On September 9, 2024, the U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury (collectively, the Departments) released new final rules implementing The Mental Health Parity and Addiction Equality Act (MHPAEA). The final rules amend certain provisions of the existing MHPAEA regulations and add new regulations. These final rules aim to further MHPAEA’s fundamental purpose – to ensure that individuals in group health plans or group or individual health insurance coverage who seek treatment for covered Mental Health conditions or Substance Use Disorders do not face greater burdens on access to benefits for those conditions or disorders than they would face when seeking coverage for the treatment of a medical condition or a surgical procedure.
In 2025, HB2738, Health insurance; coverage for mental health and substance abuse disorders; generally accepted standards of care. was passed in Virginia. This bill requires health insurance coverage, as defined in the bill, to provide coverage for mental health and substance use disorder benefits for children, adolescents, and adults and requires such coverage to apply the definitions of “generally accepted standards of mental health or substance use disorder care” and “medically necessary” provided in the bill for any determination of medical necessity, prior authorization, or utilization review under such coverage.
This January, House Bill 656 (HB656) and Senate Bill 524 (SB524) were introduced to the Virginia General Assembly.
To learn more about this bill see this one-pager developed by the Behavioral Health Providers Coalition of Virginia.
HB 565 Aims to strengthen how health insurance covers mental health and substance use disorder care. It directs the Virginia Department of Health to establish quantitative network adequacy standards — meaning measurable requirements for timely access to providers, reasonable travel distance, and overall availability of care. The bill would also require health insurance carriers to provide comparative analyses under federal law (including federal parity requirements so mental health benefits are comparable to medical benefits) to Virginia’s Bureau of Insurance and includes provisions for reporting and possible penalties for inadequate submissions. It would change definitions in state law of “mental health services” and “substance abuse services” for insurance purposes, expand reporting requirements, and authorize the Department of Health to adopt emergency regulations to implement these provisions.
SB 524 mirrors much of HB 656’s intent. It focuses on mental health and substance abuse disorders by establishing network adequacy standards for behavioral health care in insurance plans. It also requires insurers to provide data and analyses about their networks (including timeliness and geographic access). The bill allows the Bureau of Insurance to act on noncompliant analyses (including potentially requiring corrective actions). It also includes changes to how mental health and substance abuse services are defined and reported under state law, aiming to better align coverage with treatment needs.
Why do these bills matter?
Both bills are part of ongoing efforts in Virginia’s legislature to improve access to and quality of behavioral health care by ensuring insurance coverage standards for mental health and substance use disorder matches that for physical health — a goal aligned with the federal Mental Health Parity and Addiction Equity Act. They would give regulators clearer tools to assess whether plan networks are truly adequate (in provider availability and geographic reach) and require more robust reporting and oversight.
Why should behavior analysts care about these bills?
- If insurers are required to maintain adequate provider networks, they can’t rely on:
- Long waitlists
- Huge geographic gaps
- “Ghost networks” where providers aren’t available
- This can increase pressure on insurers to contract with more ABA providers, especially in underserved areas.
These bills require insurers to submit comparative analyses showing they treat behavioral health benefits the same as medical benefits.
That matters because ABA is often subject to more prior authorization, visit limits, and higher denial rates. These bills give Virginia regulators more authority to review those practices, make corrections and penalize noncompliance. This could greatly reduce arbitrary denials and delays for ABA authorizations.