HB 2331
In CommitteeHouse
Pediatric care rates
Preventing reductions in access to pediatric primary care and behavioral health services.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
HB 2331 strengthens access to pediatric and behavioral health services for Medicaid-enrolled children and families by requiring coverage for specific screenings, protecting mental health assessments for young children, and limiting rate cuts for pediatric primary care and ABA services when waitlists are long. It also updates hospital billing rules and budget reduction priorities to protect direct care services.
- Prohibits the state from cutting off life-sustaining medical services (e.g., prescriptions, oxygen, respiratory services) for Medicaid recipients.
- Requires coverage for autism and developmental delay screenings for children, and annual depression screenings for youth ages 12–18 and maternal depression screening for mothers of infants up to 6 months—subject to funding.
- Allows reimbursement for up to five mental health assessment sessions for children ages 0–5, including home/community visits and provider travel, and requires use of the DC:0-5 diagnostic classification system.
- Bars reductions in pediatric primary care and applied behavior analysis (ABA) reimbursement rates if statewide waitlists exceed 30 days, starting in fiscal year 2028 (July 1, 2027).
- Requires hospitals to use swing/skilled nursing beds when appropriate before billing under a new payment method for Medicaid patients who are ready for discharge but lack placement options (e.g., nursing homes, adult family homes).
- Mandates a standardized definition and reporting of wait times for pediatric primary care and ABA services by December 31, 2026.
Who is affected
- Children and youth — Children and youth up to age 18 who receive or need behavioral health services (e.g., depression screening, autism screening), as well as infants and toddlers up to age 5 receiving mental health assessments.
- Parents and caregivers — Parents and caregivers of young children (birth to 6 months) who will have access to maternal depression screening covered under medical assistance.
- Healthcare providers — Pediatric primary care providers and behavioral health providers (including ABA therapists) who deliver services to Medicaid-enrolled patients and may be affected by reimbursement rate rules and billing requirements.
- Hospitals — Hospitals that serve Medicaid patients, especially those who may need to use swing beds or skilled nursing beds for patients who are ready for discharge but lack available placement options.
- Recipients of personal care services — Individuals receiving personal care services (e.g., help with daily living tasks), especially those with the greatest functional disability needs, who may be protected from service reductions due to funding shortfalls.
Pro/Con Analysis
Stronger case for concerns
Potential Benefits (5)
Hospitals may face increased administrative burden to track bed availability and comply with new billing rules, and may experience revenue uncertainty if swing/skilled nursing beds are underutilized or unavailable.
HealthcareRef: Sec. 1(13)(a), (f)ABA and pediatric providers may benefit from rate protection, but small practices without scale may struggle to absorb administrative costs of tracking waitlists or meeting DC:0-5 reporting requirements.
Business & EmploymentRef: Sec. 1(15)Screening mandates are subject to appropriation, meaning funding may not materialize — leaving providers legally obligated but uncompensated, potentially discouraging participation or increasing uncompensated care burden.
HealthcareRef: Sec. 1(8), (9), (10), (11)While protecting direct care, the bill does not increase overall Medicaid funding — so if state revenues fall short, providers may still face delayed payments or reduced service volume, even if rates aren’t cut.
Local GovernmentRef: Sec. 1(16), (17)Standardized wait-time reporting by 2026 may require new IT infrastructure and staff time, especially for smaller clinics, though this is a one-time compliance cost.
HealthcareRef: Sec. 1(14)
Potential Concerns (5)
Prohibits the state from cutting off life-sustaining medical services (e.g., prescriptions, oxygen, respiratory services) for Medicaid recipients, which improves continuity of care and reduces health crises that could lead to emergency room overuse or avoidable hospitalizations.
Public SafetyRef: Sec. 1(1)Mandates coverage for autism/developmental delay screenings, annual depression screenings for youth 12–18, maternal depression screening for mothers of infants ≤6 months, and up to five mental health assessment sessions for children 0–5 — all subject to appropriation — which expands early intervention and reduces long-term mental health and developmental costs.
HealthcarePeopleRef: Sec. 1(8), (9), (10), (11)Bars reductions in pediatric primary care and ABA reimbursement rates if statewide waitlists exceed 30 days starting FY2028, which helps stabilize provider participation and prevents service gaps that disproportionately affect low-income families with children needing behavioral health care.
HealthcarePeopleRef: Sec. 1(15)Requires hospitals to use swing/skilled nursing beds before billing under alternative payment methods for Medicaid patients ready for discharge but lacking placement, which reduces inappropriate hospital stays and associated complications, especially for those with disabilities or chronic conditions.
HealthcarePeopleRef: Sec. 1(13)(a), (f)Establishes a prioritized order for budget reductions (starting with admin costs and executive salaries, ending with direct service reimbursement), protecting front-line health and personal care services — which helps maintain service continuity for vulnerable populations during fiscal downturns.
Local GovernmentPeopleRef: Sec. 1(16), (17)
Who Is Most Affected
Children and youth — especially those with developmental delays, autism, or depression — gain access to earlier, standardized screening and mental health assessments, improving long-term outcomes and reducing crisis episodes.
Parents and caregivers benefit from maternal depression screening and reduced barriers to pediatric behavioral health services, but may still face challenges if provider capacity remains constrained or transportation/logistics hinder access.
Providers of pediatric primary care and ABA services gain rate stability during high-demand periods and expanded billing for assessments, but face new administrative burdens and risk of uncompensated service if funding lags behind mandate.
Hospitals gain flexibility in billing for post-acute care via swing beds, potentially reducing bad debt and improving patient flow, but must invest in coordination with long-term care facilities and may face reimbursement delays.
Recipients of personal care services benefit from statutory protection against service cuts during budget shortfalls, with priority given to those with greatest functional disability — strengthening continuity of essential daily living support.