During the 2023 Session, the General Assembly passed and the Governor signed into law HB2216 and SB1347 regarding coverage of mobile crisis response and short-term residential crisis stabilization services by commercial health insurance carriers. In particular, the bill clarifies that health insurance carriers must provide coverage for mobile crisis response services and crisis support and stabilization services provided in a residential crisis stabilization unit to the extent that such services are covered in other settings or modalities, regardless of any difference in billing codes. This law went into effect July 1, 2023, and will be in effect for the 2024 benefit year.

The General Assembly directed the State Corporation Commission (Commission) to convene a workgroup to examine the current availability of these services and make recommendations regarding standards of care, licensure, and cost-sharing for these crisis services.

The workgroup offers ten recommendations regarding mobile crisis response and shortterm residential crisis stabilization services addressing a variety of policy issues including:

• coordination between state agencies and health insurance carriers on statewide efforts to establish and coordinate a comprehensive mental health crisis system;

• provider licensure and access to the crisis platform;

• information-sharing to allow carriers to coordinate care more effectively for their members; and

• commercial carrier service definitions.

The workgroup agreed on one recommendation for a statutory change related to balance billing. Federal law is ambiguous on whether these crisis services are considered “emergency services," so there is uncertainty whether providers could be allowed to balance bill individuals with commercial coverage. By classifying mobile crisis response and short-term residential crisis stabilization services as “emergency services" under Virginia law, it would ensure that individuals experiencing a crisis do not receive unexpected balance bills from providers related to the response and stabilization of that crisis.

The workgroup submits this report of its findings and recommendations to the Governor and members of the Health Insurance Reform Commission. While the Commission's Bureau of Insurance (Bureau) staffed the workgroup and served as facilitators, this report represents the perspectives and consensus of the participating stakeholders.