New York Codes, Rules and Regulations
Title 10 - DEPARTMENT OF HEALTH
Chapter II - Administrative Rules and Regulations
Subchapter R - Health Maintenance Organizations
Part 98 - Health Maintenance Organizations
Subpart 98-5
Section 98-5.8 - Additional MCO responsibilities regarding network adequacy and access

Universal Citation: 98-5.8 NY Comp Codes Rules and Regs § 98-5.8

Current through Register Vol. 47, No. 12, March 26, 2025

(a) A MCO shall have designated staff with sufficient knowledge to help enrollee find participating behavioral health providers that treat the enrollee's specific behavioral health condition. The MCO shall post the contact information for the department or unit, including a telephone number, on a publicly accessible area of its website, that allows the enrollee to access this designated staff directly.

(b) A MCO shall post information on a publicly accessible area of its website describing the appointment wait time standards for behavioral health services and the process to submit an access complaint.

(c)

(1) A MCO shall have an access plan that establishes a protocol for monitoring and ensuring access to behavioral health services, outlines how provider capacity is determined, and establishes procedures for quarterly monitoring of capacity and access and for improving access and managing access in times of reduced participating provider capacity. The access plan and associated monitoring protocol shall address the following:
(i) expected utilization of behavioral health services based on anticipated enrollment and health care needs of the enrollee population;

(ii) the number and types of health care providers of behavioral health services required to furnish covered behavioral health services, the number and types of providers actively providing behavioral health services within the MCO's network, and the number and types of providers accepting new patients;

(iii) the collection and monitoring of data on provider-to-enrollee ratios, travel time and distance to participating providers, and appointment wait times;

(iv) the role of telehealth in providing access to behavioral health services; and

(v) the ability of the MCO's network of behavioral health providers to meet the cultural and linguistic needs of the MCO's enrollee population.

(2) A MCO shall make the access plan available to the commissioner upon the commissioner's request.

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