BILL NUMBER: AB 154	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  JANUARY 23, 2012
	AMENDED IN ASSEMBLY  MARCH 24, 2011

INTRODUCED BY   Assembly Member Beall
    (   Coauthors:   Assembly Members 
 Ammiano   and Dickinson   ) 

                        JANUARY 18, 2011

   An act to add Section 22856 to the Government Code, to add Section
 1374.74   1374.76  to the Health and
Safety Code, and to add Section 10144.8 to the Insurance Code,
relating to health care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 154, as amended, Beall. Health care coverage: mental health
services.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law also provides for the
regulation of health insurers by the Department of Insurance. Under
existing law, a health care service plan contract and a health
insurance policy are required to provide coverage for the diagnosis
and treatment of severe mental illnesses of a person of any age.
Existing law does not define  the term  "severe mental
illnesses" for this purpose but describes it as including several
conditions.
   This bill would expand this coverage requirement for certain
health care service plan contracts and health insurance policies
issued, amended, or renewed on or after January 1,  2012
  2013  , to include the diagnosis and treatment of
a mental illness of a person of any age and would define mental
illness for this purpose as a mental disorder defined in the
Diagnostic and Statistical Manual of Mental Disorders IV 
(DSM-IV)  , including substance abuse but excluding nicotine
dependence and specified diagnoses defined in the manual, subject to
regulatory revision, as specified. The bill would specify that this
requirement does not apply to a health care benefit plan, contract,
or health insurance policy with the Board of Administration of the
Public Employees' Retirement System unless the board elects to
purchase a plan, contract, or policy that provides mental health
coverage. 
   This bill would also exempt certain health care service contracts
entered into by the Managed Risk Medical Insurance Board from its
provisions. 
   Because this bill would expand coverage requirements for health
care service plans, the willful violation of which would be a crime,
it 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.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 22856 is added to the Government Code, to read:

   22856.  The board may purchase a health care benefit plan or
contract or a health insurance policy that includes mental health
coverage as described in Section  1374.74  
1374.76  of the Health and Safety Code or Section 10144.8 of the
Insurance Code.
  SEC. 2.  Section  1374.74   1374.76  is
added to the Health and Safety Code,  immediately following
Section 1374.74,  to read:
    1374.74.   1374.76.   (a) A health care
service plan contract issued, amended, or renewed on or after
January 1,  2012   2013  , that provides
hospital, medical, or surgical coverage shall provide coverage for
the diagnosis and medically necessary treatment of a mental illness
of a person of any age, including a child, under the same terms and
conditions applied to other medical conditions as specified in
subdivision (c) of Section 1374.72. The benefits provided under this
section shall include all those set forth in subdivision (b) of
Section 1374.72.
   (b) (1) "Mental illness" for the purposes of this section means a
mental disorder defined in the Diagnostic and Statistical Manual of
Mental Disorders IV  (DSM-IV) , published by the American
Psychiatric Association, and includes substance abuse, but excludes
treatment of the following diagnoses, all as defined in the manual:
   (A) Noncompliance With Treatment (V15.81).
   (B) Partner Relational Problem (V61.1).
   (C) Physical/Sexual Abuse of an Adult (V61.12).
   (D) Parent-Child Relational Problem (V61.20).
   (E) Child Neglect (V61.21).
   (F) Physical/Sexual Abuse of a Child (V61.21).
   (G) Sibling Relational Problem (V61.8).
   (H) Relational Problem Related to a Mental Disorder or General
Medical Condition (V61.9).
   (I) Occupational Problem (V62.29).
   (J) Academic Problem (V62.3).
   (K) Acculturation Problem (V62.4).
   (L) Relational Problems (V62.81).
   (M) Bereavement (V62.82).
   (N) Physical/Sexual Abuse of an Adult (V62.83).
   (O) Borderline Intellectual Functioning (V62.89).
   (P) Phase of Life Problem (V62.89).
   (Q) Religious or Spiritual Problem (V62.89).
   (R) Malingering (V65.2).
   (S) Adult Antisocial Behavior (V71.01).
   (T) Child or Adolescent Antisocial Behavior (V71.02).
   (U) There is not a Diagnosis or a Condition on Axis I (V71.09).
   (V) There is not a Diagnosis on Axis II (V71.09).
   (W)  Nicotine Dependence (305.10).
   (2) Following publication of each subsequent volume of the manual,
the definition of "mental illness" shall be subject to revision to
conform to, in whole or in part, the list of mental disorders defined
in the then-current volume of the manual.
   (3) Any revision to the definition of "mental illness" pursuant to
paragraph (2) shall be established by regulation promulgated jointly
by the department and the Department of Insurance.
   (c) (1) For the purpose of compliance with this section, a plan
may provide coverage for all or part of the mental health services
required by this section through a separate specialized health care
service plan or mental health plan and shall not be required to
obtain an additional or specialized license for this purpose.
   (2) A plan shall provide the mental health coverage required by
this section in its entire service area and in emergency situations
as may be required by applicable laws and regulations. For purposes
of this section, health care service plan contracts that provide
benefits to enrollees through preferred provider contracting
arrangements are not precluded from requiring enrollees who reside or
work in geographic areas served by specialized health care service
plans or mental health plans to secure all or part of their mental
health services within those geographic areas served by specialized
health care service plans or mental health plans.
   (3) In the provision of benefits required by this section, a
health care service plan may utilize case management, network
providers, utilization review techniques, prior authorization,
copayments, or other cost sharing to the extent permitted by law or
regulation.
   (d) Nothing in this section shall be construed to deny or restrict
in any way the department's authority to ensure plan compliance with
this chapter when a plan provides coverage for prescription drugs.
   (e) This section shall not apply to contracts entered into
pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8
(commencing with Section 14200) of Part 3 of Division 9 of the
Welfare and Institutions Code, between the State Department of Health
Care Services and a health care service plan for enrolled Medi-Cal
beneficiaries.
   (f) This section shall not apply to a health care benefit plan or
contract entered into with the Board of Administration of the Public
Employees' Retirement System pursuant to the Public Employees'
Medical and Hospital Care Act (Part 5 (commencing with Section 22750)
of Division 5 of Title 2 of the Government Code) unless the board
elects, pursuant to Section 22856 of the Government Code, to purchase
a health care benefit plan or contract that provides mental health
coverage as described in this section.
   (g) This section shall not apply to accident-only, specified
disease, hospital indemnity, Medicare supplement, dental-only, or
vision-only health care service plan contracts. 
   (h) This section shall not apply to contracts between the Managed
Risk Medical Insurance Board and health care service plans pursuant
to the California Major Risk Medical Insurance Program (Part 6.5
(commencing with Section 12700) of the Insurance Code) or the Access
for Infants and Mothers Program (Part 6.3 (commencing with Section
12695) of the Insurance Code). 
  SEC. 3.  Section 10144.8 is added to the Insurance Code, to read:
   10144.8.  (a) A policy of health insurance that covers hospital,
medical, or surgical expenses in this state that is issued, amended,
or renewed on or after January 1,  2012   2013
 , shall provide coverage for the diagnosis and medically
necessary treatment of a mental illness of a person of any age,
including a child, under the same terms and conditions applied to
other medical conditions as specified in subdivision (c) of Section
10144.5. The benefits provided under this section shall include all
those set forth in subdivision (b) of Section 10144.5.
   (b) (1) "Mental illness" for the purposes of this section means a
mental disorder defined in the Diagnostic and Statistical Manual of
Mental Disorders IV  (DSM-IV)  , published by the American
Psychiatric Association, and includes substance abuse, but excludes
treatment of the following diagnoses, all as defined in the manual:
   (A) Noncompliance With Treatment (V15.81).
   (B) Partner Relational Problem (V61.1).
   (C) Physical/Sexual Abuse of an Adult (V61.12).
   (D) Parent-Child Relational Problem (V61.20).
   (E) Child Neglect (V61.21).
   (F) Physical/Sexual Abuse of a Child (V61.21).
   (G) Sibling Relational Problem (V61.8).
   (H) Relational Problem Related to a Mental Disorder or General
Medical Condition (V61.9).
   (I) Occupational Problem (V62.29).
   (J) Academic Problem (V62.3).
   (K) Acculturation Problem (V62.4).
   (L) Relational Problems (V62.81).
   (M) Bereavement (V62.82).
   (N) Physical/Sexual Abuse of an Adult (V62.83).
   (O) Borderline Intellectual Functioning (V62.89).
   (P) Phase of Life Problem (V62.89).
   (Q) Religious or Spiritual Problem (V62.89).
   (R) Malingering (V65.2).
   (S) Adult Antisocial Behavior (V71.01).
   (T) Child or Adolescent Antisocial Behavior (V71.02).
   (U) There is not a Diagnosis or a Condition on Axis I (V71.09).
   (V) There is not a Diagnosis on Axis II (V71.09).
   (W)  Nicotine Dependence (305.10).
   (2) Following publication of each subsequent volume of the manual,
the definition of "mental illness" shall be subject to revision to
conform to, in whole or in part, the list of mental disorders defined
in the then-current volume of the manual.
   (3) Any revision to the definition of "mental illness" pursuant to
paragraph (2) shall be established by regulation promulgated jointly
by the department and the Department of Managed Health Care.
   (c) (1) For the purpose of compliance with this section, a health
insurer may provide coverage for all or part of the mental health
services required by this section through a separate specialized
health care service plan or mental health plan and shall not be
required to obtain an additional or specialized license for this
purpose.
   (2) A health insurer shall provide the mental health coverage
required by this section in its entire in-state service area and in
emergency situations as may be required by applicable laws and
regulations. For purposes of this section, health insurers are not
precluded from requiring insureds who reside or work in geographic
areas served by specialized health care service plans or mental
health plans to secure all or part of their mental health services
within those geographic areas served by specialized health care
service plans or mental health plans.
   (3) In the provision of benefits required by this section, a
health insurer may utilize case management, managed care, or
utilization review to the extent permitted by law or regulation.
   (4) Any action that a health insurer takes to implement this
section, including, but not limited to, contracting with preferred
provider organizations, shall not be deemed to be an action that
would otherwise require licensure as a health care service plan under
the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code).
   (d) This section shall not apply to accident-only, specified
disease, hospital indemnity, or Medicare supplement insurance
policies, or specialized health insurance policies, except behavioral
health-only policies.
   (e) This section shall not apply to a policy of health insurance
purchased by the Board of Administration of the Public Employees'
Retirement System pursuant to the Public Employees' Medical and
Hospital Care Act (Part 5 (commencing with Section 22750) of Division
5 of Title 2 of the Government Code) unless the board elects,
pursuant to Section 22856 of the Government Code, to purchase a
policy of health insurance that covers mental health services as
described in this section.
  SEC. 4.  This act shall not be deemed to require a qualified health
plan that participates in the California Health Benefit Exchange to
provide any greater coverage than is required pursuant to the minimum
essential benefits package, as set forth in Section 1311 of the
federal Patient Protection and Affordable Care Act (Public Law
111-148).
  SEC. 5.  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.