Provider Participation in Health Insurance

Plain English Breakdown

The official summary confirms all claims made in the candidate explanation, including the specific provider types and the 3,000-hour requirement for social workers.

Rules for Mental Health and Substance Use Providers in Insurance Networks

This law requires insurance companies to contact mental health, substance use disorder, or psychiatric providers who have not submitted claims in a year to check their network status, allows prelicensed workers into networks under supervision with payment rights, and sets practice hour rules for clinical social workers.

What This Bill Does

• Requires commercial insurers to contact mental health, substance use disorder, or psychiatric nurse providers if they have not sent a claim in at least 12 months.
• Asks insurance companies to confirm if these inactive providers are still part of the network and accepting new patients.
• Mandates that carriers allow prelicensed providers into their networks when working under supervision by licensed mental health, substance use disorder, or psychiatric nurse professionals.
• Requires insurers to pay for services provided by prelicensed workers supervised by licensed professionals.
• Sets a rule that clinical social workers must complete 3,000 hours of practice before getting a license.

Who It Names or Affects

• Commercial health insurance carriers
• Mental health providers and substance use disorder providers
• Psychiatric nurses
• Prelicensed providers
• Clinical social workers

Terms To Know

Provider network

A group of doctors or therapists that an insurance company has agreed to work with.

Prelicensed provider

A worker who is training and supervised by a licensed professional but does not yet have their own license.

Limits and Unknowns

• The text does not say what happens if an insurance company fails to contact the inactive providers.
• The law does not specify how often insurers must check on these providers after the first year of inactivity.
• The effective date for when this law starts is not listed in the provided information.

Official Summary Text

If a mental health provider, substance use disorder provider, or psychiatric nurse (provider) has not submitted a claim for a period of at least 12 months, the act requires a commercial insurance carrier (carrier) to contact the provider to confirm the provider's participation in the carrier's provider network and to determine whether the provider is accepting new patients.
The act includes mental health providers, substance use disorder providers, and psychiatric nurses as providers who may participate in a carrier's provider network.
The act requires carriers to admit prelicensed providers into the carrier's network and to reimburse prelicensed providers for services rendered when provided under the supervision of a mental health provider, substance use disorder provider, or psychiatric nurse.
The act requires a clinical social worker to complete 3,000 hours of practice prior to licensure.
(Note: This summary applies to this bill as enacted.)