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HB 2653

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

2025-2026 Regular Session Introduced by Heather Boyd and 10 co-sponsors

HB 2653 would require insurers to improve access to behavioral health care (timely access, network adequacy, parity) and impose penalties for noncompliance.

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Bill Summary · HB 2653

Summary of HB 2653 (2025-2026) — Pennsylvania

Purpose and intent

  • HB 2653 proposes amendments to Title 40 (Insurance) of the Pennsylvania Consolidated Statutes.
  • The primary aim is to improve access to behavioral health care by insurers and related entities, addressing barriers to timely and adequate behavioral health services.
  • The bill also includes provisions that establish penalties for noncompliance with the new requirements.

Key provisions and changes

  • Behavioral health care provider access:
    • The bill requires insurers and/or health plans to take specific actions to ensure access to behavioral health care providers. While the exact mechanisms are not listed in the provided summary, typical elements in such bills include:
    • Timely appointment access standards (e.g., average wait times for behavioral health appointments)
    • Network adequacy requirements (ensure sufficient behavioral health providers within plan networks)
    • Credentialing or parity considerations to ensure behavioral health services are treated comparably to medical/surgical benefits
  • Parity and coverage requirements:
    • The legislation is expected to address parity between behavioral health benefits and physical health benefits, ensuring similar financial and treatment standards.
  • Penalties for noncompliance:
    • The bill establishes penalties for insurers or plan sponsors that fail to meet the behavioral health access standards or related requirements. Penalties could include fines, sanctions, or corrective action orders, though specific penalty amounts or processes are not provided in the summary.
  • Scope:
    • Applies to entities operating under Pennsylvania Title 40 (Insurance), likely including health insurers, managed care plans, and possibly third-party administrators or similar entities involved in administering behavioral health benefits.

Who would be affected

  • Insurers and health plans regulated under Title 40 of the Pennsylvania Consolidated Statutes.
  • Behavioral health providers (psychologists, psychiatrists, licensed clinical social workers, counselors, and other licensed mental health professionals) who participate in insurer networks.
  • Consumers/policyholders seeking behavioral health services, particularly those facing access barriers or delays in obtaining care.

Procedural and timeline considerations

  • The bill would add or modify regulatory requirements within the Pennsylvania Insurance Code, implying:
    • Implementation standards to be adopted by insurers within a specified timeframe after enactment or through subsequent department regulations.
    • An enforcement framework where the state department (likely the Department of Banking and Securities or Department of Insurance, depending on the bill’s drafting) oversees compliance and imposes penalties for violations.
  • Details on reporting requirements, milestones, or grace periods are not provided in the summary but would typically accompany such legislation (e.g., annual network adequacy reports, consumer accessibility data).

Notable details

  • Sponsorship: The bill has a broad set of co-sponsors, indicating cross‑party and cross-constituency interest, with members including Melissa Shusterman, Christina Sappey, Nikki Rivera, Mandy Steele, Tarik Khan, Tarah Probst, Heather Boyd, and Kristine Howard.

Potential impact and considerations

  • If enacted, the bill could enhance access to timely behavioral health care by tightening network adequacy and access standards and by enforcing compliance through penalties.
  • Consumers could see improved access to a broader and more reliable set of behavioral health providers.
  • Insurers may incur compliance costs related to network adjustments, reporting, and administrative changes to align with parity and access requirements.
  • Stakeholders may seek clarifications on:
    • Specific access standards (e.g., maximum wait times for initial and ongoing behavioral health appointments).
    • Definitions of “network adequacy” for behavioral health.
    • Penalty structure and appeal processes.
    • Implementation timeline and phased compliance.

If you want, I can extract or summarize the exact statutory language from the bill’s text (once available) to provide precise definitions, standards, and penalty figures.

Compiled from official sources — confirm details with the bill’s official record.

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