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Bill Summary · HB 856

Summary of HB 856 (Ohio, 136th General Assembly)

Purpose and intent

  • HB 856 proposes to require health benefit plans and Ohio’s Medicaid program to cover annual mental health well checks for both children and adults.
  • The bill defines what constitutes a mental health well check and who is a “licensed mental health professional” authorized to perform the check.
  • The goal is to ensure parity between mental health and physical health services by mandating coverage for a comprehensive annual mental health assessment.

Key provisions and changes

Section 3902.65 — Health benefit plans

  • Definitions:
    • Licensed mental health professional: broad list includes:
    • Clinical nurse specialists, certified nurse practitioners (specializing in psychiatry, family medicine, or pediatrics)
    • Physician assistants (specializing in psychiatry, family medicine, or pediatrics)
    • Physicians (primary care or psychiatry/family medicine/pediatrics)
    • Psychologists
    • Professional counselors and clinical counselors
    • Social workers and independent social workers
    • Marriage and family therapists (including independent ones)
    • Chemical dependency counselors
    • Mental health well check: an annual visit encompassing:
    • Review of medical history
    • Evaluation of risk and protective factors
    • Use of a developmentally appropriate, validated mental health screening tool
    • Education and consultation on healthy lifestyle changes
    • Referral to ongoing mental health services and other supports as needed
  • Coverage requirement:
    • Health benefit plans must cover an annual mental health well check performed by a licensed mental health professional for each enrolled child and adult, on the same basis as they cover an annual physical health well check.
  • Implementation:
    • The Ohio Superintendent of Insurance must adopt rules to implement this section (pursuant to the state’s rulemaking process).

Section 5164.11 — Medicaid

  • Coverage requirement:
    • Ohio’s Medicaid program must cover an annual mental health well check performed by a licensed mental health professional for each Medicaid recipient, to the same extent that a physical health well check is covered.
  • Implementation:
    • The Medicaid director must adopt rules to implement this section (pursuant to the state’s rulemaking process).

Applicability and timeline

  • Effective scope:
    • Section 2 specifies that the new requirements for health benefit plans apply to plans delivered, issued for delivery, modified, or renewed on or after the act’s effective date.
  • Procedural steps:
    • Rules must be adopted by the Superintendent of Insurance (for private plans) and by the Medicaid director (for the Medicaid program) to implement the coverage changes.

Who is affected

  • Individuals enrolled in private health benefit plans in Ohio (including children and adults).
  • Medicaid beneficiaries in Ohio.
  • Licensed mental health professionals who would perform annual mental health well checks under the new requirements.

Practical impact and considerations

  • Coverage parity with physical health: Mental health well checks would be treated similarly to annual physical exams in terms of coverage requirements.
  • Access and integration: By enabling a broad range of licensed professionals to perform the well check, the bill may improve access to initial mental health assessment and coordination of care.
  • Administrative load: Plans and the Medicaid program would need to implement administrative processes and coding to identify, authorize, and reimburse these annual visits.
  • Potential cost implications: While not specified in the bill, coverage expansion could affect premiums and Medicaid costs; the rulemaking process may address rate, reimbursement, and implementation specifics.

Summary statement

HB 856 seeks to normalize and ensure access to annual mental health well checks by mandating equivalent coverage to annual physical exams for both private health plans and Ohio’s Medicaid program, delivered through a broad set of licensed mental health professionals. The bill outlines the definition of the mental health well check, who can provide it, and requires state rulemaking to implement the changes.

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

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