This bill prohibits health insurers from denying coverage for mental health and substance use disorder benefits solely because the services are delivered through a primary care behavioral health model. The primary care behavioral health model involves expert consultation by a psychologist to assist a physician with assessing client needs and coordinating care. The bill also requires insurers to include appropriate billing codes for primary care behavioral health services in psychologist contracts. The bill does not mandate primary care physicians to follow the primary care behavioral health model, but only mandates insurance coverage if a primary care provider chooses to use the model. The bill takes effect 60 days after its passage.

The fiscal impact of the bill is indeterminable. The bill may increase claims costs for insurers if specialized procedure codes for primary care behavioral health services are not already included in provider contracts. This could result in an increase in insurance premium tax revenue to the state. However, if the primary care behavioral health model is more efficient and lowers claims costs, it could lower insurance premium tax revenue. The impact on the state's Retiree and Health Benefit Plan is unclear, but the bill requires only one copayment per day for multiple services, which could result in a cost shift to the state. The Department of Health and Human Services expects no fiscal impact from the bill.

Statutes affected:
Introduced: 415:18-a
As Amended by the Senate: 415:18-a