Insurers would offer contracts to qualifying behavioral health providers

Insurers would have to offer network contracts to qualifying behavioral health care providers. The rule covers behavioral health providers seeking to join an insurer’s network for a health insurance policy. Providers must be in good standing, provide services from a Pennsylvania office, offer covered services sold in the area, and accept the insurer’s standard contract terms. Insurers could exclude a provider for a material failure to follow contract terms, or during a reasonable investigation of fraud, waste, or abuse, or after finding it. For policies requiring a rate or form filing, the rule would apply when a rate or form is first filed on or after the act takes effect. For other policies, it would apply when they are issued or renewed on or after 180 days after the act takes effect.

Insurers would have to offer comparable pay and fair contract terms to qualifying providers. These requirements apply to contracts insurers must offer under the provider access rule. Pay must match that of similarly situated in-network behavioral health providers in the service area. Terms must not unfairly treat behavioral health providers differently from other health providers, or unfairly treat the provider seeking a contract. This covers practice standards, quality, credentials, pay, and network placement when used. For policies requiring a rate or form filing, the requirements would apply when a rate or form is first filed on or after the act takes effect. For other policies, they would apply when issued or renewed on or after 180 days after the act takes effect.

The Insurance Commissioner could penalize insurers that violate the chapter. These penalties apply to an insurer found to have violated the chapter. The commissioner could suspend, revoke, or refuse to renew a license, issue an order to stop the violation, or impose a civil penalty of up to $5,000 per violation, or $10,000 per willful violation. The total penalties against an insurer could not exceed $500,000 in one calendar year. For policies requiring a rate or form filing, the enforcement rules would apply when a rate or form is first filed on or after the act takes effect. For other policies, they would apply when issued or renewed on or after 180 days after the act takes effect.