BILL NUMBER: SB 22 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 28, 2013
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 and makes a
willful violation of the act a crime . 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.
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.
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: no yes .
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 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 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 the
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 an a consolidated annual
report to the Department of Insurance certifying that each of
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 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.
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.