Require health benefit plans cover behavioral health well checks

As Introduced

136th
General Assembly

Regular
Session
H. B. No. 724

2025-2026

Representatives Salvo, White, A.

To
enact section 3902.65 of the Revised Code
to
require a health benefit plan to provide coverage for annual
behavioral health well checks.

BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section
1.
That
section 3902.65 of the Revised Code be enacted to read as follows:

Sec.
3902.65.
(A)
As used in this section:

(1)
"Behavioral health well check" means an annual visit that
includes a review of medical history, evaluation of risk and
protective factors, use of a developmentally appropriate and
validated behavioral health screening tool, education and
consultation on healthy lifestyle changes, referrals to ongoing
behavioral health services, and other necessary supports as needed.

(2)
"Licensed behavioral health professional" includes all of
the following:

(a)
A clinical nurse specialist or certified nurse practitioner, each as
defined under Chapter 4723. of the Revised Code, who specializes in
the practice of psychiatry, family medicine, or pediatrics;

(b)
A physician assistant licensed under Chapter 4730. of the Revised
Code who specializes in the practice of psychiatry, family medicine,
or pediatrics;

(c)
A physician who is a primary care physician or who specializes in the
practice of psychiatry, family medicine, or pediatrics;

(d)
A psychologist licensed under Chapter 4732. of the Revised Code;

(e)
A professional counselor, professional clinical counselor, social
worker, independent social worker, marriage and family therapist, or
independent marriage and family therapist licensed under Chapter
4757. of the Revised Code;

(f)
A chemical dependency counselor licensed under Chapter 4758. of the
Revised Code.

(3)
"Physician" means an individual authorized under Chapter
4731. of the Revised Code to practice medicine and surgery or
osteopathic medicine and surgery.

(B)(1)
Notwithstanding section 3901.71 of the Revised Code, a health benefit
plan shall provide coverage of an annual behavioral health well check
for children and adults that is performed by a licensed behavioral
health professional.

(2)
Except as otherwise provided in this section, a health benefit plan
shall not impose a cost-sharing requirement for an annual behavioral
health well check. A health benefit plan may impose a cost-sharing
requirement if doing so is necessary for a health benefit plan to
maintain eligibility as a health savings account under section 223 of
the "Internal Revenue Code," 26 U.S.C. 223.

(3)
A health benefit plan shall not impose a prior authorization
requirement on an annual behavioral health well check.

(4)
A health benefit plan shall not exclude coverage for a behavioral
health service or a physical health service on the basis that the
behavioral health service and physical health service were provided
on the same day or in the same facility.

(C)
An annual behavioral health well check may be provided in a
behavioral health or a primary care setting or incorporated and
reimbursed within any type of integrated primary care service
delivery method, including any of the following:

(1)
The psychiatric collaborative care model;

(2)
The primary care behavioral health model or behavioral health
consultant model;

(3)
Any model that involves co-location of licensed behavioral health
professionals within general medical settings;

(4)
Any other integrated care model that focuses on the delivery of
primary care.

(D)
A health plan issuer shall provide reimbursement for an annual
behavioral health well check through the billing codes specified in
rules adopted by the superintendent of insurance under this section.
Reimbursement shall comply with both of the following:

(1)
The reimbursement shall be provided on the same basis and to the same
extent for all licensed behavioral health professionals using
methodology that is comparable to, and applied not more stringently
than, the reimbursement for the provision of medical care in
accordance with 45 C.F.R. 146.136(c)(4).

(2)
The reimbursement may include any adjustments for payment of claims
that are billed by a licensed behavioral health professional so long
as the methodology to determine such adjustments is comparable to,
and applied not more stringently than, the methodology for
adjustments made for reimbursement of claims billed by licensed
behavioral health professionals that are not physicians for other
medical care in accordance with 45 C.F.R. 146.136(c)(4).

(E)
The superintendent of insurance shall adopt rules in accordance with
Chapter 119. of the Revised Code that do all of the following:

(1)
Specify current procedural terminology codes for purposes of division
(D) of this section that support uniformity in payment to licensed
behavioral health professionals providing an annual behavioral health
well check and that are reflective of existing reimbursement
methodologies that can be implemented in a streamlined and efficient
way by health plan issuers;

(2)
Regularly update the current procedural terminology codes utilized
for purposes of division (D) of this section if the codes are
altered, amended, changed, deleted, or supplemented;

(3)
Specify other requirements necessary to implement this section.

(F)
Notwithstanding any provision of section 121.95 of the Revised Code
to the contrary, a regulatory restriction contained in a rule adopted
under this section is not subject to sections 121.95 to 121.953 of
the Revised Code.

Section
2.
The
enactment of section 3902.65 of the Revised Code by this act applies
to health benefit plans, as defined in section 3922.01 of the Revised
Code, that are delivered, issued for delivery, modified, or renewed
on or after January 1, 2027.