HB 2653

                                                 PRINTER'S NO.   3662
                THE GENERAL ASSEMBLY OF PENNSYLVANIA
                    HOUSE BILL
                    No. 2653
                                           Session of
                                             2026
INTRODUCED BY SAPPEY, KHAN, HOWARD, BOYD, RIVERA, PROBST,
   SHUSTERMAN, STEELE AND SANCHEZ, JUNE 18, 2026
REFERRED TO COMMITTEE ON INSURANCE, JUNE 22, 2026
                                AN ACT
1 Amending Title 40 (Insurance) of the Pennsylvania Consolidated
2    Statutes, providing for behavioral health care provider
3    access; and imposing penalties.
4    The General Assembly of the Commonwealth of Pennsylvania
5 hereby enacts as follows:
6    Section 1.    Title 40 of the Pennsylvania Consolidated
7 Statutes is amended by adding a chapter to read:
8CHAPTER 46
9BEHAVIORAL HEALTH CARE PROVIDER ACCESS
10 Sec.
11 4601.   Scope of chapter.
12 4602.   Legislative findings and intent.
13 4603.   Definitions.
14 4604.   Behavioral health care provider access to insurer
15networks.
16 4605.   Preclusion permitted.
17 4606.   Parity and nondiscrimination.
18 4607.   Claim handling.
1 4608.    Scope of practice.
2 4609.    Regulations.
3 4610.    Violations.
4 4611.    Administrative procedures.
5 § 4601.    Scope of chapter.
6    This chapter relates to behavioral health care coverage
7 provided under a health insurance policy.
8 § 4602.    Legislative findings and intent.
9    (a)    Legislative findings.--The General Assembly finds and
10 declares as follows:
11(1)   Timely and effective behavioral health care services
12    are critical for the mental and behavioral health of
13    Pennsylvanians.
14(2)   The selection of a behavioral health care provider
15    is a personal choice that can be based upon many factors,
16    including the provider's background, experience with a
17    particular condition or treatment methods.
18(3)   Individuals should have access to a behavioral
19    health care provider who understands their particular needs.
20(4)   Cost concerns or network restrictions should not
21    prevent an individual from finding and seeking treatment with
22    a behavioral health care provider that is right for the
23    individual.
24    (b)    Intent.--The intent of this chapter is to maximize
25 timely and effective access to behavioral health care services
26 for residents of this Commonwealth.
27 § 4603.    Definitions.
28    The following words and phrases when used in this chapter
29 shall have the meanings given to them in this section unless the
30 context clearly indicates otherwise:
20260HB2653PN3662  - 2 -
1    "Administrative policy."    A written document or collection of
2 documents reflecting the terms of the contractual or operating
3 relationship between an insurer and a health care provider.
4    "Behavioral health care provider."    A health care provider
5 that is licensed, certified or otherwise permitted by law or
6 regulation to provide behavioral health care services under the
7 laws of this Commonwealth, including an individual governed by
8 the act of July 9, 1987 (P.L.220, No.39), known as the Social
9 Workers, Marriage and Family Therapists and Professional
10 Counselors Act.
11    "Behavioral health care service."    A health care service
12 intended to address behavioral health, including services for
13 mental health and for substance use disorders.
14    "Commissioner."   The Insurance Commissioner of the
15 Commonwealth.
16    "Covered behavioral health care service."     A behavioral
17 health care service covered by a covered person's health
18 insurance policy.
19    "Covered person."   A policyholder, subscriber or other
20 individual who is entitled to receive health care services under
21 a health insurance policy.
22    "Health care provider."    A person that is licensed, certified
23 or otherwise permitted by law or regulation to provide health
24 care services under the laws of this Commonwealth.
25    "Health care service."    A treatment, procedure, medical
26 supply or other service, prescribed or otherwise provided or
27 proposed to be provided by a health care provider to a covered
28 person.
29    "Health insurance policy."    As defined in section 9103
30 (relating to definitions).
20260HB2653PN3662  - 3 -
1    "Insurer."      As defined in section 9103.
2    "Participating network provider."      A health care provider
3 that has entered into a contractual or operating relationship
4 with an insurer to participate in one or more designated
5 networks of the insurer to provide health care services to
6 covered persons under the terms of the administrative policy of
7 the insurer.
8    "Service area."      The geographic area in which an insurer may
9 offer a health insurance policy.
10    "Telemedicine."      As defined in section 4802 (relating to
11 definitions).
12 § 4604.    Behavioral health care provider access to insurer
13networks.
14    (a)    Willing provider.--An insurer may not refuse to contract
15 with a behavioral health care provider that is willing to enter
16 into a contract for participation in a network for a health
17 insurance policy if the behavioral health care provider
18 satisfies all of the following:
19(1)   Is in good standing with the regulatory authority
20    under which the behavioral health care provider is permitted
21    to practice in this Commonwealth.
22(2)   Provides behavioral health care services from an
23    office in this Commonwealth.
24(3)   Provides covered behavioral health care services
25    offered by the insurer for purchase in the service area.
26(4)   Is willing to abide by the standard terms and
27    conditions of the insurer's standard participating network
28    provider contract.
29    (b)    Reimbursement rate requirement.--A contract under
30 subsection (a) shall be offered to a behavioral health care
20260HB2653PN3662  - 4 -
1 provider at a reimbursement rate paid to similarly situated in-
2 network behavioral health care providers providing services to
3 covered persons in the service area.
4    (c)    Parity required and discrimination prohibited.--A
5 contract under subsection (a) must be in parity with and may not
6 unfairly discriminate against behavioral health care providers
7 generally in comparison to other health care providers, or
8 against the specific behavioral health care provider seeking to
9 contract, including with respect to the following:
10(1)   Practice standards.
11(2)   Quality requirements.
12(3)   Credentialing criteria.
13(4)   Reimbursement rates.
14(5)   Network tier placement, if applicable.
15    (d)    Construction.--Nothing in this chapter shall be
16 construed to prohibit an insurer from contracting with a
17 behavioral health care provider that provides services through
18 telemedicine from an office that is not located in this
19 Commonwealth.
20 § 4605.    Preclusion permitted.
21    An insurer may preclude a behavioral health care provider
22 from participation in a network if either of the following
23 occurs:
24(1)   The insurer demonstrates that the behavioral health
25    care provider has materially failed to comply with the
26    standard terms and conditions for participation.
27(2)   The insurer is engaged in a reasonable investigation
28    for, or has made a finding of, fraud, waste or abuse with
29    respect to the behavioral health care provider.
30 § 4606.    Parity and nondiscrimination.
20260HB2653PN3662  - 5 -
1    The terms "parity" and "discrimination" in this chapter shall
2 be construed in accordance with Article VI-B of the act of May
3 17, 1921 (P.L.682, No.284), known as The Insurance Company Law
4 of 1921.
5 § 4607.    Claim handling.
6    Claim handling, including prompt payment for claim handling,
7 shall be subject to the provisions of Article XXI of the act of
8 May 17, 1921 (P.L.682, No.284), known as The Insurance Company
9 Law of 1921.
10 § 4608.    Scope of practice.
11    Nothing in this chapter shall be construed to expand the
12 scope of practice of a health care provider or permit a health
13 care provider to render care and services other than as
14 permitted under the health care provider's license,
15 certification or other regulatory authorization to practice
16 under the laws of this Commonwealth.
17 § 4609.    Regulations.
18    The department may promulgate regulations as necessary and
19 appropriate to implement, administer and enforce the provisions
20 of this chapter.
21 § 4610.    Violations.
22    (a)     Penalties.--Subject to subsection (b), upon satisfactory
23 evidence of a violation of this chapter by an insurer, the
24 commissioner may, in the commissioner's discretion, pursue any
25 of the following courses of action:
26(1)   Suspend, revoke or refuse to renew the license of
27    the offending person.
28(2)   Enter a cease and desist order.
29(3)   Impose a civil penalty of not more than $5,000 for
30    each action in violation of this chapter.
20260HB2653PN3662  - 6 -
1(4)   Impose a civil penalty of not more than $10,000 for
2    each action in willful violation of this chapter.
3    (b)   Limitation.--Penalties imposed against an insurer under
4 this section may not exceed $500,000 in the aggregate during a
5 single calendar year.
6    (c)   Nonexclusive remedies.--The enforcement remedies imposed
7 under this section are in addition to any other remedies or
8 penalties that may be imposed under any other applicable law of
9 this Commonwealth, including:
10(1)   Article VI-B of the act of May 17, 1921 (P.L.682,
11    No.284), known as The Insurance Company Law of 1921. A
12    violation of the parity and nondiscrimination provisions of
13    this chapter shall be deemed a violation of Article VI-B of
14    The Insurance Company Law of 1921.
15(2)   Article XXI of The Insurance Company Law of 1921.
16(3)   The act of July 22, 1974 (P.L.589, No.205), known as
17    the Unfair Insurance Practices Act. A violation of this
18    chapter shall be deemed to be an unfair method of competition
19    and an unfair or deceptive act or practice under the Unfair
20    Insurance Practices Act.
21(4)   The act of December 18, 1996 (P.L.1066, No.159),
22    known as the Accident and Health Filing Reform Act.
23    (d)   Referral.--Upon receipt or discovery of evidence of a
24 potential violation of this chapter subject to the jurisdiction
25 of another regulatory or law enforcement entity, including the
26 Department of State, the Department of Health, the Department of
27 Drug and Alcohol Programs, the Department of Human Services and
28 the Office of Attorney General, the department may refer the
29 matter as may be appropriate.
30    (e)   Private actions.--
20260HB2653PN3662  - 7 -
1(1)   Nothing in this chapter shall prohibit a behavioral
2    health care provider from using an insurer's dispute
3    resolution process or seeking relief in an appropriate court
4    of general jurisdiction for an alleged failure of an insurer
5    to contract with or make a payment in accordance with this
6    chapter to the behavioral health care provider.
7(2)   Nothing in this chapter shall be construed to
8    prohibit a private cause of action for a violation of this
9    chapter under the act of December 17, 1968 (P.L.1224,
10    No.387), known as the Unfair Trade Practices and Consumer
11    Protection Law.
12 § 4611.    Administrative procedures.
13    (a)    Procedures generally.--The administrative provisions of
14 this chapter shall be subject to 2 Pa.C.S. Ch. 5 Subch. A
15 (relating to practice and procedure of Commonwealth agencies).
16    (b)    Appeals.--A party against whom penalties are assessed in
17 an administrative action may appeal to Commonwealth Court as
18 provided in 2 Pa.C.S. Ch. 7 Subch. A (relating to judicial
19 review of Commonwealth agency action).
20    Section 2.     This act shall apply as follows:
21(1)   For health insurance policies for which either rates
22    or forms are required to be filed with the Federal Government
23    or the Insurance Department, this act shall apply to any
24    policy for which a form or rate is first filed on or after
25    the effective date of this paragraph.
26(2)   For health insurance policies for which neither
27    rates nor forms are required to be filed with the Federal
28    Government or the Insurance Department, this act shall apply
29    to any policy issued or renewed on or after 180 days after
30    the effective date of this paragraph.
20260HB2653PN3662  - 8 -
1   Section 3.    This act shall take effect immediately.
20260HB2653PN3662  - 9 -