Amended in Senate May 28, 2013

Amended in Senate April 2, 2013

Amended in Senate February 26, 2013

Senate Bill No. 22

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 begin insert and makes a willful violation of the act a crime end insert . 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. begin insert Because a willful violation of the bill’s provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. end insert

begin insert

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.

end insert begin insert

This bill would provide that no reimbursement is required by this act for a specified reason.

end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program:  begin delete no end delete begin insert yes end insert .

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 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 begin delete own end delete
discretion begin delete or at the request of any person end delete .

(b) The report shall provide an analysis of the plan’s or
contractor’s compliance with Section 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, begin delete a end delete begin insert the end insert 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.

(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.

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 begin delete an end delete begin insert a consolidated end insert annual report to the Department of
Insurance certifying that begin insert each of end insert 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 begin delete own end delete
discretion begin delete or at the request of any person end delete .

(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 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.

(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 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.

begin insert

begin insert SEC. 3. end insert   

end insert begin insert

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.

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