Bill would limit mental health bills when network wait times fall short

Health plans and outside-network providers could charge patients only what they would owe for covered care inside the network. This covers patients who receive mental or behavioral care from an outside-network provider under a health insurance plan or health maintenance organization. The plan must cover the care, and its network must miss reasonable appointment wait standards. Neither the plan nor the outside provider could bill the patient for the difference between the provider's charge and the plan's payment. The proposed start date is July 1, 2026.

Insurers and health maintenance organizations would have to pay mental health and substance use providers at rates at least as favorable against Medicare rates as those for medical and surgical providers. The rule covers insurance policies and health maintenance organization contracts that cover mental illness or substance use treatment. The comparison uses Medicare rates within the same category of benefits. It would apply to covered policies issued, delivered, amended, or renewed after June 30, 2026, and covered health maintenance organization contracts entered into, delivered, amended, or renewed after that date.

People and organizations could not use an AI system to pose as or replace a licensed mental health professional for work that professional must perform. The rule covers interactions that must be handled by an Indiana professional with an unrestricted behavioral health or psychology license. A licensing board could fine a person or organization up to $5,000 for each violation. The proposed start date is July 1, 2026.

Insurers and health maintenance organizations would need advance notice and a provider's signed approval before cutting payment rates for billed services. The rate rules cover specified health insurance policies and health maintenance organization contracts. They would have to give providers at least 60 days' notice and could not apply a rate cut retroactively. Other major changes to a provider contract would also need the provider's approval and signature. The rate rules would apply to covered policies issued, delivered, amended, or renewed after June 30, 2026, and covered contracts entered into, delivered, amended, or renewed after that date.

Insurers and health maintenance organizations could not lower a claim to a cheaper service in a way that blocks payment for care actually given. It covers claims for care under specified health insurance policies and health maintenance organization plans. Some types of insurance coverage are excluded. The rule concerns a lower service classification that would pay less than the provider's contract requires. The proposed start date is July 1, 2026.