Welcome to the Ledger
The March 2026 issue of Greenberg Traurig’s quarterly Behavioral Health Law Ledger explores new developments in behavioral health law, including ASTP/ONC’s launch of U.S. pilot programs aimed at evaluating behavioral health data exchange standards and the Texas attorney general’s opinion on limitations for mental health providers when counseling minors exploring gender transitions.
ASTP/ONC Announces Pilot Programs to Test Behavioral Health Data Exchange Standards
On Feb. 2, 2026, the Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) announced that it had selected nine pilot programs to test standards for exchanging behavioral health data across health care systems.
The pilot programs, scheduled to continue through the end of 2026, will involve 45 participating organizations across nine jurisdictions that will test behavioral health data exchange standards in real-world care settings. The programs include organizations located in Colorado, Connecticut, Delaware, Florida, Massachusetts, North Carolina, Oregon, Rhode Island, and Washington, D.C. The Behavioral Health Information Technology (BHIT) Initiative will provide funding for the pilots, including approximately $20 million in funding from the Substance Abuse and Mental Health Services Administration (SAMHSA).
In support of these efforts, the pilot programs will use the United States Core Data for Interoperability (USCDI+) Behavioral Health dataset, created jointly by ASTP/ONC and SAMHSA, and the Fast Healthcare Interoperability Resources (FHIR) Behavioral Health Profiles Implementation Guide. These standards are meant to support the consistent collection, sharing, and use of behavioral health information among healthcare providers.
Through these pilots, ASTP/ONC and SAMHSA aim to evaluate how the standards function in practice, focusing on technical interoperability, consent management, and the safeguarding of sensitive patient information, including compliance with 42 C.F.R. Part 2 requirements.
The ASTP/ONC noted that the results from the pilot programs will inform the development of a Behavioral Health Information Resource, anticipated in 2027, which will provide information to facilitate broader adoption of behavioral health data exchange standards.
Texas AG Paxton Issues Advisory Opinion Declaring that Mental Health Providers Must Not ‘Facilitate’ Prohibited Gender Transition-Related Services to Minors
On Feb. 27, 2026, Texas Attorney General Ken Paxton issued a legal opinion declaring that a Texas law passed in 2023 that bans gender-transitioning medical care to minors also applies to mental health care providers licensed by the Texas Behavioral Health Executive Council (TBHEC). Paxton drafted the opinion in response to an inquiry the TBHEC’s executive director submitted in July 2025, which sought clarity for its licensees around the implications of the 2023 law, known as S.B. 14. The TBHEC licenses psychologists, social workers, marriage and family therapists, and licensed professional counselors.
S.B. 14, now codified as subchapter Y in Chapter 161 of the Texas Health and Safety Code (the Texas Code), in pertinent part, generally prohibits the provision or facilitation of certain procedures and treatments “[f]or the purpose of transitioning a child’s biological sex as determined by the sex organs, chromosomes, and endogenous profiles of the child or affirming the child’s perception of the child’s sex if that perception is inconsistent with the child’s biological sex.” Tex. Health & Safety Code § 161.702. The explicit restrictions imposed by the Texas Code apply to both “physicians” and “health care provider[s].” Id. The Texas Code defines “health care provider” as “a person other than a physician who is licensed, certified, or otherwise authorized by this state’s laws to provider or render health care or to dispense or prescribe a prescription drug in the ordinary course of business or practice of a profession.” Id. at 161.701(2). The Texas Code also prohibits the use of public money, including any grant, distribution, and/or Medicaid or child health plan program reimbursement to health care providers or physicians who provide a prohibited procedure or treatment to a child. Id. at 161.704.
In concluding that the Texas Code does apply to TBHEC-licensees, Paxton noted that several of TBHEC’s regulations applicable to its licensees speak in terms of offering patients “assessments” and “treatments” and refers to these individuals as “health care professionals,” despite the fact that the prohibited procedures and treatments themselves (which include but are not limited to performing a sterilization surgery, mastectomy, or removing otherwise healthy/non-diseased body parts or tissue, or prescribing prescription drugs that induce transient or permanent infertility) are beyond the mental health provider’s respective scopes of practice.
Paxton explained that mental health providers may unlawfully “facilitate” – a term undefined by the Texas Code – a prohibited procedure or treatment through their mental health services that may “bring about” a prohibited procedure, even where another health care provider or physician provides or performs the actual prohibited procedure. The opinion goes on to challenge the alleged “science” behind medical transitioning of children with gender dysphoria, stating that myriad entities around the world have “universally concluded that the putative evidence behind this abusive practice is non-existent.”
The opinion concluded that TBHEC-licensees who in any manner facilitate the provisions of unlawful procedures or treatments that aim to transition a child’s sex would be in violation of the Texas Code, and would thus be forbidden from receiving public money, including but not limited to Medicaid reimbursement for such mental health services.