Network adequacy is often defined as having enough providers within a health plan network to ensure reasonable and timely access to care. At a minimum, health plans should include a sufficient number of providers who deliver mental health and substance use disorder (SUD) services (collectively referred to in this report as behavioral health services) to support access to those services. Beyond a minimum number of providers, adequate networks should have an appropriate geographic distribution of providers who have the capacity to deliver a wide range of services that align with enrollees’ needs. State and federal network adequacy requirements exist, but many consumers face barriers to accessing behavioral health services because networks do not have enough providers who offer the services they need. To better understand network adequacy standards for behavioral health and best practices in developing and enforcing such standards, a targeted environmental scan was conducted and a technical expert panel (TEP) was convened. This report summarizes the findings from these activities.
The report was prepared under contract #HHSP233201500035I between HHS/ASPE Office of Behavioral Health, Disability and Aging Policy and Mathematica. For additional information about this subject, you can visit the BHDAP home page at https://aspe.hhs.gov/about/offices/bhdap or contact the ASPE Project Officers, at HHS/ASPE/BHDAP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201; Judith.Dey@hhs.gov, Laura.Jacobus-Kantor@hhs.gov, Daniel.Schwartz@hhs.gov.