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HB 5863

AN ACT RELATING TO INSURANCE -- HEALTH CARE ACCESSIBILITY AND QUALITY ASSURANCE ACT

2025 Regular Session Introduced by Edith Ajello and 9 co-sponsors

Requires a one-time rate increase for in-network outpatient behavioral health providers (CPI-U plus 5%), effective Jan 1, 2026.

04/01/2025 Committee recommended measure be held for further study
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Bill Summary · HB 5863

Summary — HB 5863: Health Care Accessibility and Quality Assurance Act

Status: Introduced Feb 28, 2025; Referred to House Health & Human Services. Committee recommended measure be held for further study (04/01/2025). Primary sponsor: Rep. Tanzi.

Purpose

The bill seeks to improve access to and payment for outpatient behavioral health services (mental health and substance use disorder services) by (1) requiring health plans to report how providers must identify and submit in‑network behavioral‑health claims, and (2) mandating a one‑time increase to in‑network outpatient behavioral‑health contract rates effective January 1, 2026.

Key provisions

  • Reporting requirement

    • By January 1, 2026 — and at least annually thereafter — each healthcare entity or network plan must compile and submit to the Office of the Health Insurance Commissioner a summary describing how its contracted providers are required to submit claims for in‑network outpatient behavioral health services.
    • The summary must describe use of specific CPT codes, behavioral‑health modifiers appended to widely used CPT codes, or any other formal claim‑identifying requirements.

  • Contractual rate increase

    • Every contract with a provider for in‑network outpatient behavioral health services (including substance use disorder) — and contracts for outpatient diagnostic/therapeutic services that carry a behavioral‑health modifier — must include a provision that, as of January 1, 2026, rates paid under the contract will be increased one time by at least:
    • the U.S. Dept. of Labor “CPI‑Urban All Items Less Food and Energy” percentage increase (the Commissioner will determine the exact percentage by October 1, 2025 based on the most recently published DOL data) PLUS
    • five percentage points (i.e., CPI‑Urban % + 5%).

  • Effective date

    • The act takes effect upon passage.

Who is affected

  • Healthcare entities and network plans (insurers, managed care organizations) — responsible for compiling/submitting reports and including the required contract provision.
  • Contracted outpatient behavioral health providers (mental health and substance use disorder clinicians and facilities) — will receive the mandated one‑time rate increase and may benefit from clearer billing/claim identification guidance.
  • Office of the Health Insurance Commissioner — receives reports and is tasked with calculating the CPI‑based percentage by Oct 1, 2025.
  • Patients may be indirectly affected through provider network stability, access, and potential downstream impacts on premiums or plan costs.

Potential impacts and considerations

  • Intended to improve provider reimbursement and clarify billing/claims practices for behavioral health, potentially increasing access to in‑network care.
  • May increase plan costs; the bill does not specify funding sources or enforcement/penalty mechanisms beyond the contractual requirement.
  • Administrative burden on plans to compile and submit the required summaries annually.
  • The Commissioner’s determination of the CPI percentage (by Oct 1, 2025) is a pivotal administrative step that fixes the numeric baseline for the required increase.

Legislative timeline (selected)

  • Introduced: 02/28/2025 (House Health & Human Services)
  • Hearing scheduled: 03/28/2025 (for 04/01/2025)
  • Committee action: 04/01/2025 — recommended measure be held for further study.

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

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