Coverage
Prior authorization for NYSHIP rehab: who calls, and when
Call The Empire Plan's MHSU Program before starting non-emergency substance use treatment. The 2026 guides say all covered services must be certified as medically necessary, network facilities obtain inpatient authorization, and emergency care does not need to wait.
Published by the NYSHIP.rehab editorial resource · Updated
Why does certification matter so much?
The guides say that if the program administrator does not certify your inpatient or outpatient treatment as medically necessary, you will not receive Empire Plan benefits and will be responsible for the full cost (printed p. 11). Calling first is how you get the highest benefit level and avoid possible penalties.
Who requests authorization — you or the provider?
| Situation | What the guides say |
|---|---|
| Network inpatient facility | The facility is responsible for obtaining authorization |
| Non-network inpatient facility | You should call before admission; a stay found not medically necessary may be your full cost |
| Outpatient care | All covered services must be certified; call MHSU before seeking services |
| Emergency admission | Go to the ER; the facility should contact MHSU within 48 hours or as soon as reasonably possible |
How do you reach the MHSU Program?
Official plan contact: call The Empire Plan at 1-877-769-7447 and press or say 3 for the MHSU Program. Choose option 3 from the MHSU menu for the Clinical Referral Line, described as available 24 hours a day, every day (printed p. 11).
Keep a call log
- Date, time and the representative's name or ID
- The provider, facility and level of care discussed
- Any reference or authorization number
- What was approved, for how long, and when the next review is
- Any cost estimate for non-network care
What if there is no network provider near you?
The guides say that if there are no network providers in your area, you have guaranteed access to network-level benefits when you call the Clinical Referral Line to arrange care with an appropriate provider. Arrange this before starting care, not afterward. See out-of-network rehab for what happens otherwise.
Related guides
- CoverageHow Empire Plan rehab coverage works in 2026How The Empire Plan's Mental Health and Substance Use Program covers rehab in 2026: who it applies to, network vs non-network rules, and what to confirm first.
- CoverageDoes NYSHIP cover detox and withdrawal management?Does NYSHIP cover detox? How Empire Plan MHSU rules apply to medically supervised withdrawal management, emergencies, network status and certification.
- CostsOut-of-network rehab with NYSHIP in 2026How the Empire Plan pays out-of-network substance abuse treatment in 2026: allowed amounts, billed-charge coinsurance, balance bills and luxury rehab.
Sources and source dates
- The Empire Plan At A Glance — Participating Employers (PE), January 2026 (opens in a new tab) — January 2026 (AAG-PE-1/26). Printed page(s) 11. New York State Department of Civil Service.
- The Empire Plan At A Glance — Council 82 (C-82), January 2026 (opens in a new tab) — January 2026 (AAG-C-82-1/26). Printed page(s) 11. New York State Department of Civil Service.
Plan guides are summaries and can change. Your Empire Plan Certificate and Certificate amendments control. This page is general education, not medical, legal or benefits advice. Read our editorial standards.