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S 5361

Provides for a minimum reimbursement rate for ambulatory behavioral health services

2025 Regular Session Introduced by Leroy Comrie

Establishes a minimum reimbursement rate for ambulatory behavioral health services to strengthen provider pay and expand access to outpatient mental health care.

REFERRED TO INSURANCE
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WeVote Research Nonpartisan
Bill Summary · S 5361

Bill Summary: S 5361

Overview

S 5361, titled “Provides for a minimum reimbursement rate for ambulatory behavioral health services,” is a bill introduced on February 20, 2025 and currently REFERRED TO INSURANCE. The primary sponsor is Leroy Comrie. The bill’s text has not been provided in the available materials, so this summary reflects the information publicly disclosed about the bill and its likely policy direction based on the title and related actions.

Purpose and Intent

  • The core aim appears to be establishing a floor (minimum) reimbursement rate for ambulatory (outpatient) behavioral health services. This would address compensation levels for providers delivering outpatient mental health and related services and seek to ensure a baseline level of payment from insurers.

Key Provisions (Based on Title; subject to the full bill text)

  • The bill would set a minimum reimbursement rate for ambulatory behavioral health services.
  • Details such as the exact dollar amount or rate schedule, which services are covered, and any carve-outs or special cases, are not provided in the available materials.
  • Implementation mechanics (e.g., phased-in Effective Date, applicability to private insurers, public programs, Medicaid, or all insurance products, and enforcement/penalties) are not specified in the provided summary.

Who Would Be Affected

  • Insurers and health plans that cover ambulatory behavioral health services.
  • Behavioral health providers and outpatient clinics that bill for outpatient mental health/substance use services.
  • Potentially patients, if higher reimbursement translates into changes in access, network participation, or premiums.

Legislative Status and Timeline

  • Introduced: February 20, 2025.
  • Current Status: REFERRED TO INSURANCE.
  • Legislative Actions: The bill appears to have two identical entries on the same date noting “REFERRED TO INSURANCE,” which may reflect a clerical duplication rather than separate actions.
  • Related Bill: S 8466 (prior-session), which may indicate a similar or prior effort related to reimbursement rates.

Related Context

  • The bill’s related session bill (S 8466) suggests that this policy idea has been pursued in prior sessions, signaling ongoing interest in aligning reimbursement levels for ambulatory behavioral health services.

Potential Impacts and Considerations

  • Pros: Could improve access to outpatient behavioral health care by ensuring providers are fairly reimbursed; may reduce under-serving gaps in behavioral health networks.
  • Cons: Could impact insurer costs and premium dynamics; stakeholders will seek specifics on rate levels, scope, phased implementation, and protections against unintended cost-shifting to consumers.
  • Important details to watch for in the full text: the exact minimum rate, the services covered, the payer types affected (private vs. public vs. all plans), effective date, enforcement mechanisms, and any exemptions or transition provisions.

Next Steps for Readers

  • Review the full bill text when released to understand the precise rate, applicability, and implementation timeline.
  • Monitor subsequent committee actions and fiscal analyses (if any) to assess potential budget impact and implementation requirements.

If you’d like, I can update this summary with specific rate figures and provisions as soon as the bill text becomes available.

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

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