurers reimburse outpatient mental health and substance use disorder services at rates comparable to Medicaid, and requires the use of transparent, nonprofit clinical guidelines.
Resources for Support
New Yorkers in need of immediate crisis support can connect with trained counselors 24/7 through the 988 Suicide & Crisis Lifeline by calling, texting, or chatting 988. Those struggling with addiction or supporting loved ones can find help and hope through the state’s HOPEline at 1-877-8-HOPENY (1-877-846-7369) or by texting HOPENY (Short Code 467369).
The Community Health Access to Addiction & Mental Healthcare Project (CHAMP) is also available to assist with insurance issues related to substance use disorder and mental health care, offering assistance with questions, complaints, and appeals.
These regulations represent a significant investment in the mental and emotional wellbeing of New Yorkers, ensuring that access to vital behavioral health services is no longer a barrier to recovery and a healthier life.
