Several states are advancing behavioral health policy changes, from syringe service program restrictions in Indiana to Medicaid reimbursement debates in Maryland and workforce reforms in Oregon.
Here are 20 updates to know:
1. New York Gov. Kathy Hochul signed legislation authorizing the state Office of Mental Health and Office of Addiction Services and Supports to establish a single set of licensing standards for integrated behavioral health services in outpatient centers.
The legislation is intended to streamline care for people with co-occurring mental health and substance use disorders by allowing the two agencies to jointly establish standards for the construction, operation, reporting and monitoring of integrated behavioral health services.
Rather than requiring patients with co-occurring disorders to navigate two separately regulated systems, the goal is to let a single licensed provider deliver both mental health and substance use treatment.
2. Louisiana lawmakers passed legislation requiring hospitals to complete new admission and discharge procedures for patients admitted for inpatient behavioral healthcare services under an emergency certificate, effective Aug. 1.
The measure requires hospitals within 72 hours of admission to ensure a licensed healthcare professional conducts a behavioral health evaluation for underlying behavioral conditions. Facilities also must contact the patient’s primary healthcare provider or behavioral health professional to establish the patient’s treatment history.
Before discharge, hospitals must make a “reasonable effort” to notify the patient’s behavioral health and primary care providers of the planned discharge unless the patient objects. If the patient does not have a behavioral health provider, the hospital must refer the patient to appropriate behavioral and primary care services.
3. A Connecticut law that took effect July 1 expands eligibility for the Department of Mental Health and Addiction Services’ psychedelic-assisted therapy pilot program at New Haven, Conn.-based Yale University.
The law allows state residents age 18 and older who meet clinical eligibility criteria established by the institutional review board at Yale School of Medicine, which administers the program, to participate. Previously, the pilot program was limited to veterans, retired first responders and direct healthcare workers. Participants must receive MDMA or psilocybin-assisted therapy as part of a research program approved by the FDA.
The act also eliminated a requirement that DMHAS end the pilot program if the FDA approves MDMA and psilocybin for medical use.
4. North Carolina Gov. Josh Stein signed House Bill 1104, which overhauls parts of the state’s involuntary commitment process, expands outpatient commitment and establishes a new framework for restoring criminal defendants’ competency to stand trial.
The law also directs multiple studies and planning initiatives aimed at improving behavioral healthcare access and public safety.
Among the law’s changes, outpatient commitment orders may last up to 180 days in many cases, up from 90 days under prior law. The legislation also requires more comprehensive outpatient treatment plans and expands coordination among providers, managed care organizations and the courts. Many of those statutory changes take effect Dec. 1.
The legislation directs the North Carolina Department of HHS to develop plans addressing shortages of staffed behavioral health beds, expand the use of mobile crisis teams in the involuntary commitment process and evaluate additional training for commitment examiners. The North Carolina Sheriffs’ Association will develop a proposal to use telehealth for initial involuntary commitment examinations in county jails.
The law also establishes a new inpatient capacity restoration program for criminal defendants found incapable of proceeding to trial. In addition, the North Carolina Collaboratory will conduct multiple studies examining the involuntary commitment system, outpatient commitment, behavioral healthcare in county jails and the operation of state psychiatric hospitals, with reports due beginning in 2026 and continuing through 2027.
5. California Gov. Gavin Newsom signed a bill that expands judicial discretion in the state’s mental health diversion program, changing the public safety standard courts apply when evaluating diversion requests.
The law removes a legal standard that limited courts’ ability to deny diversion requests and instead allows judges to determine whether diversion is appropriate based on broader public safety considerations
The state’s mental health diversion program was established to connect eligible individuals with treatment and reduce recidivism. It allows felony defendants found incompetent to stand trial to participate in community-based mental health treatment instead of inpatient competency restoration treatment.
6. Kansas Gov. Laura Kelly signed House Bill 2635 and Senate Bill 430 into law, making kratom and 7-hydroxymitragynine, also known as 7-OH, Schedule I controlled substances effective July 1.
The new law designates the substances as having a high potential for abuse and no currently accepted medical use, according to a May 8 news release from the Kansas Hospital Association. Kratom is a plant-based substance with stimulant and opioid-like effects, and 7-OH is a more potent alkaloid found in kratom products.
7. New Hampshire Gov. Kelly Ayotte signed a bill requiring syringe service programs that distribute sterile needles and syringes to provide free disposal options for used supplies and conduct annual outreach on those services.
The law also establishes quarterly reporting requirements, including syringe return rates. Programs are expected to maintain a return rate of 95% or higher and must submit a corrective action plan if they fall below that threshold for two consecutive quarters.
The measure was approved May 28 and takes effect Aug. 26, 2026.
8. Colorado’s governor signed a bill June 3 restricting the use of AI in mental and behavioral healthcare settings.
The measure requires psychotherapy to be delivered by a licensed professional and limits AI use in clinical settings to supplementary and administrative functions with oversight from a licensed provider. Healthcare providers must disclose when AI is used for support services such as recording or transcribing meetings.
The law also prohibits AI chatbots from being marketed as equivalent to licensed psychotherapists or counselors and bars chatbots from implying that patient information is protected by confidentiality safeguards such as HIPAA.
9. Virginia Gov. Abigail Spanberger signed legislation prohibiting firearms and other dangerous weapons inside medical facilities that provide mental health and developmental services.
10. California enacted new staffing rules for psychiatric hospitals June 1, establishing minimum nurse-to-patient ratios and financial penalties for facilities that fail to comply.
The emergency regulations require psychiatric hospitals to staff at least one licensed nurse for every six adult patients and at least one licensed nurse for every five patients below the age of 18. At least 50% of nurses counted toward ratios must be registered nurses. Any licensed nurse included in the nurse-to-patient ratio shall be awake and on duty in the hospital.
The emergency regulations will remain in effect for one year. The state health department will have until July 31, 2027, to finalize permanent regulations, incorporating feedback from front-line employees and hospital operators.
Hospitals that fail to meet the ratios would be required to reduce patient capacity. Violations would carry fines of $15,000 for the first violation and $30,000 for the second and each subsequent violation.
11. Oklahoma Gov. Kevin Stitt signed a bill that allows certified behavioral health case managers and peer recovery support specialists employed at the city and county level to maintain certification, effective Nov. 1.
The law applies to workers supporting county sheriffs, courts, police departments and fire departments, according to a statement from Rep. Nicole Miller, R-Edmond. She said the legislation is intended to strengthen local mental healthcare support systems and improve communities’ ability to respond to behavioral health needs.
Sen. Aaron Reinhardt, R-Jenks, served as the Senate author of the bill. He said certified behavioral health case managers can support first responders by helping de-escalate crises and connect individuals with support services.
12. Oregon Gov. Tina Kotek signed a package of behavioral health bills aimed at expanding the workforce, improving workplace safety and increasing access to mental health and addiction services.
The legislation includes measures to streamline Medicaid credentialing and background checks for behavioral health workers, establish workplace safety requirements and create a new credential for professionals trained to work with adolescents.
One law also requires AI chatbot operators to disclose interactions and implement safeguards related to self-harm and suicidal ideation, particularly for minors.
13. Idaho Gov. Brad Little signed a bill April 2 to restore Medicaid-funded mental health programs.
The legislation will use one-time legal settlement funds to reinstate the Assertive Community Treatment program and peer support services, which were previously cut by the contractor for the Idaho Behavioral Health Plan, Magellan, after state-directed budget reductions.
The funding package includes $4.6 million in tobacco settlement funds and $5.8 million in opioid settlement funds. The federal government is expected to cover $20.5 million of the nearly $31 million total cost.
14. New Jersey Gov. Mikie Sherrill signed legislation March 30 eliminating specific practice restrictions for advanced practice nurses, allowing some to independently provide primary and behavioral healthcare services.
This makes permanent the independent practice authority for qualifying advanced practice nurses as a temporary waiver tied to a joint protocol requirement was to expire. It also allows eligible advanced practice nurses to prescribe medications without a joint protocol with collaborating physicians.
15. Mississippi Gov. Tate Reeves signed legislation to fund clinical trials for ibogaine, a psychedelic drug. The law directs the Mississippi State Department of Health to establish a partnership to study the drug’s effectiveness in treating addiction, depression and traumatic brain injuries.
In 1970, ibogaine was classified by the federal government as having no medical use due to safety concerns, including fatal cardiac arrhythmias. In contrast, a 2024 study from Stanford (Calif.) University suggested it may reduce symptoms of traumatic brain injury and mental disorders, though critics cited limitations, including the lack of a control group.
No state funds are attached to the bill. Lawmakers said they plan to allocate opioid settlement funds for the effort, which could reach up to $5 million.
16. Indiana legislation allowing counties to continue syringe service programs — while adding restrictions — became law after Gov. Mike Braun did not sign or veto the bill.
The legislation extends six counties’ programs for five years. The programs provide sterile syringes, safe needle disposal, overdose prevention drugs, disease testing and referrals to healthcare and social services.
Participants are required to show identification proving they live in a county hosting the program and sites cannot operate within 1,000 feet of schools, child care centers or houses of worship without written consent.
Programs are also required to exchange one sterile syringe for each used needle returned, as well as track referrals to drug treatment, prohibit disruption of certain chemicals and allow the department to shut down sites that violate the rules after receiving complaints.
17. In Maryland, behavioral health providers and advocates have urged lawmakers to increase reimbursement rates for behavioral health services provided through Medicaid and the state’s Public Behavioral Health System.
Several behavioral health providers and activists asked the House Appropriations Subcommittee on Health and Social Services for a 3% provider rate adjustment, saying current reimbursement levels are insufficient to retain staff and maintain services for patients facing mental health challenges, substance use disorders and housing instability.
The funding request comes as lawmakers face a $1.6 billion budget deficit. Gov. Wes Moore’s proposed fiscal 2027 budget would cut $155.8 million from the Maryland Department of Health’s Behavioral Health Administration, a 3.8% reduction, allocating $3.9 billion for behavioral health services.
18. Oregon Gov. Tina Kotek signed a law March 5 requiring the creation of a centralized credentialing platform for behavioral health providers.
The step is intended to reduce wait times for clinicians ready to deliver care. It also seeks to reduce administrative requirements tied to provider burnout and expand access to master’s degree-level clinical supervision by allowing qualified licensed professionals to supervise across license types.
19. Texas Attorney General Ken Paxton issued a legal opinion March 2 stating that a state law banning gender-affirming medical care for minors applies to mental health providers licensed by the Texas Behavioral Health Executive Council.
It states the council’s licensees qualify as healthcare providers under the legislation and are governed by state law barring funds from going to those who facilitate the prohibited “transition” procedures.
It also clarifies that the statute applies not only to individuals or entities who “provide” medical interventions, but also to those who “facilitate” such interventions.
20. North Carolina Gov. Josh Stein signed an executive order Feb. 5 directing several state agencies to strengthen coordination between the state’s behavioral health and criminal justice systems.
Priority areas include supporting the behavioral health and public safety workforce, and strengthening the behavioral health crisis system.
The order focuses on improving the involuntary commitment process, expanding treatment for incarcerated people, supporting young people in the juvenile justice system with behavioral health needs, improving reentry support for people with mental health needs and strengthening cross-system coordination.
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