BILL NUMBER: SB 22 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JUNE 14, 2013
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,
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,
and every 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
those plans and insurers 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) On 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.
(b) On and after July 1, 2014,
every health care service plan and contractor of a health
care service plan described in subdivision (a)
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.
(b)
(c) The report shall provide an analysis of the
plan's or contractor's compliance by the
plan described in subdivision (a) 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)
(d) (1) As part of the report, the plan or
contractor described in subdivision (a) 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 described in
subdivision (a) shall use the compliance criteria set forth in
the URAC mental health parity standards described in subdivision
(b) (c) to structure the surveys.
(d)
(e) 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)
(f) 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.