BILL NUMBER: SB 1553 CHAPTERED 09/30/08 CHAPTER 722 FILED WITH SECRETARY OF STATE SEPTEMBER 30, 2008 APPROVED BY GOVERNOR SEPTEMBER 30, 2008 PASSED THE SENATE AUGUST 19, 2008 PASSED THE ASSEMBLY AUGUST 13, 2008 AMENDED IN ASSEMBLY AUGUST 12, 2008 AMENDED IN ASSEMBLY JULY 14, 2008 AMENDED IN ASSEMBLY JULY 2, 2008 AMENDED IN ASSEMBLY JUNE 19, 2008 AMENDED IN SENATE MAY 23, 2008 AMENDED IN SENATE APRIL 23, 2008 AMENDED IN SENATE APRIL 9, 2008 INTRODUCED BY Senator Lowenthal (Coauthor: Senator Kuehl) (Coauthors: Assembly Members Berg, Hernandez, and Huffman) FEBRUARY 22, 2008 An act to amend Section 1368.015 of, and to add Section 1367.015 to, the Health and Safety Code, relating to health care service plans. LEGISLATIVE COUNSEL'S DIGEST SB 1553, Lowenthal. Health care service plans: mental health services. Existing law provides for licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law imposes various requirements on health care service plans, including, among other things, requirements related to utilization review procedures regarding approval, modification, delay, or denial of health care services to enrollees. Existing law also requires a health care service plan, other than a plan that primarily serves Medi-Cal or Healthy Families Program enrollees, to establish a Web site. A willful violation of the provisions governing health care service plans is a crime. This bill, relative to mental health services, would prohibit a health care service plan from basing decisions to deny requests by providers for authorization or to deny claim reimbursement on whether admission was voluntary or involuntary or the method of transportation to the health care facility. The bill would also require a health plan that provides coverage for professional mental health services to include information on its Web site that will assist subscribers and enrollees in accessing mental health services. Because this bill would impose additional requirements on health care service plans, the willful violation of which would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 1367.015 is added to the Health and Safety Code, to read: 1367.015. In addition to complying with subdivision (h) of Section 1367.01, in determining whether to approve, modify, or deny requests by providers prior to, retrospectively, or concurrent with the provision of health care services to enrollees, based in whole or in part on medical necessity, a health care service plan subject to Section 1367.01 shall not base decisions to deny requests by providers for authorization for mental health services or to deny claim reimbursement for mental health services on either of the following: (a) Whether admission was voluntary or involuntary. (b) The method of transportation to the health facility. SEC. 2. Section 1368.015 of the Health and Safety Code is amended to read: 1368.015. (a) Effective July 1, 2003, every plan with a Web site shall provide an online form through its Web site that subscribers or enrollees can use to file with the plan a grievance, as described in Section 1368, online. (b) The Web site shall have an easily accessible online grievance submission procedure that shall be accessible through a hyperlink on the Web site's home page or member services portal clearly identified as "GRIEVANCE FORM." All information submitted through this process shall be processed through a secure server. (c) The online grievance submission process shall be approved by the Department of Managed Health Care and shall meet the following requirements: (1) It shall utilize an online grievance form in HTML format that allows the user to enter required information directly into the form. (2) It shall allow the subscriber or enrollee to preview the grievance that will be submitted, including the opportunity to edit the form prior to submittal. (3) It shall include a current hyperlink to the California Department of Managed Health Care Web site, and shall include a statement in a legible font that is clearly distinguishable from other content on the page and is in a legible size and type, containing the following language: "The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan at (insert health plan's telephone number) and use your health plan' s grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (1-888-HMO-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department' s Internet Web site http://www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online." The plan shall update the URL, hyperlink, and telephone numbers in this statement as necessary. (d) A plan that utilizes a hardware system that does not have the minimum system requirements to support the software necessary to meet the requirements of this section is exempt from these requirements until January 1, 2006. (e) For purposes of this section, the following terms shall have the following meanings: (1) "Homepage" means the first page or welcome page of a Web site that serves as a starting point for navigation of the Web site. (2) "HTML" means Hypertext Markup Language, the authoring language used to create documents on the World Wide Web, which defines the structure and layout of a Web document. (3) "Hyperlink" means a special HTML code that allows text or graphics to serve as a link that, when clicked on, takes a user to another place in the same document, to another document, or to another Web site or Web page. (4) "Member services portal" means the first page or welcome page of a Web site that can be reached directly by the Web site's homepage and that serves as a starting point for a navigation of member services available on the Web site. (5) "Secure server" means an Internet connection to a Web site that encrypts and decrypts transmissions, protecting them against third-party tampering and allowing for the secure transfer of data. (6) "URL" or "Uniform Resource Locator" means the address of a Web site or the location of a resource on the World Wide Web that allows a browser to locate and retrieve the Web site or the resource. (7) "Web site" means a site or location on the World Wide Web. (f) Every health care service plan, except a plan that primarily serves Medi-Cal or Healthy Families Program enrollees, shall maintain a Web site. For a health care service plan that provides coverage for professional mental health services, the Web site shall include, but not be limited to, providing information to subscribers, enrollees, and providers that will assist subscribers and enrollees in accessing mental health services. SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.