Bill > S0463

This bill requires healthcare entities and network plans to compile and report to the health insurance commissioner a detailed summary of how they instruct their contracted providers to submit claims for in-network outpatient behavioral health services. Specifically, the bill mandates that these entities explain their claim submission requirements, including the use of specific Current Procedural Terminology (CPT) codes or modifiers that identify behavioral health service claims. Additionally, the bill stipulates that as of January 1, 2026, every contract with providers for outpatient behavioral health services must include a rate increase of at least the Consumer Price Index (CPI) for Urban Consumers (determined by the U.S. Department of Labor as of October 1, 2025) plus an additional 5%. This requirement aims to ensure transparency in behavioral health service claim processes and provide a mechanism for maintaining provider reimbursement rates in line with inflation. The bill will take effect immediately upon passage, with the first reporting requirement and rate increase set to occur before January 1, 2026.

Health and Social Services

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