NY's behavioral health access regulation requires MCOs to meet strict new standards by Dec 31st.
If you're a managed care organization (MCO) operating in New York, 2026 brings a full year of new operational requirements that fundamentally change how you manage provider data, respond to access complaints, and demonstrate regulatory compliance.
Here's what your team needs to execute this year.
These aren't one-time projects. They're continuous operational workflows that need to be built into your systems.
Your network must meet strict appointment availability thresholds under NY's behavioral health access standards:
These standards can be met through telehealth unless the member specifically requests an in-person appointment.
When a member can't find an in-network provider who meets the wait time standards, you have 3 business days to:
If no such provider exists, you must approve an out-of-network referral at in-network cost-sharing. The referral stays active until care is no longer medically necessary or until you locate an appropriate in-network provider and can transition care without harm to the member.
Your behavioral health provider directory must now include:
The directory must be searchable and filterable by behavioral health services provided, conditions treated, level of care, languages spoken, affiliations, and location.
When members or providers report directory errors, you have 15 calendar days to review and correct them. This timeline makes provider directory accuracy a continuous operational priority, not a quarterly cleanup task.
When a member requests a list of providers for a specific behavioral health condition, you have 3 business days to provide it.
By March 1 and September 1 each year, your team must:
This claims-based monitoring is separate from your annual directory verification, and it's designed to catch providers who may have stopped seeing patients but remain listed as active in your network.
At least once per year, you must verify the accuracy of all information in your provider directory with every behavioral health provider in your network.
The regulation doesn't prescribe the verification method—email, phone, electronic verification, or written confirmation are all acceptable. But the verification must happen, and you must document it.
By the end of this year, you must submit a written certification to the Commissioner, signed by an officer of your MCO, confirming:
Let's be clear about what this means for your team:
If you're still managing provider data with spreadsheets, manual outreach, and quarterly batch updates, you're not equipped for this level of responsiveness.
This isn't a compliance project. It's an operational transformation.
Health plans that treat provider data automation as a "nice to have" efficiency play are missing the point. Under 10 NYCRR Subpart 98-5, accurate provider directories with real-time availability tracking are regulatory infrastructure.
New York's behavioral health access standards create an interesting compliance challenge: you can have technically adequate network coverage on paper while still failing to meet access requirements in practice.
Network adequacy has traditionally been measured by provider-to-member ratios and geographic distribution. But these new access standards add a layer of operational accountability:
The regulation essentially says: your network is only "adequate" if members can actually access it.
This is why MCOs are now treating provider data quality as a compliance risk, not just an operational annoyance.
Leap Orbit's AI-powered provider data automation platform is purpose-built for exactly these requirements:
We've built our platform to solve the messy, high-stakes operational problems that regulations like this create, because we know that compliance failures aren't just about fines. They're about members who can't access care when they need it most.
Learn more at www.leaporbit.com or reach out to our team to discuss your 2026 compliance roadmap.