Network adequacy standards mandate that health plans maintain a sufficient number of providers and facilities to ensure that individuals have reasonable access to necessary health care services, including mental health and substance use disorder services. However, there are widening gaps between access to behavioral health care and access to medical care, and there are higher out-of-network utilization and out-of-pocket costs for behavioral health services.
NCQA conducted an environmental scan and stakeholder interviews to synthesize the state of evidence on behavioral health network adequacy standards and metrics in this white paper report. This report also highlights models demonstrated to enhance access, which have the potential to influence the design of behavioral health networks and future network adequacy standards. This report summarizes recommendations from the environmental scan and interviews, with the goal of enhancing measurement and accountability of network adequacy standards.
This work is supported by The Sozosei Foundation, a philanthropic arm of Otsuka. The Foundation’s primary focus is to eliminate the use of jails and prisons for the diagnosis and treatment of mental illness by improving access to mental health care in communities. Visit www.sozoseifoundation.org to learn more.