Managed Care
National Health Law Program Calls for State Enforcement of Behavioral Health Network Adequacy Standards
The National Health Law Program is urging states to strengthen enforcement of network adequacy requirements for behavioral health services in Medicaid managed care plans. The organization highlights gaps in provider networks that leave enrollees unable to access timely mental health and substance use disorder treatment. States have existing authority under federal Medicaid managed care regulations to monitor network adequacy through time and distance standards, appointment wait times, and secret shopper surveys. The recommendation comes as states face ongoing challenges ensuring adequate behavioral health provider networks in managed care arrangements.
Why it mattersStates that fail to enforce network adequacy standards face enrollee access issues, potential federal corrective action, and increased emergency department utilization when behavioral health services are unavailable through managed care networks.