David Behar, M.D., E.J.D.

Thursday, May 28, 2026

TREAT for All Act Tele-Mental Health Reimbursement Equity and Access to Treatment for All Act A Model Federal Act to Encourage State Adoption of the TREAT Act and Protect Nationwide Tele-Mental Health Access

Section 1. Short Title

This Act may be cited as the “TREAT for All Act,” the Tele-Mental Health Reimbursement Equity and Access to Treatment for All Act.

Section 2. Congressional Findings

Congress finds that:

Mental health care is essential health care.
Outpatient mental health care, including psychiatry, mental health therapy, counseling, psychotherapy, behavioral health treatment, substance use disorder counseling, crisis prevention, safety planning, and medication management, is a core component of the Nation’s health care system.
Most outpatient mental health care does not require hands-on physical procedures.
The principal exceptions to telehealth-appropriate outpatient mental health care include electroconvulsive therapy, inpatient psychiatric hospitalization, residential treatment requiring physical presence, crisis stabilization requiring physical supervision, physical examination when medically necessary, laboratory testing, toxicology testing, and services that cannot meet the applicable standard of care unless delivered in person.
Requiring in-person attendance as a condition of receiving outpatient mental health care creates barriers for rural patients, disabled patients, working patients, parents, caregivers, students, older adults, patients without reliable transportation, patients with limited broadband access, patients with limited income, and patients whose mental health symptoms make travel difficult.
Unnecessary in-person requirements reduce access to mental health care, delay treatment, increase missed appointments, worsen workforce shortages, and increase the public costs of untreated and undertreated mental health conditions.
Telehealth, including audio-video and audio-only care when clinically appropriate, is an essential access pathway for outpatient mental health care.
Payment reductions for telehealth mental health services discourage providers from offering telehealth, narrow provider networks, and create financial incentives that restrict access to care.
It is in the national interest to encourage every State to make telehealth the default mode of access for outpatient mental health care and to require reimbursement for covered tele-mental health services at rates equal to comparable in-person services.

Section 3. Purpose

The purposes of this Act are to:

encourage all States to enact and enforce a State-level Tele-Mental Health Reimbursement Equity and Access to Treatment Act, known as the TREAT Act;
make telehealth the default access pathway for outpatient mental health care nationwide;
prohibit unnecessary in-person requirements for outpatient mental health care;
protect audio-only telehealth when clinically appropriate or necessary for access;
require payment parity for covered outpatient mental health services delivered by telehealth;
preserve patient choice and individualized clinical judgment;
protect patients and providers from reduced access caused by state inaction; and
condition a portion of covered federal mental health payments on State adoption and enforcement of TREAT-compliant laws.

Section 4. Definitions

For purposes of this Act:

A. “Audio-only telehealth”

“Audio-only telehealth” means the delivery of health care services through real-time, two-way voice communication without video when the treating provider determines that the service can be delivered consistent with the applicable standard of care.

B. “Covered federal mental health payment”

“Covered federal mental health payment” means any federal payment, allotment, grant, cooperative agreement, or federal financial participation paid to or administered by a State for outpatient mental health services, behavioral health services, or substance use disorder services.

The term includes, to the extent permitted by federal law:

Community Mental Health Services Block Grant funds;
federal block grant funds used for outpatient mental health or substance use disorder treatment;
federal grants to a State mental health authority or behavioral health authority for outpatient mental health access;
federal Medicaid payments to a State attributable to outpatient mental health, behavioral health, or substance use disorder services;
federal Children’s Health Insurance Program payments to a State attributable to outpatient mental health, behavioral health, or substance use disorder services;
federal administrative payments to a State for mental health access, behavioral health access, Medicaid mental health administration, or telehealth implementation; and
any other state-administered federal funds designated by the Secretary as covered federal mental health payments.

The term does not include direct payments to Indian Health Service facilities, Tribal health programs, urban Indian organizations, federally qualified health centers, rural health clinics, or other non-State entities unless the payment is administered by the State.

C. “Covered outpatient mental health service”

“Covered outpatient mental health service” means any outpatient service, visit, consultation, treatment, procedure, program, or encounter covered under a mental health, behavioral health, or substance use disorder benefit that would be covered if delivered in person.

The term includes, but is not limited to:

psychiatric evaluation;
psychiatric diagnosis;
medication management;
psychotherapy;
mental health therapy;
individual counseling;
family counseling;
group counseling;
behavioral health treatment;
substance use disorder counseling or treatment;
crisis prevention;
safety planning;
care coordination;
case management;
intensive outpatient services;
partial hospitalization services when clinically appropriate for telehealth delivery;
community mental health center services;
federally qualified health center behavioral health services;
rural health clinic behavioral health services;
school-based mental health services; and
any substantially similar outpatient mental health or behavioral health service.

D. “Health plan”

“Health plan” means any insurer, health maintenance organization, nonprofit health service corporation, Medicaid managed care organization, managed care organization, state employee health plan, public employee health benefit plan, or other entity subject to State regulation that provides, administers, or pays for health care coverage.

The term includes third-party administrators and self-funded plans to the maximum extent permitted by federal law.

E. “Secretary”

“Secretary” means the Secretary of Health and Human Services.

F. “State”

“State” means each of the 50 States, the District of Columbia, Puerto Rico, the United States Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, and any other territory or possession of the United States receiving covered federal mental health payments.

G. “TREAT-compliant law”

“TREAT-compliant law” means a State law, regulation, or enforceable statewide policy that satisfies the minimum requirements described in Section 5 of this Act.

Section 5. Minimum Requirements for State TREAT Compliance

A State shall be considered compliant with this Act only if the State has in effect and enforces a TREAT-compliant law that, at minimum, provides the following protections.

A. Telehealth as Default Access

The State shall make telehealth the default mode of access for covered outpatient mental health services when the service can be delivered by telehealth consistent with the applicable standard of care.

B. Prohibition on In-Person Requirements

The State shall prohibit any provider, health plan, utilization review entity, licensing board, State agency, Medicaid managed care organization, or State-funded program from requiring an in-person visit as a condition of providing, covering, authorizing, renewing, continuing, prescribing for, or reimbursing a covered outpatient mental health service, unless a narrow exception applies.

C. Permitted Exceptions

The State may permit in-person requirements only for:

electroconvulsive therapy;
inpatient psychiatric hospitalization;
residential psychiatric treatment requiring physical presence;
crisis stabilization requiring physical supervision;
emergency detention, involuntary commitment, or custody proceedings requiring physical control, transport, or examination under State law;
laboratory testing, imaging, toxicology testing, vitals collection, or physical examination when physically necessary and not otherwise obtainable;
a service for which federal law expressly requires an in-person encounter;
an individualized clinical determination, documented by the treating provider, that telehealth cannot meet the applicable standard of care for that patient and service; or
a patient’s affirmative request for in-person care when in-person care is available.

D. Coverage Parity

The State shall require every health plan subject to State authority, every Medicaid managed care organization, the State Medicaid program, and every State-funded mental health program to cover a covered outpatient mental health service delivered by telehealth if the same or substantially equivalent service would be covered when delivered in person.

E. Payment Parity

The State shall require reimbursement for covered outpatient mental health services delivered by telehealth at a rate not less than 100 percent of the rate paid for the same or substantially equivalent service when delivered in person.

Payment parity shall apply to:

psychiatric evaluation and management;
psychiatric diagnostic evaluation;
psychotherapy;
counseling;
mental health therapy;
medication management;
family therapy;
group therapy;
behavioral health treatment;
substance use disorder counseling and treatment;
crisis services;
case management;
care coordination;
intensive outpatient services;
partial hospitalization services when clinically appropriate for telehealth delivery;
community mental health center services;
federally qualified health center behavioral health services;
rural health clinic behavioral health services;
bundled payments;
per-diem outpatient program rates;
professional components;
facility or clinic components when payable for comparable in-person care; and
any other covered outpatient mental health service, visit, procedure, or program.

F. Audio-Only Protection

The State shall require coverage and reimbursement of audio-only telehealth for covered outpatient mental health services when clinically appropriate or necessary for access.

Audio-only telehealth shall be protected when:

the patient lacks video technology;
the patient lacks reliable broadband;
the patient cannot use video technology because of disability, symptoms, privacy concerns, device limitations, language access needs, or other access barriers;
the patient does not consent to video communication;
the patient reasonably prefers audio-only communication; or
the treating provider determines that audio-only care is clinically appropriate.

G. No Originating-Site or Geographic Restrictions

The State shall prohibit geographic, rural-area, county-based, distance-based, facility-based, or originating-site restrictions on covered outpatient mental health services delivered by telehealth.

A patient’s home, school, workplace, shelter, community setting, residential setting, correctional setting, or any other safe and private location may serve as the originating site.

H. Provider-Patient Relationship by Telehealth

The State shall allow a provider-patient relationship for outpatient mental health care to be established by telehealth.

A prior in-person relationship shall not be required.

I. Prescribing by Telehealth

The State shall permit prescribing, ordering, and managing medication through telehealth for outpatient mental health treatment to the fullest extent permitted by federal law.

The State shall not impose an in-person requirement for prescribing unless expressly required by federal law or by an individualized clinical determination documented by the treating provider.

J. Patient Choice

The State shall preserve a patient’s right to request telehealth and a patient’s right to request in-person care when in-person care is available.

K. Enforcement

The State shall provide meaningful enforcement mechanisms, including complaint rights, appeal rights, penalties for payer noncompliance, payment of underpaid claims, and protection against retaliation.

Section 6. State Certification

Not later than 18 months after enactment of this Act, each State receiving covered federal mental health payments shall submit to the Secretary a certification stating whether the State has enacted and implemented a TREAT-compliant law.
The certification shall include:

a. the text of the State law, regulation, or enforceable statewide policy;

b. an explanation of how the State satisfies each requirement in Section 5;

c. identification of the State agencies responsible for enforcement;

d. the State’s process for patient and provider complaints;

e. the State’s process for health plan enforcement;

f. the State’s Medicaid tele-mental health coverage and payment policies;

g. the State’s audio-only telehealth policies;

h. documentation of stakeholder consultation, including consultation with mental health providers, patients, disability advocates, rural health advocates, Medicaid beneficiaries, and community mental health providers; and

i. any other information the Secretary determines necessary.
A State shall update its certification annually.
The Secretary shall publish each State certification and compliance determination on a public website.

Section 7. Federal Review and Determination of Compliance

The Secretary shall review each State certification and determine whether the State has enacted and implemented a TREAT-compliant law.
The Secretary shall issue a preliminary determination not later than 120 days after receiving a State certification.
If the Secretary determines that a State is not compliant, the Secretary shall provide written notice identifying each deficiency.
A State shall have 180 days after receiving notice to cure the deficiency.
After the cure period, the Secretary shall issue a final compliance determination.
A State may request administrative reconsideration of a final noncompliance determination in accordance with procedures established by the Secretary.
A State law that substantially adopts the model State TREAT Act shall be deemed compliant unless the Secretary identifies a specific conflict with the requirements of this Act.

Section 8. Ten Percent Withholding for Noncompliant States

Beginning with the first fiscal year that starts at least 24 months after enactment of this Act, if the Secretary determines that a State has failed to enact and implement a TREAT-compliant law, the Secretary shall reduce covered federal mental health payments to that State by 10 percent for that fiscal year.
The 10 percent reduction shall apply only to covered federal mental health payments.
The reduction shall continue for each fiscal year in which the State remains noncompliant.
The Secretary shall restore full covered federal mental health payments beginning with the first fiscal quarter after the Secretary determines that the State has enacted and implemented a TREAT-compliant law.
A reduction under this section shall not be construed to authorize a State, health plan, Medicaid managed care organization, provider, or contractor to reduce, deny, delay, or terminate medically necessary mental health care for any individual.
A State subject to a reduction under this section shall maintain coverage, reimbursement, and access for eligible patients using State funds or other available funds.
A State may not reduce provider reimbursement, narrow eligibility, reduce covered benefits, or impose new patient cost sharing as a means of offsetting a reduction under this section.
A State subject to a reduction shall submit to the Secretary a corrective access plan explaining how the State will prevent harm to patients and providers during the period of noncompliance.

Section 9. Reallotment and Use of Withheld Funds

Amounts withheld under Section 8 shall remain available to the Secretary for grants to compliant States, local governments, Tribal organizations, community mental health centers, federally qualified health centers, rural health clinics, school-based mental health programs, and nonprofit providers to expand tele-mental health access.
Priority shall be given to projects that:

a. expand tele-mental health access in rural areas;

b. expand access for disabled patients;

c. expand audio-only access for patients without broadband or video technology;

d. support community mental health providers;

e. reduce wait times for outpatient mental health care;

f. improve access for Medicaid beneficiaries;

g. expand culturally competent and language-accessible mental health services;

h. support school-based mental health services;

i. improve telehealth access for older adults;

j. improve telehealth access for children and adolescents; or

k. support technology and workflow improvements for small and safety-net mental health providers.
Withheld funds shall not revert to the Treasury if they can be used to expand tele-mental health access under this section.

Section 10. Maintenance of Effort

A State receiving covered federal mental health payments shall maintain State expenditures for outpatient mental health services, behavioral health services, and substance use disorder services at a level not less than the average level of such expenditures for the two fiscal years preceding the fiscal year for which payment is sought.
A State may not use federal funds made available under this Act to supplant State funds.
The Secretary may waive all or part of the maintenance-of-effort requirement for a fiscal year if the Secretary determines that extraordinary economic conditions in the State justify the waiver and that the waiver will not reduce access to outpatient mental health care.

Section 11. Protection of Individual Benefits

Nothing in this Act shall be construed to reduce an individual’s entitlement to Medicaid, the Children’s Health Insurance Program, or any other federal health benefit.
No individual shall be denied eligibility, coverage, treatment, medication, therapy, counseling, crisis care, or other medically necessary mental health care because a State is subject to a reduction under Section 8.
No provider shall be denied payment for a covered service furnished to an eligible individual solely because a State is subject to a reduction under Section 8.
The Secretary shall enforce this section to ensure that any funding reduction is borne by the noncompliant State and not by patients or providers.

Section 12. Medicaid and CHIP State Plan Requirements

As a condition of receiving covered federal mental health payments under Medicaid or the Children’s Health Insurance Program, a State plan or waiver shall provide that covered outpatient mental health services may be delivered by telehealth when clinically appropriate.
A State Medicaid program and Children’s Health Insurance Program shall not impose in-person requirements for covered outpatient mental health services except as permitted under Section 5(C).
A State Medicaid program and Children’s Health Insurance Program shall reimburse covered outpatient mental health services delivered by telehealth at a rate not less than 100 percent of the rate paid for the same or substantially equivalent service delivered in person.
Medicaid managed care organizations and CHIP managed care organizations shall comply with this Act as a condition of contracting with the State.
The Secretary may issue guidance, regulations, State Medicaid Director letters, and model State plan amendment language to implement this section.

Section 13. Private Insurance and ERISA Savings Clause

A State shall apply its TREAT-compliant law to all health plans subject to State regulation.
Nothing in this Act shall be construed to limit a State’s authority to regulate insurance, health maintenance organizations, Medicaid managed care organizations, public employee health plans, or any other health coverage subject to State law.
This Act applies to self-funded employee benefit plans only to the extent permitted by federal law.
Nothing in this Act shall be construed to reduce or preempt any stronger State law that provides broader telehealth access, stronger payment parity, broader audio-only protection, or greater mental health coverage.

Section 14. Rulemaking

Not later than 180 days after enactment, the Secretary shall issue interim final regulations to implement this Act.
Final regulations shall be issued not later than 1 year after enactment.
Regulations shall include:

a. model State TREAT Act language;

b. certification procedures;

c. compliance review procedures;

d. public reporting requirements;

e. withholding procedures;

f. reallotment procedures;

g. Medicaid and CHIP implementation guidance;

h. enforcement procedures;

i. patient and provider complaint processes; and

j. standards for determining whether audio-only telehealth is protected.
The Secretary shall consult with:

a. State mental health authorities;

b. State Medicaid agencies;

c. State insurance regulators;

d. mental health providers;

e. community mental health centers;

f. federally qualified health centers;

g. rural health clinics;

h. disability rights organizations;

i. patient advocates;

j. Tribal health organizations;

k. youth mental health advocates;

l. substance use disorder treatment providers; and

m. privacy and civil rights experts.

Section 15. Annual Reports to Congress

Not later than 2 years after enactment, and annually thereafter, the Secretary shall submit a public report to Congress on implementation of this Act.
The report shall include:

a. each State’s compliance status;

b. States subject to withholding;

c. amounts withheld from each noncompliant State;

d. amounts reallotted under Section 9;

e. tele-mental health utilization data;

f. audio-only telehealth utilization data;

g. outpatient mental health wait-time data, where available;

h. Medicaid and CHIP tele-mental health access data;

i. complaint and enforcement data;

j. provider network adequacy data;

k. rural access data;

l. disability access data;

m. recommendations for improving tele-mental health access; and

n. recommendations for additional congressional action.

Section 16. Enforcement

The Secretary may enforce this Act through audits, corrective action plans, payment reductions, grant conditions, Medicaid and CHIP oversight, civil monetary penalties where authorized, and any other remedy available under federal law.
The Secretary may require a State to submit documents, claims data, plan documents, provider manuals, reimbursement schedules, utilization management criteria, Medicaid managed care contracts, and other materials necessary to determine compliance.
A State that knowingly submits a false certification under this Act shall be subject to all remedies available under federal law.
The Secretary shall establish a public complaint process through which patients, providers, advocates, and health plans may report State noncompliance.
The Secretary shall investigate credible complaints and publish aggregate complaint data annually.

Section 17. No Retaliation

A State, health plan, Medicaid managed care organization, provider, contractor, or other entity shall not retaliate against any patient, provider, facility, program, or advocate for asserting rights under this Act.
Prohibited retaliation includes termination, nonrenewal, reduced reimbursement, denial of claims, exclusion from a network, adverse licensing action, adverse credentialing action, harassment, or any other penalty related to asserting rights under this Act.

Section 18. Construction

This Act shall be liberally construed to promote access to outpatient mental health care.
Nothing in this Act shall be construed to:

a. require telehealth when telehealth would violate the applicable standard of care;

b. prohibit a patient from requesting in-person care;

c. prohibit a provider from offering in-person care;

d. authorize a service prohibited by federal law;

e. authorize prescribing prohibited by federal law;

f. reduce privacy protections under federal or State law;

g. reduce mental health parity protections under federal or State law;

h. reduce disability rights protections under federal or State law;

i. reduce Medicaid or CHIP beneficiary protections; or

j. preempt stronger State telehealth protections.
If another federal or State law provides broader telehealth access, stronger payment parity, broader audio-only protection, or greater mental health access, the more protective provision shall control.

Section 19. Severability

If any provision of this Act, or the application of any provision to any person, entity, State, program, payment, or circumstance, is held invalid, the invalidity shall not affect any other provision or application of this Act that can be given effect without the invalid provision or application.

Section 20. Effective Date

This Act shall take effect on the date of enactment.
State certification requirements shall begin 18 months after enactment.
The 10 percent withholding under Section 8 shall begin with the first fiscal year that starts at least 24 months after enactment.
The Secretary may issue implementation guidance immediately upon enactment.

TREAT Act Tele-Mental Health Reimbursement Equity and Access to Treatment Act A Model State Act to Make Telehealth the Default for Outpatient Mental Health Care and Require Payment Parity

Section 1. Short Title

This Act shall be known and may be cited as the “TREAT Act,” the Tele-Mental Health Reimbursement Equity and Access to Treatment Act.

Section 2. Legislative Findings and Purpose

The Legislature finds and declares that:

Outpatient mental health care, including psychiatry, mental health therapy, counseling, psychotherapy, behavioral health treatment, substance use disorder counseling, and medication management, is essential health care.
Most outpatient mental health care does not require hands-on physical procedures. The core functions of outpatient mental health care include listening, assessment, diagnosis, counseling, therapy, medication management, safety planning, crisis prevention, care coordination, and follow-up.
The principal exceptions to telehealth-appropriate outpatient mental health care are services that inherently require physical presence, including electroconvulsive therapy, inpatient psychiatric hospitalization, crisis stabilization requiring physical supervision, and other services that cannot meet the applicable standard of care unless delivered in person.
Requiring in-person attendance as a condition of receiving outpatient mental health care creates unnecessary barriers for patients, including rural patients, disabled patients, elderly patients, working patients, students, caregivers, parents, patients without reliable transportation, and patients whose mental health symptoms make travel difficult.
In-person requirements for outpatient mental health care reduce access to care, delay treatment, increase missed appointments, worsen workforce shortages, and are inconsistent with the public interest in early and continuous treatment.
Payment reductions for telehealth mental health services discourage providers from offering telehealth, weaken provider networks, and create financial incentives that restrict access to care.
Untreated and undertreated mental health conditions impose significant costs on individuals, families, employers, health systems, schools, correctional systems, and the State.

The purposes of this Act are to:

make telehealth the default mode of access for outpatient mental health care;
prohibit unnecessary in-person requirements;
protect audio-video and audio-only telehealth when clinically appropriate;
require coverage of outpatient mental health services delivered by telehealth on the same basis as in-person services;
require reimbursement for telehealth mental health services at rates equal to comparable in-person services; and
preserve patient choice, clinical judgment, safety, privacy, and the applicable professional standard of care.

Section 3. Definitions

For purposes of this Act:

A. “Audio-only telehealth”

B. “Carrier” or “health plan”

“Carrier” or “health plan” means any insurer, health maintenance organization, nonprofit health service corporation, managed care organization, Medicaid managed care organization, state employee health plan, public employee health benefit plan, or other entity subject to state regulation that provides, administers, or pays for health care coverage.

The term includes third-party administrators and self-funded plans to the maximum extent permitted by federal law.

C. “Covered outpatient mental health service”

The term includes, but is not limited to:

psychiatric evaluation;
psychiatric diagnosis;
medication management;
psychotherapy;
mental health therapy;
individual counseling;
family counseling;
group counseling;
behavioral health treatment;
substance use disorder counseling or treatment;
crisis prevention and safety planning;
care coordination;
case management;
intensive outpatient services;
partial hospitalization services when clinically appropriate for telehealth delivery;
community mental health center services;
federally qualified health center behavioral health services;
school-based mental health services; and
any substantially similar outpatient mental health or behavioral health service.

D. “Default mode of access”

“Default mode of access” means that a covered outpatient mental health service shall be available, covered, authorized, and reimbursed by telehealth unless a specific exception under this Act applies.

E. “Distant site”

“Distant site” means the location of the provider delivering a telehealth service.

F. “In-person requirement”

“In-person requirement” means any requirement that a patient appear physically in the same location as a provider before, during, or after receiving outpatient mental health care.

The term includes, but is not limited to:

an in-person intake requirement;
an in-person examination requirement;
an in-person annual visit requirement;
an in-person reassessment requirement;
an in-person medication management requirement;
an in-person relationship-establishment requirement;
a requirement that a patient appear at a clinic, hospital, physician office, or other facility as the originating site; or
any other condition that restricts access to telehealth solely because the patient and provider are not physically present in the same location.

G. “Originating site”

“Originating site” means the location of the patient at the time a telehealth service is furnished.

The originating site may include, but is not limited to:

the patient’s home;
workplace;
school;
college or university;
shelter;
community setting;
correctional setting;
residential program;
assisted living facility;
long-term care facility; or
any other location chosen by the patient that allows the service to be delivered safely and privately.

H. “Provider”

“Provider” means any individual, group practice, clinic, facility, community mental health center, federally qualified health center, rural health clinic, hospital outpatient department, substance use disorder treatment provider, or other person or entity legally authorized to provide covered outpatient mental health services in this State.

The term includes, but is not limited to:

psychiatrists;
psychiatric nurse practitioners;
psychologists;
licensed clinical social workers;
licensed professional counselors;
licensed mental health counselors;
marriage and family therapists;
addiction counselors;
psychiatric physician assistants;
psychiatric pharmacists when acting within scope of practice;
behavioral health case managers;
peer support specialists when covered by law or benefit design; and
any other licensed, certified, registered, or otherwise authorized mental health professional.

I. “Telehealth” or “tele-mental health”

“Telehealth” or “tele-mental health” means the delivery of covered outpatient mental health services through electronic or telecommunications technology when the service is delivered consistent with the applicable standard of care.

Telehealth includes, but is not limited to:

audio-video communication;
audio-only communication;
secure messaging;
asynchronous communication;
remote monitoring;
digital therapeutic support;
mobile health applications; and
any combination of technologies that supports clinically appropriate care.

Section 4. Telehealth as the Default for Outpatient Mental Health Care

Telehealth shall be the default mode of access for all covered outpatient mental health services in this State.
A provider, health plan, utilization review entity, state agency, licensing board, or managed care organization shall not require an in-person visit as a condition of providing, covering, authorizing, renewing, continuing, or reimbursing a covered outpatient mental health service unless an exception under Section 10 applies.
A covered outpatient mental health service that can be delivered by telehealth consistent with the applicable standard of care shall be made available by telehealth.
A patient may receive outpatient mental health care by telehealth from any originating site, including the patient’s home.
No health plan, state agency, or provider network may impose geographic, rural-area, distance, facility-based, county-based, or originating-site restrictions on covered outpatient mental health services delivered by telehealth.
A provider-patient relationship may be established through telehealth for covered outpatient mental health services.
A prior in-person relationship shall not be required before a patient may receive outpatient mental health care by telehealth.
Telehealth shall be the default access pathway and shall not be construed to prohibit a patient from requesting in-person care when available.

Section 5. Prohibition on In-Person Requirements

Except as provided in Section 10, no provider, health plan, utilization review entity, state agency, licensing board, or managed care organization shall impose an in-person requirement for covered outpatient mental health services.
Prohibited in-person requirements include, but are not limited to:

a. requiring an in-person intake before telehealth care;

b. requiring an in-person physical examination before telehealth care;

c. requiring an annual or periodic in-person visit as a condition of continued telehealth care;

d. requiring in-person reassessment for medication management;

e. requiring the patient to travel to a medical facility to receive telehealth;

f. requiring in-person attendance solely because the service is a new-patient visit;

g. requiring in-person attendance solely because the service involves prescribing;

h. denying telehealth coverage because the patient is located at home; or

i. denying telehealth coverage because the patient and provider have not previously met in person.
A general preference for in-person care shall not constitute a valid basis for denying, restricting, delaying, or reducing access to telehealth.
A payer policy, provider policy, or agency rule that categorically requires in-person care for outpatient mental health services shall be void and unenforceable unless expressly authorized by this Act or required by federal law.

Section 6. Patient Choice and Clinical Judgment

A patient has the right to request telehealth for covered outpatient mental health services.
A patient has the right to request in-person care when in-person care is offered by the provider or program.
A provider may determine, based on the patient’s individualized clinical circumstances, that a specific service cannot be delivered by telehealth consistent with the applicable standard of care.
A provider who determines that telehealth is not clinically appropriate for a specific patient and service shall document the individualized clinical basis for that determination in the patient’s record.
A provider may not deny telehealth based solely on:

a. diagnosis;

b. age;

c. disability;

d. payer type;

e. new-patient status;

f. medication status;

g. patient location;

h. lack of prior in-person relationship; or

i. generalized administrative convenience.
Nothing in this Act shall require a provider to deliver a service by telehealth when doing so would violate the applicable standard of care.

Section 7. Audio-Only Telehealth

Audio-only telehealth shall be a covered and reimbursable modality for outpatient mental health care when clinically appropriate.
Audio-only telehealth shall be permitted when:

a. the patient lacks access to video technology;

b. the patient lacks reliable broadband access;

c. the patient cannot use video technology because of disability, symptoms, privacy concerns, device limitations, language access needs, or other access barriers;

d. the patient does not consent to video communication;

e. the patient reasonably prefers audio-only communication; or

f. the treating provider determines that audio-only care is clinically appropriate.
A health plan shall not deny, reduce, delay, or condition reimbursement for a covered outpatient mental health service solely because the service was delivered by audio-only telehealth.
Audio-only telehealth shall be reimbursed at the same rate as the same or substantially equivalent service delivered in person when the service is otherwise covered and clinically appropriate.
A provider shall not be required to document the patient’s lack of broadband, lack of video equipment, or reason for using audio-only telehealth beyond documenting that audio-only telehealth was clinically appropriate or necessary for access.

Section 8. Coverage Parity

A health plan shall cover a covered outpatient mental health service delivered by telehealth if the same or substantially equivalent service would be covered when delivered in person.
Coverage shall not be denied solely because:

a. the service was delivered by telehealth;

b. the service was delivered by audio-only telehealth;

c. the patient was located at home;

d. the provider was not located in a clinic, hospital, or office;

e. the patient and provider had not previously met in person;

f. the provider-patient relationship was established by telehealth;

g. the service was furnished outside ordinary business hours; or

h. the patient was located in a nonclinical community setting.
A health plan shall not impose on telehealth mental health services any requirement that is more restrictive than requirements imposed on comparable in-person mental health services.
Prohibited restrictions include, but are not limited to, more restrictive:

a. prior authorization;

b. medical necessity review;

c. concurrent review;

d. retrospective review;

e. documentation requirements;

f. cost sharing;

g. network rules;

h. referral requirements;

i. credentialing standards;

j. billing rules; or

k. utilization management criteria.

Section 9. Payment Parity

A health plan shall reimburse a covered outpatient mental health service delivered by telehealth at a rate not less than 100 percent of the rate the health plan would pay for the same or substantially equivalent service if delivered in person.
Payment parity shall apply to:

a. psychiatric evaluation and management services;

b. psychiatric diagnostic evaluations;

c. medication management;

d. individual psychotherapy;

e. family therapy;

f. group therapy;

g. counseling;

h. behavioral health treatment;

i. substance use disorder counseling and treatment;

j. crisis services;

k. case management;

l. care coordination;

m. intensive outpatient services;

n. partial hospitalization services when clinically appropriate for telehealth delivery;

o. community mental health services;

p. federally qualified health center behavioral health services;

q. rural health clinic behavioral health services;

r. facility or clinic components when payable for comparable in-person care;

s. bundled payments;

t. per-diem outpatient program rates;

u. add-on codes; and

v. any other covered outpatient mental health service, procedure, visit, or program.
A health plan shall not reduce reimbursement, deny payment, downcode, impose a lower fee schedule, apply a different conversion factor, reduce a relative value, deny a facility component, deny a professional component, or apply a site-of-service reduction solely because a covered outpatient mental health service was delivered by telehealth.
A health plan shall not require a telehealth-specific modifier, place-of-service code, billing code, or administrative designation for the purpose or effect of reducing payment below the rate paid for comparable in-person care.
A health plan shall not require a provider to use a proprietary platform, exclusive vendor, or health plan-selected technology as a condition of payment, provided that the technology used by the provider complies with applicable privacy and security law.
A health plan shall not impose patient cost sharing for telehealth outpatient mental health services that is greater than the cost sharing imposed for comparable in-person outpatient mental health services.

Section 10. Exceptions

This Act does not require telehealth delivery, telehealth coverage, or telehealth payment parity for a service that cannot be delivered by telehealth consistent with the applicable standard of care.
Exceptions include:

a. electroconvulsive therapy;

b. inpatient psychiatric hospitalization;

c. residential psychiatric treatment requiring physical presence;

d. crisis stabilization requiring physical supervision for patient safety;

e. emergency detention, involuntary commitment, or custody proceedings requiring physical control, transport, or examination under state law;

f. laboratory testing, imaging, vitals collection, toxicology testing, or physical examination when physically necessary and not otherwise obtainable;

g. a service for which federal law expressly requires an in-person encounter;

h. a circumstance in which the treating provider makes and documents an individualized clinical determination that telehealth cannot meet the applicable standard of care for that patient and service; or

i. a patient’s affirmative request for in-person care when in-person care is available.
The exceptions in this section shall be construed narrowly.
A health plan, provider, licensing board, or state agency may not create categorical exceptions beyond those authorized by this Act unless required by federal law.
Administrative preference, cost control, generalized fraud concern, or historical practice shall not constitute an exception.

Section 11. Prescribing by Telehealth

A provider may prescribe, order, or manage medication through telehealth for outpatient mental health treatment to the fullest extent permitted by federal and state law.
No state agency, licensing board, health plan, pharmacy benefit manager, or pharmacy shall require an in-person visit as a condition of prescribing, covering, dispensing, or reimbursing medication for outpatient mental health treatment unless:

a. an in-person visit is expressly required by federal law;

b. an in-person visit is expressly required by state law and not preempted or superseded by this Act; or

c. the treating provider documents an individualized clinical determination that an in-person visit is necessary for that patient and medication.
A pharmacy, pharmacy benefit manager, or health plan shall not refuse to fill, cover, or reimburse a prescription solely because the prescription was issued after a telehealth encounter.
This section shall not be construed to authorize prescribing that is otherwise prohibited by federal law.

Section 12. Medicaid and Public Programs

The State Medicaid program shall cover covered outpatient mental health services delivered by telehealth to the same extent as comparable in-person services.
The State Medicaid program shall reimburse covered outpatient mental health services delivered by telehealth at a rate not less than 100 percent of the rate paid for the same or substantially equivalent service delivered in person.
Medicaid managed care organizations shall comply with this Act as a condition of contracting with the State.
The state employee health plan and any public employee health benefit program shall comply with this Act.
State-funded mental health programs, behavioral health programs, substance use disorder programs, correctional health programs, school-based mental health programs, and community mental health programs shall make telehealth the default mode of access for covered outpatient mental health services when clinically appropriate.
The State Medicaid agency and all relevant state agencies shall amend contracts, provider manuals, billing guidance, fee schedules, managed care contracts, and regulations as necessary to implement this Act.

Section 13. Network Adequacy and Provider Directories

A health plan shall maintain an adequate network of outpatient mental health providers available by telehealth.
A health plan may not use the existence of telehealth services as a substitute for maintaining an adequate mental health provider network.
A health plan shall maintain accurate provider directories that identify:

a. whether a provider offers telehealth;

b. whether a provider offers audio-video care;

c. whether a provider offers audio-only care;

d. whether a provider is accepting new patients;

e. the types of mental health services offered; and

f. the languages in which services are available.
A health plan shall update telehealth provider directory information at least monthly.
A health plan shall not list a provider as available for telehealth unless the provider has confirmed such availability.

Section 14. Professional Standards, Consent, and Documentation

A provider delivering telehealth under this Act shall comply with the same professional standard of care that applies to comparable in-person services.
A licensing board shall not discipline, sanction, restrict, or deny renewal to a provider solely because the provider delivers covered outpatient mental health services through telehealth, including audio-only telehealth, when the provider complies with the applicable standard of care.
Consent to telehealth may be obtained verbally, electronically, or in writing.
A provider shall document telehealth consent in the patient record.
A separate written telehealth consent form shall not be required unless expressly required by federal law.
A provider shall make reasonable efforts to document:

a. the patient’s location at the time of service;

b. emergency contact information when clinically appropriate;

c. the modality used for the service;

d. consent to telehealth; and

e. any individualized clinical determination required by this Act.
A provider shall use technology that is reasonable and appropriate for the patient, the service, the clinical circumstances, and applicable privacy and security law.

Section 15. Anti-Discrimination and Access Protections

A patient shall not be denied outpatient mental health care solely because the patient requests telehealth.
A provider shall not discharge, refuse to treat, penalize, or reduce access for a patient solely because the patient requests telehealth, unless the provider documents that telehealth cannot meet the applicable standard of care for that patient and service.
A health plan shall not discriminate against a provider because the provider delivers covered outpatient mental health services by telehealth.
A health plan shall not discriminate against a patient because the patient receives covered outpatient mental health services by telehealth.
A provider, health plan, or state agency shall make reasonable accommodations to ensure telehealth access for patients with disabilities, limited English proficiency, limited digital literacy, or limited technology access.
A health plan shall not use telehealth availability as a basis to reduce mental health benefits, narrow provider networks, or deny medically necessary care.

Section 16. Enforcement

A violation of this Act by a health plan shall constitute an unfair insurance practice.
The Insurance Commissioner may investigate violations of this Act and may order corrective action, restitution, payment of denied or underpaid claims, civil penalties, and any other remedy authorized by law.
A violation of this Act by a Medicaid managed care organization shall constitute a breach of contract with the State and may result in corrective action, sanctions, liquidated damages, suspension of enrollment, withholding of payment, or termination.
A patient, provider, facility, or program may file a complaint regarding a violation of this Act with:

a. the Insurance Commissioner;

b. the State Medicaid agency;

c. the Attorney General;

d. the Department of Health;

e. the Department of Mental Health or Behavioral Health; or

f. the relevant licensing board.
For any underpayment in violation of this Act, the health plan shall pay:

a. the unpaid amount;

b. interest at the statutory judgment rate;

c. any applicable clean-claim penalty;

d. reasonable attorney’s fees and costs if the provider or patient prevails in an administrative or judicial proceeding; and

e. any additional remedy authorized by law.
The Attorney General may bring an action to enforce this Act and may seek injunctive relief, restitution, civil penalties, attorney’s fees, costs, and any other remedy available under law.
A health plan shall not retaliate against a patient, provider, or facility for filing a complaint, appealing a denial, seeking payment parity, or asserting rights under this Act.

Section 17. Rulemaking

The Insurance Commissioner, State Medicaid agency, Department of Health, Department of Mental Health or Behavioral Health, and relevant licensing boards shall adopt rules necessary to implement this Act within 180 days after enactment.
Rules adopted under this Act shall be consistent with the following principles:

a. telehealth is the default access pathway for outpatient mental health care;

b. in-person requirements are prohibited unless expressly authorized by this Act or required by federal law;

c. audio-only care is protected when clinically appropriate or necessary for access;

d. telehealth mental health services are reimbursed at the same rate as comparable in-person services;

e. patient choice shall be preserved;

f. exceptions shall be narrow and based on individualized clinical need; and

g. cost control, administrative convenience, or payer preference shall not justify restricting telehealth access.

Section 18. Annual Reports

Beginning one year after the effective date of this Act, and annually thereafter, the Insurance Commissioner and State Medicaid agency shall submit a public report to the Legislature regarding implementation of this Act.
The report shall include:

a. the number of telehealth outpatient mental health claims submitted, approved, denied, and appealed;

b. the number of audio-only outpatient mental health claims submitted, approved, denied, and appealed;

c. reimbursement rates for telehealth services compared with comparable in-person services;

d. the number and type of complaints received;

e. enforcement actions taken;

f. network adequacy data for outpatient mental health services;

g. provider participation data;

h. patient access data, including wait times where available;

i. data regarding use of telehealth by rural patients, disabled patients, Medicaid beneficiaries, and other underserved populations where available and legally permissible; and

j. recommendations to improve access to outpatient mental health care.

Section 19. Construction

This Act shall be liberally construed to promote access to outpatient mental health care.
Nothing in this Act shall be construed to:

a. require telehealth when telehealth would violate the applicable standard of care;

b. prohibit a patient from requesting in-person care;

c. prohibit a provider from offering in-person care;

d. authorize a service prohibited by federal law;

e. reduce privacy protections under state or federal law;

f. reduce mental health parity protections under state or federal law; or

g. limit any broader telehealth right, payment right, or mental health access protection provided under any other law.
Where another provision of state law provides greater access to telehealth, greater payment parity, broader mental health coverage, or stronger patient protections, the more protective provision shall control.

Section 20. Severability

If any provision of this Act, or the application of any provision to any person, entity, or circumstance, is held invalid, the invalidity shall not affect any other provision or application of this Act that can be given effect without the invalid provision or application.

Section 21. Effective Date

This Act shall take effect on [DATE].
For health plans, this Act shall apply to all policies, contracts, certificates, and plans issued, renewed, amended, administered, or continued on or after [DATE].
Medicaid, Medicaid managed care organizations, the state employee health plan, and all state-funded mental health programs shall comply with this Act no later than [DATE].
State agencies shall issue any necessary implementation guidance no later than 180 days after enactment.