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 afterbegin delete Julyend deletebegin insert Octoberend insert 1, 2014, require every health care 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.begin insert The bill would require the departments to collaborate with each other and consult with experts and stakeholders to create the standards for the form and content of those reports on or before July 1, 2014. The bill would require those departments to report to the Legislature on or before January 1, 2020, on the information obtained through those annual reports.end insert The bill would require the reports to be a public record made available upon request and to be published on the respectivebegin delete department’send deletebegin insert departmentsend insertbegin insert’end insert
Internet Webbegin delete siteend deletebegin insert sitesend insert. The bill would require those plans and insurersbegin delete to provide an analysis of the entity’s compliance with the law using certain mental health parity standards andend delete 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 1374.18 is added to the Health and Safety
2Code, to read:
(a) This section shall apply to every health care
4service plan that provides hospital, medical, or surgical coverage
5or any specialized mental health care service plan that contracts
6with a health care service plan to provide mental health services.
7(b) On and afterbegin delete Julyend deletebegin insert Octoberend insert 1, 2014, every
plan described in
8subdivision (a) shall submit an annual report to the department
9certifying compliance with Section 1374.72 and the federal Paul
10Wellstone and Pete Domenici Mental Health Parity and Addiction
11Equity Act of 2008 (Public Law 110-343), hereafter referred to as
12the MHPAEA, its implementing regulations, and all related federal
13guidance. The annual report shall be a public record made available
14upon request and shall be published on the department’s Internet
15Web site. The department may hold public hearings on the reports
16at its discretion.
17(c) The report shall provide an analysis of the
compliance by
18the plan described in subdivision (a) with Section 1374.72 and the
19MHPAEA using all of the elements set forth in those provisions
20of law, as well as in standards P-MHP 1, P-MHP 2, and P-MHP
213 of the American Accreditation HealthCare Commission (URAC)
22Health Plan Accreditation Guide, Version 7, or any subsequent
23versions.
24(d) (1)
end delete
25begin insert(c)end insert As part of the report, the plan described in subdivision (a)
26shall conduct both of the following:
27(A)
end delete
28begin insert(end insertbegin insert1)end insert A survey of enrollees to collect responses pertaining to
29enrollee experiences with mental health and substance use care.
30(B)
end delete
31begin insert(end insertbegin insert2)end insert A survey of providers to collect responses pertaining to
32provider experiences with providing mental health and substance
33use
care.
P4 1(2) The plan described in subdivision (a) shall use the
2compliance criteria set forth in the URAC mental health parity
3standards described in subdivision (c) to structure the surveys.
4(d) On or before July 1, 2014, the department shall collaborate
5with the Department of Insurance and consult with experts and
6stakeholders to create standards for the form and content of
7information to be reported pursuant to subdivision (b). These
8standards shall ensure that data reported, including the results of
9surveys conducted pursuant to subdivision (c), are standardized
10and intercomparable. For the creation of standards
for certifying
11compliance with MHPAEA, the department shall consider national
12mental health parity compliance standards, including, but not
13limited to, the standards P-MHP-1, P-MHP-2, and P-MHP-3 of
14the American Accreditation HealthCare Commission (URAC)
15Health Plan Accreditation Guide, Version 7, or any subsequent
16versions.
17(e) On or before January 1, 2020, the department shall report
18to the Legislature on the information obtained through the annual
19reports in subdivision (b). The report shall include a summary of
20any regulatory actions taken as a result of information gathered
21through the reports.
22(e)
end delete
23begin insert(f)end insert A report submitted to the department pursuant to this section
24shall not include any information that may individually identify
25enrollees, including, but not limited to, medical record numbers,
26names, and addresses.
27(f)
end delete
28begin insert(g)end insert This section shall not apply to contracts entered into pursuant
29to Chapter 7 (commencing with Section 14000) or Chapter 8
30(commencing with Section 14200) of Part 3 of Division 9 of the
31Welfare and Institutions Code, between the State Department of
32Health Care Services and a health care service plan for enrolled
33Medi-Cal
beneficiaries.
Section 10144.53 is added to the Insurance Code, to
35read:
(a) On and afterbegin delete Julyend deletebegin insert Octoberend insert 1, 2014, every health
37insurer shall submit a consolidated annual report to the Department
38of Insurance certifying that each of its health insurance policies
39comply with Section 10144.5 and the federal Paul Wellstone and
40Pete Domenici Mental Health Parity and Addiction Equity Act of
P5 12008 (Public Law 110-343), hereafter referred to as the MHPAEA,
2its implementing regulations, and all related federal guidance. The
3annual report shall be a public record made available upon request
4and shall be published on the department’s Internet
Web site. The
5department may hold public hearings on the reports at its discretion.
6(b) The report shall provide an
analysis of the insurer’s
7compliance with Section 10144.5 and the MHPAEA using all of
8the elements set forth in those provisions of law, as well as in
9standards P-MHP 1, P-MHP 2, and P-MHP 3 of the American
10Accreditation HealthCare Commission (URAC) Health Plan
11Accreditation Guide, Version 7, or any subsequent versions.
12(c) (1)
end delete
13begin insert(b)end insert As part of the report, an insurer shall conduct both of the
14following:
15(A)
end delete
16begin insert(1)end insert A survey of insureds to collect responses pertaining to
17insured’s experiences with mental health and substance use care.
18(B)
end delete
19begin insert(end insertbegin insert2)end insert A survey of providers to collect responses pertaining to
20provider experiences with providing mental health and substance
21use care.
22(2) The insurer shall use the compliance criteria set forth in the
23URAC mental health parity standards described in subdivision (b)
24to structure the surveys.
25(c) On or before July 1, 2014, the department shall collaborate
26with the Department of Managed Health Care and consult with
27experts and stakeholders to create standards for the form and
28content of information to be reported pursuant to subdivision (a).
29These standards shall ensure that data reported, including the
30results of surveys conducted pursuant to subdivision (b), are
31standardized and intercomparable. For the creation of standards
32for certifying compliance with MHPAEA, the department shall
33consider national mental health parity compliance standards,
34including, but not limited to, the standards P-MHP-1, P-MHP-2,
35and P-MHP-3 of the American Accreditation HealthCare
36Commission (URAC) Health Plan Accreditation Guide, Version
377, or any subsequent versions.
38(d) On or before
January 1, 2020, the department shall report
39to the Legislature on the information obtained through the annual
40reports in subdivision (a). The report shall include a summary of
P6 1any regulatory actions taken as a result of information gathered
2through the reports.
3(d)
end delete
4begin insert(e)end insert A report submitted to the department pursuant to this section
5shall not include any information that may individually identify
6insureds, including, but not limited to, medical record numbers,
7names, and addresses.
8(e)
end delete
9begin insert(f)end insert This section shall not apply to policies or health benefit plans
10issued pursuant to Chapter 7 (commencing with Section 14000)
11or Chapter 8 (commencing with Section 14200) of Part 3 of
12Division 9 of the Welfare and Institutions Code, between the State
13Department of Health Care Services and an insurance policy or
14health benefit plan for enrolled Medi-Cal beneficiaries.
No reimbursement is required by this act pursuant to
16Section 6 of Article XIII B of the California Constitution because
17the only costs that may be incurred by a local agency or school
18district will be incurred because this act creates a new crime or
19infraction, eliminates a crime or infraction, or changes the penalty
20for a crime or infraction, within the meaning of Section 17556 of
21the Government Code, or changes the definition of a crime within
22the meaning of Section 6 of Article XIII B of the California
23Constitution.
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