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Bill Summary · HB 724

Summary of HB 724 (Session 136, Ohio)

This bill would require health benefit plans to cover an annual behavioral health well check performed by a licensed behavioral health professional, starting with plan years or renewals on or after January 1, 2027.

Purpose and intent

  • Establish a mandated benefit: each health benefit plan delivered, issued for delivery, modified, or renewed on or after January 1, 2027 must cover an annual behavioral health well check for children and adults.
  • Align behavioral health care with preventive and integrated primary care approaches, improving access to routine behavioral health screening and early intervention.

Key provisions and changes

Definition and scope

  • Behavioral health well check: an annual visit including review of medical history, assessment of risk and protective factors, use of a developmentally appropriate behavioral health screening tool, education on healthy lifestyle changes, referrals to ongoing services, and other needed supports.
  • Licensed behavioral health professional: includes a broad roster (see below) who can perform the well check.

Providers eligible to perform the well check

  • Clinical nurse specialist or certified nurse practitioner (psychiatry, family medicine, or pediatrics)
  • Physician assistant (psychiatry, family medicine, or pediatrics)
  • Primary care physician or specialist in psychiatry, family medicine, or pediatrics
  • Psychologist
  • Professional counselor, professional clinical counselor, social worker, independent social worker, marriage and family therapist, independent marriage and family therapist
  • Chemical dependency counselor

Coverage and cost sharing

  • Mandated coverage: health benefit plans must cover the annual behavioral health well check for both children and adults when performed by a licensed behavioral health professional.
  • Cost-sharing: generally prohibited for the well check; plans may impose cost-sharing only if necessary to maintain eligibility for a health savings account (HSA) under federal law (IRS §223).
  • Prior authorization: prohibited for the annual well check.
  • Surface issue: plans may not exclude coverage for a behavioral health service or a physical health service on the basis that they were provided on the same day or in the same facility.

Setting and delivery models

  • The annual well check may occur in:
    • A behavioral health setting
    • A primary care setting
    • Integrated primary care delivery models, including:
    • Psychiatric collaborative care model
    • Primary care behavioral health model or behavioral health consultant model
    • Co-located licensed behavioral health professionals within general medical settings
    • Other integrated primary care delivery models focusing on primary care

Reimbursement and parity

  • Reimbursement must be provided through CPT codes specified by rules adopted by the Ohio Superintendent of Insurance.
  • Reimbursement must be:
    • On the same basis and to the same extent for all licensed behavioral health professionals, using methodologies comparable to reimbursement for medical care under federal parity requirements (26 U.S.C. §223 and related 45 C.F.R. 146.136(c)(4)).
    • Allow adjustments for claim payments using a methodology comparable to adjustments for claims billed by licensed behavioral health professionals who are not physicians, consistent with federal parity rules.

Rulemaking and implementation

  • The Superintendent of Insurance must adopt rules to implement:
    • Specification of CPT codes for reimbursement to ensure uniform payment across providers
    • Processes for updating CPT codes when codes are changed or supplemented
    • Any additional requirements necessary to implement the section
  • These rules are exempt from certain rule removal requirements that typically apply to new rules.

ERISA/exemption considerations

  • The bill includes a clause exempting its mandated-benefit requirements from ERISA preemption concerns, acknowledging the potential interaction with federally regulated employee benefit plans. This aims to ensure applicability to plans beyond state-regulated non-ERISA plans.

Affected entities

  • Health benefit plan issuers in Ohio (insurers and any entities defined as health benefit plans under state law)
  • Licensed behavioral health professionals (providers eligible to perform the well checks)
  • Plan enrollees (children and adults covered by the health benefit plans)
  • Employers and employer-sponsored plans subject to Ohio law (in the context of non-ERISA plans and ERISA considerations)

Procedural and timeline aspects

  • Effective date: the provision applies to health benefit plans delivered, issued for delivery, modified, or renewed on or after January 1, 2027.
  • Rulemaking timeline: the Superintendent of Insurance will issue implementing rules, including CPT codes and update processes, under the authority of the bill.
  • Administrative process: standard regulatory rulemaking procedures under Ohio law (Chapter 119) apply to the rulemaking, with certain statutory exemptions noted.

Potential impact (high-level)

  • Expands access to preventive behavioral health screening and early intervention for both children and adults.
  • Creates reimbursement parity expectations to ensure fair compensation for licensed behavioral health professionals performing well checks.
  • Encourages integration of behavioral health within primary care or integrated care models, potentially improving care coordination.
  • May influence employer-sponsored and other health plans, including considerations under federal ERISA for plan design and administration.

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

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