BILL NUMBER: SB 22 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 2, 2013
AMENDED IN SENATE FEBRUARY 26, 2013
INTRODUCED BY Senator Beall
( Coauthors: Senators
Correa, De León, DeSaulnier, and Yee
)
( Coauthors: Assembly Members
Ammiano and Chesbro )
DECEMBER 3, 2012
An act to add Section 1374.18 to the Health and Safety Code, and
to add Section 10144.53 to the Insurance Code, relating to health
care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 22, as amended, Beall. Health care coverage: mental health
parity.
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. Existing law provides
for the regulation of health insurers by the Department of
Insurance. Existing law requires health care service plan contracts
or health insurance policies issued, amended, or renewed on or after
July 1, 2000, to provide coverage for the diagnosis and medically
necessary treatment of severe mental illnesses, as defined, and of
serious emotional disturbances of a child, as specified, under the
same terms and conditions applied to other medical conditions.
Existing federal law, the federal Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)
requires group health plans and health insurance issuers to ensure
that financial requirements and treatment limitations applicable to
mental health or substance use disorder benefits are no more
restrictive than the predominant requirements or limitations applied
to substantially all medical and surgical benefits. Existing state
law requires individual and small group health care service plan
contracts and health insurance policies issued, amended, or renewed
on or after January 1, 2014, to comply with MHPAEA.
This bill would, on or after July 1, 2014, require every health
care service plan, contractor of a health service plan, and health
insurer to submit an annual report to the Department of Managed
Health Care or the Department of Insurance, as appropriate,
certifying compliance with specified state laws and the MHPAEA,
except as provided. The bill would require the reports to be a public
record made available upon request and to be published on the
respective department's Internet Web site. The bill would require a
plan, contractor, and health insurer to provide an analysis of the
entity's compliance with the law using certain mental health parity
standards and to conduct surveys of enrollees, insureds, and
providers as part of the report, as specified. The bill would
prohibit the inclusion of any information that may individually
identify enrollees or insureds in the reports submitted to the
respective departments pursuant to the provisions described above.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1374.18 is added to the Health and Safety Code,
to read:
1374.18. (a) On and after July 1, 2014, every health care service
plan and contractor of a health care service plan shall submit an
annual report to the department certifying compliance with Section
1274.72 1374.72 and the federal Paul
Wellstone and Pete Domenici Mental Health Parity and Addiction Equity
Act of 2008 (Public Law 110-343), hereafter referred to as the
MHPAEA, its implementing regulations, and all related federal
guidance. The annual report shall be a public record made available
upon request and shall be published on the department's Internet Web
site. The department may hold public hearings on the reports at its
own discretion or at the request of any person.
(b) The report shall provide an analysis of the plan's or
contractor's compliance with Section 1274.72
1374.72 and the MHPAEA using all of the elements set forth in
those provisions of law, as well as in standards P-MHP 1, P-MHP 2,
and P-MHP 3 of the American Accreditation HealthCare Commission
(URAC) Health Plan Accreditation Guide, Version 7, or any subsequent
versions.
(c) (1) As part of the report, a plan or contractor shall conduct
both of the following:
(A) A survey of enrollees to collect responses pertaining to
enrollee experiences with mental health and substance use care.
(B) A survey of providers to collect responses pertaining to
provider experiences with providing mental health and substance use
care.
(2) The plan or contractor shall use the compliance criteria set
forth in the URAC mental health parity standards described
in subdivision (b) to structure the surveys.
(d) A report submitted to the department pursuant to this section
shall not include any information that may individually identify
enrollees, including, but not limited to, medical record numbers,
names, and addresses.
(d)
(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 Part 3 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.
SEC. 2. Section 10144.53 is added to the Insurance Code, to read:
10144.53. (a) On and after July 1, 2014, every health insurer
shall submit an annual report to the Department of Insurance
certifying that its health insurance policies comply with Section
10144.5 and the federal Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008 (Public Law 110-343),
hereafter referred to as the MHPAEA, its implementing regulations,
and all related federal guidance. The annual report shall be a public
record made available upon request and shall be published on the
department's Internet Web site. The department may hold public
hearings on the reports at its own discretion or at the request of
any person.
(b) The report shall provide an analysis of the insurer's
compliance with Section 10144.5 and the MHPAEA using all of the
elements set forth in those provisions of law, as well as in
standards P-MHP 1, P-MHP 2, and P-MHP 3 of the American Accreditation
HealthCare Commission (URAC) Health Plan Accreditation Guide,
Version 7, or any subsequent versions.
(c) (1) As part of the report, an insurer shall conduct both of
the following:
(A) A survey of insureds to collect responses pertaining to
insured's experiences with mental health and substance use care.
(B) A survey of providers to collect responses pertaining to
provider experience experiences with
providing mental health and substance use care.
(2) The insurer shall use the compliance criteria set forth in the
URAC mental health parity standards described in subdivision (b) to
structure the surveys.
(d) A report submitted to the department pursuant to this section
shall not include any information that may individually identify
insureds, including, but not limited to, medical record numbers,
names, and addresses.
(d)
(e) This section shall not apply to policies or health
benefit plans issued pursuant to Chapter 7 (commencing with Section
14000) or Chapter 8 (commencing with Section 14200) of Part 3 of
Division 9 of Part 3 of the Welfare and
Institutions Code, between the State Department of Health Care
Services and an insurance policy or health benefit plan for enrolled
Medi-Cal beneficiaries.