A BILL to amend the Code of Virginia by adding a section numbered 38.2-3412.2, relating to health insurance; reimbursement rates for mental health services.
HB763 would add a new section to Virginia insurance law requiring health carriers to reimburse in-network providers for covered mental health services and outpatient treatment at negotiated rates that are not less than 100% of the applicable Medicare reimbursement rate for the same provider and service. The bill defines the relevant terms by cross-reference to existing insurance statutes and includes geographic locality adjustments, provider-type differences, and site-of-service modifiers when determining the Medicare benchmark.
In practical terms, the bill sets a floor for payment rates in the commercial insurance market for mental health care. It would apply to in-network providers licensed under Title 54.1 and authorized to provide covered outpatient mental health services, and it would affect how insurers and providers negotiate reimbursement for these services under health plans regulated by the Commonwealth.
The bill would create a new statutory reimbursement standard in Title 38.2 for mental health services, effectively tying commercial insurance payment rates to Medicare as a minimum benchmark. If enacted, it would constrain health carriers’ ability to reimburse in-network mental health providers below the specified floor and could increase payments for affected services, with corresponding effects on insurer costs, provider revenue, and potentially patient access to mental health care.
There is limited recorded discussion in the available materials, and no committee transcript or vote breakdown is provided. The bill was continued to the next session in the Labor and Commerce Committee by voice vote, which suggests it was not advanced at this stage but also was not subject to a recorded divided vote. Overall, the available record indicates a neutral-to-cautious procedural posture rather than clear support or opposition on the merits.
The main policy issue inherent in the bill is the use of Medicare rates as a reimbursement floor for private insurance, which may be attractive to mental health providers seeking higher or more predictable payment but could be opposed by health carriers concerned about premium impacts and reduced pricing flexibility. Another likely point of contention is whether a statutory minimum rate could improve network participation and access to care or instead raise costs without guaranteeing better outcomes. No specific stakeholder objections or endorsements are included in the provided record.