A provision in HB2653 bars insurers from excluding qualifying behavioral health providers—shifting who controls network access.
Most behavioral health practice owners in Pennsylvania don't realize a significant shift in insurer power just took effect. Under a provision buried in HB2653, insurers can no longer simply refuse to contract with a qualifying therapist, counselor, social worker, or other behavioral health provider. The rule is real, it's law, and it changes how in-network access works.
Section 4604(a) of HB2653 requires insurers to accept any behavioral health provider into their network if that provider meets four qualifying criteria. Previously, insurers had broad discretion to exclude providers for reasons ranging from network adequacy claims to simple preference. That gatekeeping power is now constrained by law.
The rule applies to small behavioral health practices—individual therapists, counselors, licensed social workers, and similar providers operating independently or in small group settings. If you meet the four statutory criteria, an insurer cannot deny you network participation based on discretionary factors like "network saturation" or general preference.
Access to a network is only half the equation. Subsection (b) of the same section requires that reimbursement rates offered to newly admitted providers match what similarly situated in-network providers already receive. You cannot be admitted at a lower rate simply because you're new or because the insurer prefers to pay less.
This removes a common negotiation barrier: insurers can no longer use "take it at a discount or stay out-of-network" as a standard offer. The rate must be comparable to existing in-network providers in your specialty and geographic area.
The effective date depends on the type of insurance policy:
Immediate: For newly filed policy forms, the rule took effect upon enactment of HB2653.
180 Days After Enactment: For existing policies that don't require a form filing or renewal, insurers have 180 days from the bill's enactment to comply.
This staggered timeline means some insurers may already be operating under the rule, while others have a compliance window. Check your state's legislative records for the exact enactment date if you need to calculate the 180-day deadline for your specific contracts.
The rule doesn't guarantee a contract with every insurer—you still must meet the four qualifying criteria set out in the statute. It doesn't override credentialing or licensure requirements. And it doesn't apply to out-of-state or national insurers unless they're regulated under Pennsylvania law.
If you've been denied network participation or offered below-market rates, this provision may now be in your favor. Document your qualifications against the four criteria and the rates offered to comparable providers. If an insurer continues to exclude you or underpay after the effective date, you have grounds to challenge the decision under state law.
For a detailed breakdown of the four qualifying criteria and how to apply them to your practice, consult your state trade association or a healthcare attorney familiar with Pennsylvania insurance law.