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”
“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. “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”
“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 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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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