VirginiaHB6562026 Regular SessionHouseWALLET

Mental health & substance abuse disorders; network adequacy standards, comparative analyses, report.

Sponsored By: Rodney T. Willett (Democratic)

Signed by Governor

Summary

Mental health and substance abuse disorders; network adequacy standards; comparative analyses; report; emergency regulations. Directs the Department of Health to issue regulations that include quantitative network adequacy standards for timely access to care, travel time, and geographical distance that are at least as stringent as those imposed for qualified health plans and qualified dental plans. The bill amends the definitions of "mental health services" and "substance abuse services" for the purposes of health insurance coverage. The bill requires health carriers to submit all comparative analyses prepared pursuant to federal law to the Bureau of Insurance on the date and frequency as specified by the Bureau and includes additional information to include in such submission. Under the bill, the Bureau may impose a penalty not to exceed $100,000 for a noncompliant or insufficient comparative analysis or require a carrier to remove, revise, or remedy noncompliant treatment limitations. The bill also amends the contents of the annual report submitted by the Bureau to the General Assembly to cover enforcement efforts with respect to the federal Mental Health Parity and Addiction Equity Act of 2008.The bill authorizes the Bureau to promulgate regulations as necessary to implement the provisions of the bill and directs the Department of Health to adopt emergency regulations to implement the provisions of the bill. The bill directs the Department of Human Resource Management to evaluate the impact of the proposed changes to the provisions of the bill related to health insurance. The provisions of the bill related to health insurance have a delayed effective date of July 1, 2027. This bill is identical to SB 524.

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Bill Overview

Analyzed Economic Effects

6 provisions identified: 4 benefits, 1 costs, 1 mixed.

Older small-group plans must protect benefits

Beginning July 1, 2027, grandfathered small-group plans must follow full parity rules or keep specified minimum benefits. The minimum option provides at least 20 inpatient days for adults and 25 for children and teens each policy year. Each person gets at least 20 outpatient visits, with limits no stricter than those for physical illnesses. Up to 10 inpatient days can become partial-hospitalization days, at no less than 1.5 days per inpatient day. Medication-management visits of up to 20 minutes count as outpatient care but do not use up the visit maximum. Visits applied to a deductible also do not count toward that maximum. After the first five outpatient visits, the insurer must cover at least 50% of covered costs. The minimum option excludes excepted-benefit policies and coverage designed for Medicare-eligible people or similar government coverage.

Stronger mental health coverage for patients

Beginning July 1, 2027, group and individual plans must cover mental health and substance use care on equal terms with medical care. This applies even when federal parity rules do not directly apply, with exceptions for grandfathered small-group plans. Care approval decisions must follow the required accepted standards, not conflicting or stricter criteria. Plans must cover mobile crisis response and crisis stabilization when they cover those services in other settings, despite billing-code differences. Current ICD or DSM diagnostic categories define mental health and substance use benefits separately.

Health plans face stronger network standards

Virginia's Board of Health must set measurable network standards for managed care health plans. The rules must address timely care, travel time, and distance to providers. They must be at least as strict as standards for qualified health and dental plans on Virginia's insurance exchange. The regulations must take effect within 280 days of enactment.

Health cost reports protect payment details

Public releases from Virginia's health claims database must use masked payment amounts rather than actual provider payments. The masking method must be public and approved by the data release committee. The Department of Health can request actual amounts for grouped disease-cost reports or average-payment analyses. Other analyses using actual amounts need committee approval. Total-cost reports using actual amounts must include costs from all data suppliers and cannot identify or point to an individual provider.

Health data suppliers face reporting penalties

Virginia must collect claims data for its All-Payer Claims Database, not just paid claims or claims for covered benefits. Applicable reporting thresholds are at least 1,000 covered lives for insurers and health maintenance organizations, or 1,000 Virginia covered lives for administrators and specified entities. Employers with ERISA workplace plans can opt in voluntarily; participation continues until they give 30 days' written notice to leave. Medigap, disability income, workers' compensation, long-term care, disease-specific, dental, vision, and other supplemental insurance remain excluded. A private supplier faces penalties only after written notice of a missed deadline and no good-faith effort to respond within two weeks. Fines can reach $1,000 per week per violation, capped at $50,000 per violation; the money supports database improvements.

Public coverage reviews and insurer penalties

Health insurers must submit mental health parity comparisons at least every two years, starting by October 1, 2026. The first submission must include all existing comparisons and online access information; the Bureau of Insurance must make current comparisons public. The Bureau must request data on denials, appeals, out-of-network claims, care approvals, provider payments, and network access. Its review also covers credentialing delays, provider directories, and providers accepting new patients. Insufficient or noncompliant comparisons are violations; the Bureau can investigate, impose fines up to $100,000 per violation, or require insurers to fix improper care limits. Beginning in 2027, the Bureau must publish a plain-language oversight report by December 1 of each odd-numbered year, while protecting confidential information.

Sponsors & Cosponsors

Sponsor

  • Rodney T. Willett

    Democratic • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 324 • No: 11

House vote • 3/11/2026

Senate substitute agreed to by House

Yes: 92 • No: 6

Senate vote • 3/10/2026

Education and Health Substitute agreed to

Yes: 0 • No: 0

Senate vote • 3/10/2026

Passed Senate with substitute Block Vote

Yes: 40 • No: 0

Senate vote • 3/9/2026

Constitutional reading dispensed Block Vote (on 2nd reading)

Yes: 40 • No: 0

Senate vote • 3/9/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote • 3/6/2026

Reported from Finance and Appropriations

Yes: 14 • No: 0

Senate vote • 2/26/2026

Reported from Education and Health with substitute and rereferred to Finance and Appropriations

Yes: 15 • No: 0

House vote • 2/16/2026

Read third time and passed House

Yes: 95 • No: 3

House vote • 2/10/2026

Reported from Health and Human Services with substitute

Yes: 21 • No: 1

House vote • 2/5/2026

Subcommittee recommends reporting with substitute

Yes: 7 • No: 1

Actions Timeline

  1. Acts of Assembly Chapter text (CHAP0652)

    4/13/2026Governor
  2. Approved by Governor - Chapter 652 (effective - see bill)

    4/13/2026Governor
  3. Fiscal Impact Statement from Department of Planning and Budget (HB656)

    3/31/2026House
  4. Governor's Action Deadline 11:59 p.m., April 13, 2026

    3/31/2026Governor
  5. Enrolled Bill communicated to Governor on March 31, 2026

    3/31/2026House
  6. Signed by Speaker

    3/31/2026House
  7. Bill text as passed House and Senate (HB656ER)

    3/30/2026House
  8. Enrolled

    3/30/2026House
  9. Signed by President

    3/30/2026Senate
  10. Senate substitute agreed to by House (92-Y 6-N 0-A)

    3/11/2026House
  11. Passed Senate with substitute Block Vote (40-Y 0-N 0-A)

    3/10/2026Senate
  12. Education and Health Substitute agreed to

    3/10/2026Senate
  13. Engrossed by Senate - committee substitute

    3/10/2026Senate
  14. Read third time

    3/10/2026Senate
  15. Passed by for the day Block Vote (Voice Vote)

    3/9/2026Senate
  16. Constitutional reading dispensed Block Vote (on 2nd reading) (40-Y 0-N 0-A)

    3/9/2026Senate
  17. Rules suspended

    3/9/2026Senate
  18. Reported from Finance and Appropriations (14-Y 0-N)

    3/6/2026Senate
  19. Fiscal Impact Statement from Department of Planning and Budget (HB656)

    3/3/2026House
  20. Committee substitute printed 26108828D-S1

    2/27/2026Senate
  21. Reported from Education and Health with substitute and rereferred to Finance and Appropriations (15-Y 0-N)

    2/26/2026Senate
  22. Referred to Committee on Education and Health

    2/17/2026Senate
  23. Constitutional reading dispensed (on 1st reading)

    2/17/2026Senate
  24. Read third time and passed House (95-Y 3-N 0-A)

    2/16/2026House
  25. Fiscal Impact Statement from Department of Planning and Budget (HB656)

    2/16/2026House

Bill Text

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