BILL NUMBER: SB 22 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JULY 2, 2013
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 October
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.
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. The bill would require the reports to be
a public record made available upon request and to be published on
the respective department's departments
' Internet Web site sites .
The bill would require 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) 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 October 1,
2014, every 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.
(c) The report shall provide an analysis of the 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.
(d) (1)
(c) As part of the report, the plan described in
subdivision (a) shall conduct both of the following:
(A)
( 1) A survey of enrollees to collect
responses pertaining to enrollee experiences with mental health and
substance use care.
(B)
( 2) A survey of providers to collect
responses pertaining to provider experiences with providing mental
health and substance use care.
(2) The plan described in subdivision (a) shall use the compliance
criteria set forth in the URAC mental health parity standards
described in subdivision (c) to structure the surveys.
(d) On or before July 1, 2014, the department shall collaborate
with the Department of Insurance and consult with experts and
stakeholders to create standards for the form and content of
information to be reported pursuant to subdivision (b). These
standards shall ensure that data reported, including the results of
surveys conducted pursuant to subdivision (c), are standardized and
intercomparable. For the creation of standards for certifying
compliance with MHPAEA, the department shall consider national mental
health parity compliance standards, including, but not limited to,
the 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.
(e) On or before January 1, 2020, the department shall report to
the Legislature on the information obtained through the annual
reports in subdivision (b). The report shall include a summary of any
regulatory actions taken as a result of information gathered through
the reports.
(e)
(f) 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.
(f)
(g) 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 October
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)
(b) As part of the report, an insurer shall conduct
both of the following:
(A)
(1) A survey of insureds to collect responses
pertaining to insured's experiences with mental health and substance
use care.
(B)
( 2) 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.
(c) On or before July 1, 2014, the department shall collaborate
with the Department of Managed Health Care and consult with experts
and stakeholders to create standards for the form and content of
information to be reported pursuant to subdivision (a). These
standards shall ensure that data reported, including the results of
surveys conducted pursuant to subdivision (b), are standardized and
intercomparable. For the creation of standards for certifying
compliance with MHPAEA, the department shall consider national mental
health parity compliance standards, including, but not limited to,
the 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.
(d) On or before January 1, 2020, the department shall report to
the Legislature on the information obtained through the annual
reports in subdivision (a). The report shall include a summary of any
regulatory actions taken as a result of information gathered through
the reports.
(d)
(e) 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)
(f) 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.