Amended in Assembly June 14, 2013

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 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 begin delete , contractor of a health service plan, end delete begin insert that provides hospital, medical, or surgical coverage, every specialized mental health care service plan that contracts with a health care service plan to provide mental health services, end insert and begin insert every end insert 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 begin delete a plan, contractor, and health insurer end delete begin insert those plans and insurers end insert 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: 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)  begin delete On end delete begin insert This section shall apply to every health care
service plan that provides hospital, medical, or surgical coverage
or any specialized mental health care service plan that contracts
with a health care service plan to provide mental health services. end insert

begin insert (b) end insert begin insert   end insert begin insert On end insert and after July 1, 2014, every begin delete health care service plan
and contractor of a health care service end delete plan begin insert described in subdivision
(a) end insert 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 discretion.

begin delete

(b)

end delete

begin insert (c) end insert  The report shall provide an analysis of the begin delete plan’s or
contractor’s end delete compliance begin insert by the end insert begin insert plan described in subdivision (a) end insert
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.

begin delete

(c)

end delete

begin insert (d) end insert  (1) As part of the report, the plan begin delete or contractor end delete begin insert described
in subdivision (a) end insert 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 begin delete or contractor end delete begin insert described in subdivision (a) end insert shall use
the compliance criteria set forth in the URAC mental health parity
standards described in subdivision begin delete (b) end delete begin insert (c) end insert to structure the surveys.

begin delete

(d)

end delete

begin insert (e) end insert  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.

begin delete

(e)

end delete

begin insert (f) end insert  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 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 discretion.

(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.