An Act amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, providing for behavioral health care provider access; and imposing penalties.

PRINTER'S NO. 3662
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2653
Session of
2026
INTRODUCED BY SAPPEY, KHAN, HOWARD, BOYD, RIVERA, PROBST,
SHUSTERMAN, STEELE AND SANCHEZ, JUNE 18, 2026
REFERRED TO COMMITTEE ON INSURANCE, JUNE 22, 2026
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, providing for behavioral health care provider
access; and imposing penalties.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 46
BEHAVIORAL HEALTH CARE PROVIDER ACCESS
Sec.
4601. Scope of chapter.
4602. Legislative findings and intent.
4603. Definitions.
4604. Behavioral health care provider access to insurer
networks.
4605. Preclusion permitted.
4606. Parity and nondiscrimination.
4607. Claim handling.
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4608. Scope of practice.
4609. Regulations.
4610. Violations.
4611. Administrative procedures.
§ 4601. Scope of chapter.
This chapter relates to behavioral health care coverage
provided under a health insurance policy.
§ 4602. Legislative findings and intent.
(a) Legislative findings.--The General Assembly finds and
declares as follows:
(1) Timely and effective behavioral health care services
are critical for the mental and behavioral health of
Pennsylvanians.
(2) The selection of a behavioral health care provider
is a personal choice that can be based upon many factors,
including the provider's background, experience with a
particular condition or treatment methods.
(3) Individuals should have access to a behavioral
health care provider who understands their particular needs.
(4) Cost concerns or network restrictions should not
prevent an individual from finding and seeking treatment with
a behavioral health care provider that is right for the
individual.
(b) Intent.--The intent of this chapter is to maximize
timely and effective access to behavioral health care services
for residents of this Commonwealth.
§ 4603. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
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"Administrative policy." A written document or collection of
documents reflecting the terms of the contractual or operating
relationship between an insurer and a health care provider.
"Behavioral health care provider." A health care provider
that is licensed, certified or otherwise permitted by law or
regulation to provide behavioral health care services under the
laws of this Commonwealth, including an individual governed by
the act of July 9, 1987 (P.L.220, No.39), known as the Social
Workers, Marriage and Family Therapists and Professional
Counselors Act.
"Behavioral health care service." A health care service
intended to address behavioral health, including services for
mental health and for substance use disorders.
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Covered behavioral health care service." A behavioral
health care service covered by a covered person's health
insurance policy.
"Covered person." A policyholder, subscriber or other
individual who is entitled to receive health care services under
a health insurance policy.
"Health care provider." A person that is licensed, certified
or otherwise permitted by law or regulation to provide health
care services under the laws of this Commonwealth.
"Health care service." A treatment, procedure, medical
supply or other service, prescribed or otherwise provided or
proposed to be provided by a health care provider to a covered
person.
"Health insurance policy." As defined in section 9103
(relating to definitions).
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"Insurer." As defined in section 9103.
"Participating network provider." A health care provider
that has entered into a contractual or operating relationship
with an insurer to participate in one or more designated
networks of the insurer to provide health care services to
covered persons under the terms of the administrative policy of
the insurer.
"Service area." The geographic area in which an insurer may
offer a health insurance policy.
"Telemedicine." As defined in section 4802 (relating to
definitions).
§ 4604. Behavioral health care provider access to insurer
networks.
(a) Willing provider.--An insurer may not refuse to contract
with a behavioral health care provider that is willing to enter
into a contract for participation in a network for a health
insurance policy if the behavioral health care provider
satisfies all of the following:
(1) Is in good standing with the regulatory authority
under which the behavioral health care provider is permitted
to practice in this Commonwealth.
(2) Provides behavioral health care services from an
office in this Commonwealth.
(3) Provides covered behavioral health care services
offered by the insurer for purchase in the service area.
(4) Is willing to abide by the standard terms and
conditions of the insurer's standard participating network
provider contract.
(b) Reimbursement rate requirement.--A contract under
subsection (a) shall be offered to a behavioral health care
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provider at a reimbursement rate paid to similarly situated in-
network behavioral health care providers providing services to
covered persons in the service area.
(c) Parity required and discrimination prohibited.--A
contract under subsection (a) must be in parity with and may not
unfairly discriminate against behavioral health care providers
generally in comparison to other health care providers, or
against the specific behavioral health care provider seeking to
contract, including with respect to the following:
(1) Practice standards.
(2) Quality requirements.
(3) Credentialing criteria.
(4) Reimbursement rates.
(5) Network tier placement, if applicable.
(d) Construction.--Nothing in this chapter shall be
construed to prohibit an insurer from contracting with a
behavioral health care provider that provides services through
telemedicine from an office that is not located in this
Commonwealth.
§ 4605. Preclusion permitted.
An insurer may preclude a behavioral health care provider
from participation in a network if either of the following
occurs:
(1) The insurer demonstrates that the behavioral health
care provider has materially failed to comply with the
standard terms and conditions for participation.
(2) The insurer is engaged in a reasonable investigation
for, or has made a finding of, fraud, waste or abuse with
respect to the behavioral health care provider.
§ 4606. Parity and nondiscrimination.
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The terms "parity" and "discrimination" in this chapter shall
be construed in accordance with Article VI-B of the act of May
17, 1921 (P.L.682, No.284), known as The Insurance Company Law
of 1921.
§ 4607. Claim handling.
Claim handling, including prompt payment for claim handling,
shall be subject to the provisions of Article XXI of the act of
May 17, 1921 (P.L.682, No.284), known as The Insurance Company
Law of 1921.
§ 4608. Scope of practice.
Nothing in this chapter shall be construed to expand the
scope of practice of a health care provider or permit a health
care provider to render care and services other than as
permitted under the health care provider's license,
certification or other regulatory authorization to practice
under the laws of this Commonwealth.
§ 4609. Regulations.
The department may promulgate regulations as necessary and
appropriate to implement, administer and enforce the provisions
of this chapter.
§ 4610. Violations.
(a) Penalties.--Subject to subsection (b), upon satisfactory
evidence of a violation of this chapter by an insurer, the
commissioner may, in the commissioner's discretion, pursue any
of the following courses of action:
(1) Suspend, revoke or refuse to renew the license of
the offending person.
(2) Enter a cease and desist order.
(3) Impose a civil penalty of not more than $5,000 for
each action in violation of this chapter.
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(4) Impose a civil penalty of not more than $10,000 for
each action in willful violation of this chapter.
(b) Limitation.--Penalties imposed against an insurer under
this section may not exceed $500,000 in the aggregate during a
single calendar year.
(c) Nonexclusive remedies.--The enforcement remedies imposed
under this section are in addition to any other remedies or
penalties that may be imposed under any other applicable law of
this Commonwealth, including:
(1) Article VI-B of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921. A
violation of the parity and nondiscrimination provisions of
this chapter shall be deemed a violation of Article VI-B of
The Insurance Company Law of 1921.
(2) Article XXI of The Insurance Company Law of 1921.
(3) The act of July 22, 1974 (P.L.589, No.205), known as
the Unfair Insurance Practices Act. A violation of this
chapter shall be deemed to be an unfair method of competition
and an unfair or deceptive act or practice under the Unfair
Insurance Practices Act.
(4) The act of December 18, 1996 (P.L.1066, No.159),
known as the Accident and Health Filing Reform Act.
(d) Referral.--Upon receipt or discovery of evidence of a
potential violation of this chapter subject to the jurisdiction
of another regulatory or law enforcement entity, including the
Department of State, the Department of Health, the Department of
Drug and Alcohol Programs, the Department of Human Services and
the Office of Attorney General, the department may refer the
matter as may be appropriate.
(e) Private actions.--
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(1) Nothing in this chapter shall prohibit a behavioral
health care provider from using an insurer's dispute
resolution process or seeking relief in an appropriate court
of general jurisdiction for an alleged failure of an insurer
to contract with or make a payment in accordance with this
chapter to the behavioral health care provider.
(2) Nothing in this chapter shall be construed to
prohibit a private cause of action for a violation of this
chapter under the act of December 17, 1968 (P.L.1224,
No.387), known as the Unfair Trade Practices and Consumer
Protection Law.
§ 4611. Administrative procedures.
(a) Procedures generally.--The administrative provisions of
this chapter shall be subject to 2 Pa.C.S. Ch. 5 Subch. A
(relating to practice and procedure of Commonwealth agencies).
(b) Appeals.--A party against whom penalties are assessed in
an administrative action may appeal to Commonwealth Court as
provided in 2 Pa.C.S. Ch. 7 Subch. A (relating to judicial
review of Commonwealth agency action).
Section 2. This act shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with the Federal Government
or the Insurance Department, this act shall apply to any
policy for which a form or rate is first filed on or after
the effective date of this paragraph.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the Federal
Government or the Insurance Department, this act shall apply
to any policy issued or renewed on or after 180 days after
the effective date of this paragraph.
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Section 3. This act shall take effect immediately.
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