Access to health care is determined not only by what services a health plan covers, but also whether a health plan’s enrollees can realistically obtain those services from qualified providers. A health plan may cover the full set of mental health and substance. use disorder (MH/SUD) services on paper, but if an enrollee cannot find a provider to deliver that care, those benefits are effectively meaningless.

Too often, regulators and plans assess network adequacy only “as written,” through published provider directories, even though directory inaccuracies are another major barrier to access. True compliance must also be evaluated “in operation,” including the extent of these directory inaccuracies and whether enrollees can actually obtain timely appointments with in-network providers.

These Gold Standards help regulators move from a qualitative assessment of network adequacy to a quantitative measure, ensuring regulators evaluate compliance both:

• As written (network metrics, directories, standards), and
• In operation (actual provider availability, treatment access, and limitations)

Ultimately, this helps consumers access care within their networks and improves mental health access overall. Read on to learn how to more meaningfully measure services in your state.