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Subcommittee holds children’s mental‑health bill as insurers, NFI and DHS race to agree billing codes
Summary
A Commerce & Consumer Affairs subcommittee paused legislation expanding children’s mental‑health services after hearings exposed that nonprofit provider NFI has not billed commercial insurers because of missing commercially billable codes and incomplete contracts; insurers and the Department of Health and Human Services agreed to pursue coding and contracting solutions during a one‑week follow‑up.
A House Commerce & Consumer Affairs subcommittee on Tuesday held action on legislation expanding children’s mental‑health services after a prolonged dispute over who should bill for services provided by nonprofit partner NFI North and how those services map to commercial insurance billing codes.
Chair opened the discussion by tracing the program’s origin to an executive‑council contract with NFI and said the expectation in that contract was that NFI would bill commercial insurers when children had private coverage. NFI’s executive director, Luke Reernard, told the panel that NFI has not yet billed Anthem or other carriers because “there is no existing code. So, there’s no mechanism for us to send them an invoice.”
Anthem’s policy lead, Sabrina Dunlap, said Anthem has engaged with NFI since late 2024 and that carriers are working in good faith to resolve the issue, but negotiations have been slow because the providers were not in‑network and there were questions about volume and appropriate codes. Department of Health and Human Services legislative liaison Jenny O’Higgins explained that the state contract uses standard language naming the state payer of last resort and that the underlying problem is the absence of commercially billable procedure codes for some of the wraparound and care‑management services NFI provides.
Committee members pressed both sides on the scope and cost implications. Members noted the program’s fiscal note (approximately $2.5 million in the form discussed at prior hearings) and that intensive services per child are expensive and time‑capped under current program design. Jim Monahan of the Dupont Group, speaking for community behavioral health centers, urged technical fixes (effective dates and billing alignment) to avoid leaving providers uncompensated for care they must provide.
Rather than advance legislation with the disputed assessment mechanism included, the subcommittee set a one‑week action item: carriers and NFI should seek a practical contracting and coding approach so the committee can consider a targeted bill or amendment next week. The chair said if parties cannot agree by the follow‑up, the committee will consider legislative backstops in September. The bill remains on hold pending that outcome.
The subcommittee scheduled continued work next Tuesday to resolve remaining bills.
What’s next: Insurers and NFI are expected to report back to the committee with progress on commercial coding and contracting; the committee will reconvene next week to consider a narrowly targeted amendment or further action.
