VirginiaSB5242026 Regular SessionSenateWALLET

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

Sponsored By: R. Creigh Deeds (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 HB 656.

Personalized for You

How does this bill affect your finances?

Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.

Bill Overview

Analyzed Economic Effects

7 provisions identified: 5 benefits, 0 costs, 2 mixed.

Stronger mental health coverage for patients

Beginning July 1, 2027, Virginia group and individual health plans must cover mental health and substance use care on par with medical care. This applies even when federal parity law does not directly apply. Medical-need decisions, prior approvals, and care reviews must follow the law’s accepted care standards, without conflicting or stricter review criteria. Plans must cover mobile crisis response and specified crisis-stabilization services when those services are covered in other settings or treatment types. By November 1, 2026, the Department of Human Resource Management must report on coverage, feasibility, costs, and an implementation plan.

Older small-group plans must cover treatment

Beginning July 1, 2027, grandfathered small-group plans must provide parity coverage or the following yearly mental health and substance use benefits. The alternative requires at least 20 inpatient days for adults, 25 for children and adolescents, and 20 outpatient visits per person. When medically needed, patients or children’s parents can convert up to 10 inpatient days into partial hospitalization, at least 1.5 days per inpatient day. After the first five covered outpatient visits, coinsurance must be at least 50%; medication-management visits receive coverage like physical-illness visits and do not count toward visit limits. Visits with covered expenses applied to a deductible do not count toward the outpatient maximum; excepted-benefit policies and specified Medicare-oriented or similar government coverage are excluded.

Stronger care access rules for patients

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

Public checks on insurers’ treatment rules

Health carriers must submit analyses comparing mental health and substance use treatment rules with medical-care rules by October 1, 2026. Later submissions are required at least every two years, and current analyses must be publicly available online. Public posting does not mean the Bureau of Insurance has approved an analysis or found compliance. After reviewing analyses and related data, the Bureau can investigate, fine carriers up to $100,000 per violation, and require rule changes or removal; insufficient analyses count as violations. Beginning in 2027, the Bureau must publish an annual or biennial report on analyses, enforcement, and compliance trends for legislative committee chairs.

Practitioners avoid claims database operating fees

No one may charge health care practitioners fees to form or operate Virginia’s claims database. A reasonable fee is allowed when practitioners voluntarily access data for purposes other than checking data accuracy. The Commissioner and nonprofit board must develop short- and long-term funding plans beyond state appropriations.

Health data access with privacy limits

A nonprofit operates Virginia’s claims database under submission and use agreements, with advisory and data-release committees overseeing access and privacy. The operator, Health Department, Medicaid agency, and Bureau of Insurance get free data access for public health work; other users need approval and use agreements. Data are confidential and exempt from public disclosure; public releases use HIPAA-consistent de-identified data, approved limited data sets, or aggregate counts above 10. Releases use masked reimbursement amounts under a public, approved method; actual amounts are allowed for specified Health Department area-cost or average-payment studies, with other actual-amount analyses requiring committee approval. Named providers or payers, and entities representing at least 60% of released data, get at least 30 days to correct inaccuracies; the operator reports annually on data use, processing, and security.

Broader claims reporting with supplier penalties

Virginia’s All-Payer Claims Database collects claims beyond paid claims or covered benefits, including diagnoses, services, payments, and member costs. Insurers and third-party administrators with at least 1,000 Virginia covered lives in the prior calendar year must report; Medicaid, CHIP, and state-plan data are included. Local and federal plan data depend on availability and legal permission; supplemental claims, including Medigap, disability income, workers’ compensation, long-term care, disease-specific, dental, and vision coverage, remain excluded. ERISA employers can join voluntarily, with reporting starting next period and continuing until written opt-out notice at least 30 days before the next period; administrators’ required lists are due January 31 annually, and pre-contract claims need not be submitted. Private suppliers failing a good-faith response within two weeks after written notice of a missed deadline face up to $1,000 weekly per violation, capped at $50,000; proceeds fund database improvements.

Sponsors & Cosponsors

Sponsor

  • R. Creigh Deeds

    Democratic • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 425 • No: 45

House vote • 3/13/2026

Conference report agreed to by House

Yes: 93 • No: 1

Senate vote • 3/13/2026

Conference report agreed to by Senate

Yes: 38 • No: 0

Senate vote • 3/6/2026

Senate acceded to request Block Vote

Yes: 40 • No: 0

Senate vote • 3/3/2026

House substitute rejected by Senate

Yes: 0 • No: 40

House vote • 2/27/2026

Passed House with substitute

Yes: 92 • No: 4

House vote • 2/24/2026

Reported from Health and Human Services with substitute

Yes: 21 • No: 0 • Other: 1

Senate vote • 2/16/2026

Constitutional reading dispensed Block Vote (on 3rd reading)

Yes: 39 • No: 0

Senate vote • 2/16/2026

Education and Health Substitute rejected

Yes: 0 • No: 0

Senate vote • 2/16/2026

Read third time and passed Senate Block Vote

Yes: 39 • No: 0

Senate vote • 2/16/2026

Finance and Appropriations Substitute agreed to

Yes: 0 • No: 0

Senate vote • 2/13/2026

Constitutional reading dispensed Block Vote (on 1st reading)

Yes: 35 • No: 0

Senate vote • 2/12/2026

Reported from Finance and Appropriations with substitute

Yes: 13 • No: 0

Senate vote • 2/5/2026

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

Yes: 15 • No: 0

Actions Timeline

  1. Acts of Assembly Chapter text (CHAP0653)

    4/13/2026Governor
  2. Approved by Governor-Chapter 653 (Effective - see bill)

    4/13/2026Governor
  3. Fiscal Impact Statement from Department of Planning and Budget (SB524)

    3/31/2026Senate
  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

    3/31/2026Senate
  6. Signed by Speaker

    3/31/2026House
  7. Bill text as passed Senate and House (SB524ER)

    3/30/2026Senate
  8. Enrolled

    3/30/2026Senate
  9. Signed by President

    3/30/2026Senate
  10. Conference report agreed to by House (93-Y 1-N 0-A)

    3/13/2026House
  11. Conference report agreed to by Senate (38-Y 0-N 0-A)

    3/13/2026Senate
  12. Conference Report released

    3/12/2026
  13. House Conferees: Willett, Gardner, Cherry

    3/11/2026House
  14. Conferees appointed by House

    3/11/2026House
  15. Senate acceded to request Block Vote (40-Y 0-N 0-A)

    3/6/2026Senate
  16. Senate Conferees: Deeds, Favola, Pillion

    3/6/2026Senate
  17. Conferees appointed by Senate

    3/6/2026Senate
  18. House requested conference committee

    3/4/2026House
  19. House insisted on substitute

    3/4/2026House
  20. House substitute rejected by Senate (0-Y 40-N 0-A)

    3/3/2026Senate
  21. Passed House with substitute (92-Y 4-N 0-A)

    2/27/2026House
  22. Engrossed by House - committee substitute

    2/27/2026House
  23. committee substitute agreed to

    2/27/2026House
  24. Read third time

    2/27/2026House
  25. Read second time

    2/26/2026House

Bill Text

Related Bills

Back to State Legislation