Insufficient access to behavioral health (BH) care and the inability to get timely care are significant problems in the United States. Concerns about BH network adequacy have been prompted by evidence of narrow networks for BH, variation in network adequacy across plans, and evidence that network adequacy impacts access to certain specialties. Federal and state regulatory agencies have therefore prioritized efforts to ensure the adequacy of BH provider networks. Specific network adequacy requirements vary by regulator, insurer, and provider type, but typical metrics applied to BH provider networks include time and distance standards and provider-to-member ratios. Although these measures objectively measure network size and distribution, they do not capture other dimensions of network adequacy reflecting patients’ experience. Input from a technical advisory panel facilitated by ASPE in 2020 identified appointment wait times (WTs) as a potential addition to network monitoring efforts because of their desirable properties. However, one obstacle to developing WT standard is an absence of research to inform standards. This ASPE study aims to inform efforts to measure and monitor BH provider networks through WT standards using an environmental scan, key informant interviews and case studies. As of April 2023, 17 states have adopted standards for behavioral WTs for one or more regulated insurance markets with seven adding standards since 2020. State regulators interviewed faced three main challenges when setting standards: balancing the conflicting interests of members their markets serve and the health plans they oversee, pervasiveness of provider shortages which limit what health plans can do to recruit providers to their networks, and lack of research or data to inform their decisions.
This research was funded under contract between HHS/ASPE’s Office of Behavioral Health, Disability, and Aging Policy (BHDAP) and Research Triangle Institute. Additional research in this area is available at the ASPE Behavioral Health page.
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