Mental health coverage

AN ACT Relating to the truth in mental health coverage act; 1
adding a new section to chapter 48.43 RCW; and creating a new 2
section. 3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
NEW SECTION. Sec. 1. The legislature finds:5
(1) Analyses by Milliman in 2017 and 2019 and RTI International 6
in 2024 demonstrate that, over multiple years, Washington residents 7
have experienced substantially greater difficulty accessing in-8
network mental health and substance use services than accessing 9
medical and surgical services. 10
(2) In 2021, Washington residents were 7.1 times more likely to 11
receive outpatient behavioral health services out-of-network than 12
outpatient medical and surgical services; 12.1 times more likely for 13
outpatient facility services; and 16.7 times more likely for 14
inpatient behavioral health services. 15
(3) In Washington, average in-network reimbursement in 2021 for 16
medical and surgical clinicians was 41 percent higher than for 17
behavioral health clinicians, indexed to medicare reimbursement. This 18
gap discourages behavioral health clinicians from joining insurance 19
networks and further limits access to care for enrollees. More recent 20
S-4253.1
SENATE BILL 6305
State of Washington 69th Legislature 2026 Regular Session
By Senators Riccelli, Chapman, Hasegawa, Nobles, Saldaña, and C.
Wilson
Read first time 01/26/26. Referred to Committee on Health & Long-
Term Care.
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Washington-specific data is unavailable due to the absence of 1
standardized public reporting requirements. 2
(4) Federal regulators have cited the RTI data as evidence of the 3
need for greater accountability and transparency by health plans and 4
issuers. 5
(5) Youth face even greater barriers to access due to health 6
benefit plans' narrow networks that lack sufficient child and 7
adolescent behavioral health providers. 8
(6) Independent economic analyses by McKinsey and Company show 9
that individuals with behavioral health diagnoses incur two to four 10
times higher total medical costs than those without such diagnoses, 11
largely because untreated behavioral health conditions worsen 12
physical health outcomes. The same analyses by Milliman show that 13
individuals with behavioral health diagnoses incur between 3.2 and 14
6.2 times higher medical costs. Earlier access to effective treatment 15
reduces these downstream costs. 16
(7) Transparent, comparable information on coverage and access, 17
including information maintained on a public dashboard, is an 18
essential regulatory function necessary to effectuate compliance with 19
state insurance laws, protect consumers and employers as informed 20
purchasers, and reduce the higher downstream medical costs associated 21
with untreated mental health and substance use disorders.22
NEW SECTION. Sec. 2. A new section is added to chapter 48.43 23
RCW to read as follows: 24
(1)(a) Each carrier shall annually submit completed templates to 25
the commissioner, as specified by the commissioner pursuant to this 26
section, with carrier-level coverage and access data, and coverage 27
and access data at any subcarrier level specified by the commissioner 28
in rule, in the form, manner, and time prescribed by the 29
commissioner, but no later than July 1st of each year for data from 30
the previous calendar year. 31
(b) The data submitted by the carrier must be sufficient to 32
support an independent technical evaluation and to enable meaningful 33
public understanding, by geographic area as specified by the 34
commissioner, of access to and coverage by facility type and 35
professional provider type of: 36
(i) Mental health disorder services; 37
(ii) Substance use disorder services; 38
(iii) Medical and surgical services; 39
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(iv) Youth and adult services, separately and combined; and1
(v) In-person and telehealth services, separately and combined.2
(c) The data submitted by the carrier must indicate whether the 3
facility or professional provider is affiliated with, owned by, or 4
under common control with the carrier, as specified by the 5
commissioner. 6
(2) The commissioner shall adopt uniform templates, definitions, 7
audit procedures, and correction protocols to ensure comparability of 8
data submitted by carriers under this section across carriers and 9
over time. In specifying reporting templates and data elements for 10
purposes of this section, the commissioner may refine, group, 11
stratify, or not include diagnostic categories or conditions within 12
mental health and substance use disorder services in specified 13
metrics or analyses to ensure meaningful, accurate, and comparable 14
public reporting. 15
(3)(a) Each carrier shall report, disaggregated by facility type, 16
professional provider type, youth services, adult services, in-person 17
services, and telehealth services: 18
(i) Utilization reviews, including the number and percentage of 19
approvals, modified approvals, denials, and partial denials, using 20
both utilization review and claims data, average decision time 21
frames, top denial reasons, and other measures specified by the 22
commissioner to assess the effects of utilization review on access to 23
timely, clinically appropriate care; 24
(ii) Out-of-network utilization rates using allowed claims data;25
(iii) In-network reimbursement including average allowed amounts 26
and allowed amounts at the 50th, 75th, and 95th percentiles, each 27
indexed to medicare; 28
(iv) The number of unique enrollees served by listed in-network 29
professional providers; 30
(v) The percentage of listed in-network providers relative to 31
state-licensed providers of the same type; 32
(vi) Network admission evaluations including the average time 33
from completed application to network admission for each facility and 34
professional provider type; 35
(vii) Psychiatric collaborative care models including number of 36
enrollees, including pediatric and adult collaborative care 37
separately, penetration rate per 100,000 covered lives with a 38
behavioral health diagnosis, and reimbursement indexed to medicare;39
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(viii) Appeals and external reviews including counts and outcomes 1
of adverse benefit determinations and independent review decisions; 2
and 3
(ix) Additional metrics the commissioner determines necessary for 4
public comparison or oversight. 5
(b) Any data cell containing fewer than 11 enrollees must be 6
suppressed consistent with centers for medicare and medicaid services 7
cell suppression standards. 8
(4) In developing and specifying the templates, the commissioner 9
shall consider formats that are: 10
(a) Utilized by state insurance regulators; 11
(b) Endorsed and utilized by one or more employer coalitions, 12
human resources associations, or mental health nonprofit 13
organizations; and 14
(c) Cited by the United States department of labor or the United 15
States department of health and human services. 16
(5)(a) The commissioner shall post, in an easily accessible, 17
consumer-friendly manner and on a public website, all underlying data 18
and data files reported under this section no later than three months 19
after receipt. 20
(b) Posts must include raw data and downloadable files to permit 21
public analysis, research, and independent comparison.22
(c) Data must be posted separately at the carrier level and any 23
subcarrier level specified by the commissioner in rule.24
(d) Information collected under this section is not considered to 25
be proprietary or confidential and must be publicly disclosed, 26
subject only to cell suppression standards. 27
(6)(a) The commissioner shall maintain an interactive public 28
dashboard that visually presents the posted data, including separate 29
displays of youth and adult outcomes, and allows comparison across 30
carriers and any subcarrier level specified by the commissioner.31
(b) The dashboard must allow users to view metrics for mental 32
health services, substance use services, and medical and surgical 33
services. 34
(c) The dashboard must be updated no later than nine months after 35
receipt of the data. 36
(7) Each carrier shall submit a certification, in a form and 37
manner specified by the commissioner, signed by the chief financial 38
officer of the carrier or another officer designated by the 39
commissioner with responsibility for the accuracy and completeness of 40
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the reported data, stating that the reported data, to the best of the 1
officer's knowledge and belief, is complete and accurate and follows 2
template definitions and instructions, and that the carrier made a 3
good-faith effort, through reasonable policies, procedures, and 4
oversight, to ensure that the data was prepared and submitted in 5
accordance with this section and the commissioner's instructions. The 6
commissioner may require a carrier to submit additional or clarifying 7
information related to the reported data or the processes used to 8
prepare the data. 9
(8) The commissioner may adopt rules necessary to implement this 10
section. 11
(9) Each carrier shall retain all data relating to the 12
information reported under this section for three years and make such 13
records available to the commissioner upon request.14
(10) This section applies to health plans issued or renewed on or 15
after January 1, 2027. 16
(11) For purposes of this section: 17
(a) "Adult" means individuals age 18 and older.18
(b) "Facility type" means a category of facilities and levels of 19
care in which mental health disorder services, substance use disorder 20
services, or medical and surgical services are delivered.21
(c) "Medical and surgical services" means all other health care 22
services or benefits that are not mental health and substance use 23
disorder services as defined in RCW 48.43.766. 24
(d) "Mental health disorder services" are services or benefits 25
for the diagnosis or treatment of mental disorders other than 26
substance use disorders, as classified in the mental and behavioral 27
disorders chapters of the international classification of diseases 28
and the mental disorder diagnostic categories of the diagnostic and 29
statistical manual of mental disorders. 30
(e) "Out-of-network allowed claims" means claims which are 31
allowed at the out-of-network plan benefits level, with corresponding 32
enrollee out-of-pocket expenses, rather than the in-network plan 33
benefits level. 34
(f) "Professional provider type" means categories of health care 35
professionals that furnish mental health disorder services, substance 36
use disorder services, or medical and surgical services in an office 37
setting. 38
(g) "Substance use disorder services" are services or benefits 39
for the diagnosis or treatment of substance use disorders as 40
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classified in the substance-related and addictive disorders chapters 1
of the most current version of the international classification of 2
diseases and the substance-related and addictive disorders diagnostic 3
categories of the most current version of the diagnostic and 4
statistical manual of mental disorders. 5
(h) "Templates" means documents containing embedded formulae for 6
quantitative data using definitions and instructions specified by the 7
commissioner. 8
(i) "Youth" means individuals under age 18. 9
NEW SECTION. Sec. 3. If any provision of this act or its 10
application to any person or circumstance is held invalid, the 11
remainder of the act or the application of the provision to other 12
persons or circumstances is not affected.13
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