Couch to Capitol: April 2026 Legislative Updates

A payer suddenly demands money back, lawmakers debate how long clawbacks should even be allowed, and the Supreme Court redraws the lines around counseling regulation when speech is the treatment. We walk through the urgent CareSource of Ohio recoupment news and the concrete steps we recommend right now: push for claim-level specificity, document everything, review your provider contract, consider formal dispute options, and escalate patterns of concern through the right oversight channels. If you’re a mental health provider worried about retroactive audits and reimbursement instability, this breakdown is built for you.

From the Ohio Statehouse, we recap OCA’s Legislative Advocacy Day and where the biggest policy priorities stand. We track Senate Bill 162 on insurance clawback limits and House Bill 220 on prior authorization reform, plus what counselor advocates are asking legislators to do next. We also share how advocacy training and coalition work can turn frustration into action, especially when policy decisions ripple into client access, staffing, and continuity of care.

At the federal level, we unpack the Supreme Court’s ruling in Chiles v. Salazar and what it could mean for laws that aim to protect clients from harmful practices, including sexual orientation and gender identity change efforts. We close with positive momentum too: the Counseling Compact continues to expand interstate practice privileges, and Ohio’s election calendar is a timely reminder that civic engagement shapes mental health systems. Subscribe for monthly counseling policy updates, share this with a colleague, and leave a review to help more counselors find the show.

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Links Mentioned on the Episode:

Counseling Compact

Connect with the Ohio Counseling Association Insurance Advocacy Committee 

Caresource Clawbacks

Make Your Voting Plan

SUPPORT: Senate Bill 162- limiting clawbacks from insurance companies

SUPPORT: House Bill 724-  require health benefit plans to provide coverage for annual behavioral health. 

OPPOSE: House Bill 172-  prohibit the temporary provision of mental health services to minors without parental consent.

PASSED: House Bill 220-  prior authorization reform bill 

Chiles v Salazar Supreme Court Decision- classified counseling and other mental health services as free speech, not professional conduct 

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Created by the OCA's Media, Public Relations, and Membership (MPRM) Committee & its Podcast Subcommittee

·Hosted by Dr. Chase Morgan-Swaney

·Pre-Production & Coordination by Marisa Cargill, Victoria Frazier, Mariah Payne, and Chase Morgan-Swaney

·Editing by Victoria Frazier

Transcript

Welcome And What We Track

SPEAKER_01 0:01

Welcome to Ohio Counseling Conversations Couch to Capital, your quick connection from the counseling office to where laws meet lives. In this segment, we break down the latest legislative and judicial updates, policy changes, and advocacy efforts that impact counselors across Ohio. Whether you're licensed, in training, or just passionate about the field of counseling, we've got what you need to stay informed and empowered.

CareSource Recoupment Alert

Steps To Protect Your Practice

Legislative Advocacy Day Highlights

Ohio Bills On Insurance Reform

Supreme Court Ruling And Counseling

Advocacy Training And National Recognition

SPEAKER_00 0:31

Welcome back to Couch to Capital, where we break down the legislative, executive, and judicial goings-on at the state and federal levels that shape the work of counselors across Ohio and beyond. I'm Dr. Chase Morgan Swainey, President-elect of the Ohio Counseling Association, an assistant professor in the Department of Counseling at Baldwin Wallace University, and the Associate Director of Arbersana Counseling and Wellness. Today, we're covering significant updates affecting our profession, our clients, and our communities. Before we get into our recap, we want to call listeners' attention to a late-breaking development from last week. CareSource of Ohio will begin recouping 15% of monies already distributed to mental health providers for services rendered in 2024 and through the present day. OCA's Insurance Advocacy Committee, Government Relations Committee, and the Ohio Association for Counselors and Private Practice Division, along with our executive board, are actively exploring ways to best represent and advocate for our members. While we conduct further research, please consider the following steps which you could start enacting today. Request specificity and documentation immediately. Ask for a detailed claim level explanation of any recoupement, including the exact rationale, for example, documentation, coding, medical necessity, and the specific contract clause being applied. A flat percentage without individualized justification should be questioned. Often utilizing this language is done to preempt legal challenges. Review your contract and file a formal dispute. Examine your provider agreement with care source for provisions on audits, rate changes, and retroactive adjustments. If the recruitment appears inconsistent, initiate a formal provider dispute and preserve all communication. Consult legal counsel and consider collective action. If significant funds are at stake or the rationale is unclear, consult a healthcare or administrative attorney. Coordinating with peers or professional groups like OCA can strengthen challenges to broad or unsupported recruitment practices. Escalate concerns to oversight and advocacy bodies. Report patterns of concern to the Ohio Department of Medicaid. The OCA Insurance Advocacy Committee is currently putting together a how to file agreement training for all the major insurance providers. But they recommend two items. Get an ROI for the clients from whom you are filing a complaint for your records. Document all emails and information provided by the Medicaid provider to submit. Stay tuned for more from OCA on this in the coming days and weeks. On a personal note, I wish to thank our volunteer servant leaders who graciously share of their time and energy to be responsive to matters such as the care source recoupement in a thoughtful, deliberate, and expert manner on behalf of our association and its members. We understand that counselors across Ohio have been gobsmacked by this news, and we too are fearful of the potential adverse effects on our livelihoods and angered by how this may affect our ability to continue serving our clients. I hope that we can all be mindful of this as we move forward. To paraphrase OCA President Carmela Hill, we're in this together, and together we advance. Thank you for indulging me. Now, let's dig in. We've got a lot to cover. On Tuesday, March 24th, OCA held its annual Legislative Advocacy Day at the Ohio State House in Columbus. Approximately 70 OCA members converged on the state capitol to meet with their state representatives and senators in the 136th Ohio General Assembly. This year, OCA focused on supporting Senate Bill 162, which, if enacted, would limit clawbacks by insurance companies to the same time providers are given to submit claims, as well as House Bill 724, which, if enacted, would require health benefit plans to provide coverage for annual behavioral health well visits, much like an annual physical exam. OCA members in attendance also implored their legislators to oppose House Bill 172, which, if enacted, would repeal section 5122.04 of the Ohio Revised Code to prohibit the temporary provision of mental health services to minors without parental consent. In addition to meetings with legislators, counselor advocates in attendance heard from several special guests about the importance of legislative advocacy, including Dr. Rachel Baker, member of the Ohio House of Representatives, American Counseling Association President-elect, Dr. Victoria Kress, and Mr. Brian Carnahan, Executive Director of the Ohio Counselor, Social Worker, and Marriage and Family Therapist Board. We would like to extend a special thank you to our Executive Director, Amy Barcello, our Government Relations Committee co-chairs Keith Vukasinovich and Dr. CJ Potter, and our lobbyists with the Government Advantage Group, Rachel Aresman and Amanda Sines, without whom Legislative Advocacy Day would not have been a resounding success. While we're on the subject at the state legislature, here is an update on a few key pieces of legislation that OCA has been tracking this month. SB 162, the insurance clawback limit bill, passed the Ohio Senate unanimously two weeks ago. It will now head to the Ohio House of Representatives for further committee hearings before being formally considered by the full chamber. Be sure to contact your member in the Ohio House and ask them to support Senate Bill 162. Additionally, House Bill 220, the prior authorization reform bill, passed the Ohio House in late March. As of two weeks ago, it was referred to the Senate Financial Institutions, Insurance and Technology Committee, and we are hopeful that the bill will be scheduled for hearings upon the legislator's return in May. Contact your state senator and kindly ask them to support House Bill two hundred twenty. Shifting gears a bit, let's see what's been happening at 11st Street in Washington, D.C. On March 31st, the Supreme Court of the United States issued its ruling in Chiles v. Salazar, which some listeners may recall was the focus of a long form episode of Ohio Counseling Conversations back in October of last year. At the heart of the case was whether a state may regulate counseling as professional conduct, or whether doing so violates the First Amendment's free speech clause when a regulation purports to restrict counselor-client conversations based on viewpoint. In an 8-1 ruling, the court held that Colorado's regulation barring licensed counselors from subjecting minors to sexual orientation and gender identity change efforts, commonly referred to as conversion therapy, indeed regulated speech based on viewpoint, and that the lower courts failed to apply sufficiently rigorous First Amendment scrutiny. For the counseling profession, the implications are significant. This ruling may make it harder for states to regulate or prohibit harmful practices. Given that treatment in the counseling context predominantly occurs through speech, and it is likely to invite renewed challenges to similar laws and regulations in other jurisdictions. It also signals that future efforts to protect clients may hinge heavily on whether a law or regulation governing the practice of counseling is written and enforced in a viewpoint neutral way, rather than on a state's intent to safeguard the public against illegitimate and discredited practices. Like the ACA and all other reputable mental health professional associations, OCA remains clear that sexual orientation and gender identity change efforts are harmful and fundamentally inconsistent with ethical, evidence-based, and culturally humble care. LGBTQ youth deserve care that affirms their dignity, enhances their well-being, and elevates their vitality. In the wake of this ruling, we urge counselor advocates to collaborate with legislators, policymakers, and regulators to pursue constitutionally durable protections that preserve both client safety and the integrity, legitimacy, and longevity of the counseling profession. On Saturday, April 11th, OCA was elated to have been invited to join the ACA Government Affairs and Public Policy Team to offer a breakout session titled How to Be an Effective Advocate at the annual American Counseling Association Conference and Expo held in the very heart of it all, Columbus, Ohio. We were honored to be joined by Dr. Beth Liston, a member of the Ohio Senate, who shared about the importance of being an effective legislative advocate. Many thanks to Senator Liston for her time and wisdom, and to the ACA Government Affairs and Public Policy Director, Gila Todd and his team for the opportunity. OCA is proud to be recognized by ACA as an exemplar in the legislative advocacy space across state branches. Lastly, on April 20th, Louisiana became the fourth state in the nation to begin issuing privileges under the Counseling Compact, marking another significant milestone in expanding access to professional counseling services across state lines. Independently licensed counselors in Ohio who are interested in practicing in Arizona, Minnesota, and most recently Louisiana can visit www.counselingcompact.gov for more information and the application to apply for privileges under the compact. The team at Couch to Capital will continue to update listeners as more states go live. That brings us to the end of this month's Couch to Capital. Today, we covered a wide range of updates affecting counselors, clients, and communities across the state, including OCA's response to the care source recruitment matter, highlights from Legislative Advocacy Day, movement on key state legislation related to insurance recruitment and prior authorization reform, the U.S. Supreme Court's ruling in Childs versus Salazar and its implications for the regulation of counseling, OCA's advocacy presence at the ACA conference and Expo, and the continued implementation of the Counseling Compact. Before we sign off, we also want to remind listeners that Ohio's primary election will take place on Tuesday, May 5th, with early in-person voting and absentee voting by mail already underway. As professional counselors, our ethical commitment to client welfare does not stop at our office door. Political systems shape access to care, insurance reimbursement, licensure, education, civil rights, public health, and the social conditions that affect our clients' daily lives. Our daily lives. Engaging in the electoral process is but one way we live out our professional values, advocate for the communities we serve, and help reform systems to promote dignity, wellness, and justice. So make your voting plan, encourage others to do the same, and remember our voices matter, and they're needed in the public square. Thanks for joining us for this episode of Couch to Capital. Until next time.

SPEAKER_01 13:34

That's it for this edition of Couch to Capital, brought to you by the Ohio Counsel Association and Ohio Counseling Conversations. In the meantime, stay tuned, stay engaged, and keep advocating for the future of counseling in Ohio. Because what happens at the Capitol doesn't stay at the Capitol. It impacts every counseling conversation.