Bill > H5863

This bill requires healthcare entities and network plans to compile and report to the health insurance commissioner a detailed summary of how they instruct contracted providers to submit claims for in-network outpatient behavioral health services. Specifically, the bill mandates that these entities explain their requirements for using specific Current Procedural Terminology (CPT) codes, modifiers, or other formal identification methods for behavioral health service claims. Additionally, the bill stipulates that starting January 1, 2026, these entities must include in their provider contracts a provision for a one-time rate increase for outpatient behavioral health services. This increase will be calculated based on the U.S. Department of Labor's Consumer Price Index for Urban Consumers (CPI-Urban) percentage change, as determined by the health insurance commissioner by October 1, 2025, with an additional 5% added to that percentage. The bill aims to improve transparency in behavioral health service billing and ensure fair compensation for providers by mandating these reporting and payment adjustments.

Health and Social Services

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