BILL ANALYSIS �
SB 22
Page 1
Date of Hearing: August 14, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
SB 22 (Beall) - As Amended: July 2, 2013
Policy Committee: HealthVote:17-2
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill requires health plans and insurers to report to the
Department of Managed Health Care (DMHC) and the Department of
Insurance (CDI), respectively, on compliance with state and
federal law related to mental health parity. Specifically, this
bill:
1)Requires reports to be submitted annually on and after October
1, 2014.
2)By July 1, 2014, requires DMHC and CDI to jointly create
reporting standards that are standardized and intercomparable.
3)By January 1, 2020, requires DMHC and CDI to report to the
Legislature on the information contained in reports, as well
as a summary of related regulatory actions.
4)Requires plans and insurers to conduct surveys of
enrollees/insured and providers for inclusion in reports.
5)Exempts managed care plan contracts that serve Medi-Cal
enrollee from the bill's requirements.
FISCAL EFFECT
1)One-time costs to CDI and DMHC in the range of $650,000 total
(Insurance Fund and Managed Care Fund) for collaborative
rulemaking, development of standards for reporting, and
initial review.
2)Annual costs of at least $100,000 total to CDI and DMHC
(Insurance Fund and Managed Care Fund) for ongoing review of
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filed reports. Costs could exceed this level depending on plan
compliance, consumer complaints, and enforcement actions. For
example, if the filed reports raise concerns about the plans'
provision of mental health services and the DMHC determines
non-routine surveys are required, DMHC could incur contractor
costs of up to $75,000 for each survey (Managed Care Fund).
COMMENTS
1)Rationale . The author indicates that, in spite of the
appearance of compliance with federal and state laws requiring
mental health and substance abuse services to be treated at
parity with medical services, plans and insurers routinely do
not actually operationalize the parity laws at the point of
service delivery. He cites examples from both mental health
patients and providers that indicate patients with mental
disorders are not able to access medically necessary care.
Finally, he believes a complaint-driven system is inadequate
for enforcement of mental health parity laws because people
with mental health disorders are not as likely to file
complaints.
2)Mental Health Parity . Mental health parity laws generally
require that patient financial participation (such as co-pays
and deductibles) and treatment limitations (such as visit
limits) applicable to mental health or substance use disorder
benefits are no more restrictive than the predominant
requirements or limitations applied to medical benefits. Under
current law, California has had partial mental health parity
for specified conditions since AB 88 (Thompson), Chapter 524,
Statutes of 1999. AB 88 requires treatment parity for serious
mental illness such as schizophrenia, autism, and anorexia
nervosa.
The federal Mental Health Parity and Addiction Equity Act
(MHPEA) of 2008 went into effect on January 1, 2010, and
requires group health plans with more than 50 employees that
offer both medical and mental health benefits to ensure parity
for mental health. Although interim final rules have been
available since February 2010, final rules implementing MHPEA
are have not yet been promulgated. Additionally, the Patient
Protection and Affordable Care Act (ACA) requires all plans to
cover mental health and substance use disorder services as one
of 10 essential health benefits, which is likely to apply
parity to additional plans that currently do not cover mental
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health and substance use disorder services.
3)Opposition . Health plans and insurers oppose this bill, citing
redundancy with current reporting requirements and enforcement
authority of regulators.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081