Health insurance; reimbursement rates.

Plain English Breakdown

The bill does not specify what happens if the negotiated rate is less than Medicare's rate, but it mandates that rates cannot be lower than Medicare's.

Health Insurance Reimbursement for Mental Health Services

This law requires health insurance companies to pay mental health providers at least the same rate Medicare pays for similar services.

What This Bill Does

• Defines key terms like 'health carrier', 'in-network', and 'mental health services'.
• Requires health insurance companies to reimburse in-network providers for mental health services and outpatient treatment based on negotiated rates, but not less than what Medicare pays.

Who It Names or Affects

• Health insurance companies that cover mental health services
• Mental health service providers who are in-network with these insurers

Terms To Know

Health carrier

A company that provides health insurance.

In-network provider

A healthcare provider who has a contract with an insurance company to provide services at negotiated rates.

Limits and Unknowns

• The bill only applies to in-network providers and does not cover out-of-network situations.
• It specifies that reimbursement must be no less than Medicare's rate, including geographic adjustments and other modifiers.

Official Summary Text

Health insurance; reimbursement rates.
Requires health insurance carriers to reimburse in-network providers for covered mental health services and outpatient treatment at rates negotiated between the health carrier and the in-network provider, provided that such rates are no less than 100 percent of the applicable reimbursement rate under Medicare for the same provider and service.

Current Bill Text

A BILL to amend the Code of Virginia by adding a section numbered
38.2-3412.2
, relating to health insurance; reimbursement rates for mental health services.

Be it enacted by the General Assembly of Virginia:

1. That the Code of Virginia is amended by adding a section numbered
38.2-3412.2
as follows:

§
38.2-3412.2
.
Reimbursement rates for mental health services
.

A.

As used in this section:

"Health carrier" has the same meaning as provided in §
38.2-3438
.

"In-network" has the same meaning as provided in §
38.2-3438
.

"Mental health services" has the same meaning as provided in
§
38.2-34
12.1
and includes services provided by any health care provider licensed under Title 54.1 and authorized to provide covered outpatient mental health services.

"Outpatient treatment" has the same meaning a
s
provided in §
38.2-3412.1
.

B.
Reimbursement for covered
mental health services
and outpatient treatment
shall be at rates negotiated between the health
carrier
and the in
-network provider
,
provided that such rates are no less than 100 percent of the applica
ble reimbursement rate
under Title XVIII of the Social Security Act
(
Medicare
)

for the same provider and service.
The applicable Medicare reimbursement rate shall include
geographic locality adjustments, provider type, and site-of-service modifiers, as applicable.