BILL NUMBER: AB 1253 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Members Matthews and Thomson
FEBRUARY 23, 2001
An act to amend Section 1010 of the Evidence Code, to amend
Section 13960 of the Government Code, to amend Sections 1373 and
1373.8 of the Health and Safety Code, and to amend Sections 10176 and
10177 of the Insurance Code, relating to nursing.
LEGISLATIVE COUNSEL'S DIGEST
AB 1253, as introduced, Matthews. Nursing.
Existing law, the Nursing Practice Act, requires that a nurse
satisfy specified requirements in order to practice as a clinical
nurse specialist. Various other provisions of law include within
their application a registered nurse with education or experience in
psychiatric-mental health nursing.
This bill would recast those provisions, specifying that the
registered nurse be certified as a clinical nurse specialist who
participates in expert clinical practice in the specialty of
psychiatric-mental health nursing.
Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1010 of the Evidence Code is amended to read:
1010. As used in this article, "psychotherapist" means:
(a) A person authorized, or reasonably believed by the patient to
be authorized, to practice medicine in any state or nation who
devotes, or is reasonably believed by the patient to devote, a
substantial portion of his or her time to the practice of psychiatry.
(b) A person licensed as a psychologist under Chapter 6.6
(commencing with Section 2900) of Division 2 of the Business and
Professions Code.
(c) A person licensed as a clinical social worker under Article 4
(commencing with Section 4996) of Chapter 14 of Division 2 of the
Business and Professions Code, when he or she is engaged in applied
psychotherapy of a nonmedical nature.
(d) A person who is serving as a school psychologist and holds a
credential authorizing that service issued by the state.
(e) A person licensed as a marriage, family, and child counselor
under Chapter 13 (commencing with Section 4980) of Division 2 of the
Business and Professions Code.
(f) A person registered as a psychological assistant who is under
the supervision of a licensed psychologist or board certified
psychiatrist as required by Section 2913 of the Business and
Professions Code, or a person registered as a marriage, family, and
child counselor intern who is under the supervision of a licensed
marriage, family, and child counselor, a licensed clinical social
worker, a licensed psychologist, or a licensed physician certified in
psychiatry, as specified in Section 4980.44 of the Business and
Professions Code.
(g) A person registered as an associate clinical social worker who
is under the supervision of a licensed clinical social worker, a
licensed psychologist, or a board certified psychiatrist as required
by Section 4996.20 of the Business and Professions Code.
(h) A person exempt from the Psychology Licensing Law pursuant to
subdivision (d) of Section 2909 of the Business and Professions Code
who is under the supervision of a licensed psychologist or board
certified psychiatrist.
(i) A psychological intern as defined in Section 2911 of the
Business and Professions Code who is under the supervision of a
licensed psychologist or board certified psychiatrist.
(j) A trainee, as defined in subdivision (c) of Section 4980.03 of
the Business and Professions Code, who is fulfilling his or her
supervised practicum required by subdivision (b) of Section 4980.40
of the Business and Professions Code and is supervised by a licensed
psychologist, board certified psychiatrist, a licensed clinical
social worker, or a licensed marriage, family, and child counselor.
(k) A person licensed as a An advanced
practice registered nurse who is certified as a clinical
nurse specialist pursuant to Article 9 (commencing with
Section 2838) of Chapter 6 (commencing with Section
2700) of Division 2 of the Business and Professions Code
, who possesses a master's degree in psychiatric mental
and who participates in expert clinical practice in
the specialty of psychiatric-mental health nursing.
(l) A person rendering mental health treatment or counseling
services as authorized pursuant to Section 6924 of the Family Code.
SEC. 2. Section 13960 of the Government Code, as added by Section
1.4 of Chapter 895 of the Statutes of 1998, is amended to read:
13960. As used in this article:
(a) (1) "Victim" means a resident of the State of California, a
member of the military stationed in California, or a family member
living with a member of the military stationed in California who
sustains injury or death as a direct result of a crime.
(2) "Derivative victim" means a resident of California who is one
of the following:
(A) At the time of the crime was the parent, sibling, spouse, or
child of the victim.
(B) At the time of the crime was living in the household of the
victim.
(C) A person who had previously lived in the household of the
victim for a period of not less than two years in a relationship
substantially similar to a relationship listed in subparagraph (A).
(D) Is another family member of the victim, including the victim's
fiance, and witnessed the crime.
(b) "Injury" includes physical or emotional injury, or both.
However, this article does not apply to emotional injury unless that
injury is incurred by a victim who also sustains physical injury or
threat of physical injury. For purposes of this article, a victim of
a crime committed in violation of Section 261, 262, 271, 273a, 273d,
285, 286, 288, 288a, 288.5, or 289, or subdivision (b) or (c) of
Section 311.4, of the Penal Code, who sustains emotional injury is
presumed to have sustained physical injury. For purposes of this
article, a victim of a crime committed in violation of Section 270 of
the Penal Code, as a result of conduct other than a failure to pay
child support, who sustains emotional injury is presumed to have
sustained physical injury if criminal charges were filed or a
prosecuting attorney expresses the opinion that the child is a victim
of that section.
(c) "Crime" means a crime or public offense that would constitute
a misdemeanor or a felony if committed in California by a competent
adult which that results in injury to a
resident of this state, including a crime or public offense,
wherever it may take place, when the resident is temporarily absent
from the state. "Crime" includes an act of terrorism, as defined in
Section 2331 of Title 18 of the United States Code, committed against
a resident of the state, whether or not the act occurs within the
state. No act involving the operation of a motor vehicle, aircraft,
or water vehicle which that results in
injury or death constitutes a crime for the purposes of this article,
except that a crime shall include any of the following:
(1) Injury or death intentionally inflicted through the use of a
motor vehicle, aircraft, or water vehicle.
(2) Injury or death caused by a driver in violation of Section
20001 of the Vehicle Code.
(3) Injury or death caused by a person who is under the influence
of any alcoholic beverage or drug.
(4) Injury or death caused by a driver of a motor vehicle in the
immediate act of fleeing the scene of a crime in which he or she
knowingly and willingly participated.
For the purpose of the limitations imposed by this article, a
crime shall mean one act or series of related acts arising from the
same course of conduct with the same perpetrator or perpetrators.
(d) "Pecuniary loss" means the following expenses for which the
victim or derivative victim has not been and will not be reimbursed
from any other source:
(1) The amount of medical or medical-related expenses incurred by
the victim, including inpatient psychological or psychiatric
expenses, and including, but not limited to, eyeglasses, hearing
aids, dentures, or any prosthetic device taken, lost, or destroyed
during the commission of the crime, or the use of which became
necessary as a direct result of the crime.
(2) The amount of outpatient psychiatric, psychological, or other
mental health counseling related expenses which
that became necessary as a direct result of the crime.
These counseling services may only be reimbursed if provided by any
of the following individuals:
(A) A person licensed as a physician who is certified in
psychiatry by the American Board of Psychiatry and Neurology or who
has completed a residency in psychiatry.
(B) A person licensed as a psychologist under Chapter 6.6
(commencing with Section 2900) of Division 2 of the Business and
Professions Code.
(C) A person licensed as a clinical social worker under Article 4
(commencing with Section 4996) of Chapter 14 of Division 2 of the
Business and Professions Code.
(D) A person licensed as a marriage, family, and child counselor
under Chapter 13 (commencing with Section 4980) of Division 2 of the
Business and Professions Code.
(E) A person registered as a psychological assistant who is under
the supervision of a licensed psychologist or board certified
psychiatrist as required by Section 2913 of the Business and
Professions Code.
(F) A person registered with the Board of Psychology who is
providing services in a nonprofit community agency pursuant to
subdivision (d) of Section 2909 of the Business and Professions Code.
(G) A person registered as a marriage, family, and child counselor
intern who is under the supervision of a licensed marriage, family,
and child counselor, a licensed clinical social worker, a licensed
psychologist, or a licensed physician certified in psychiatry, as
specified in Section 4980.44 of the Business and Professions Code.
(H) A person registered as an associate clinical social worker, as
defined in Section 4996.18 of the Business and Professions Code, who
is under the supervision of a licensed clinical social worker, a
licensed psychologist, or a board certified psychiatrist.
(I) An advanced practice registered nurse certified as a clinical
nurse specialist under Article 9 (commencing with Section 2838) of
Chapter 6 of Division 2 of the Business and Professions Code, who
participates in expert clinical practice in the specialty of
psychiatric-mental health nursing.
(3) The loss of income that the victim or the loss of support that
the derivative victim has incurred or will incur as a direct result
of an injury or death.
(4) Pecuniary loss also includes nonmedical remedial care and
treatment rendered in accordance with a religious method of healing
recognized by state law.
(5) The amount of family psychiatric, psychological, or mental
health counseling expenses necessary as a direct result of the crime
for the successful treatment of the victim, provided to family
members of the victim in the presence of the victim, whether or not
the family member relationship existed at the time of the crime.
(e) "Board" means the State Board of Control.
(f) "Victim centers" means those centers as specified in Section
13835.2 of the Penal Code.
(g) "Peer counselor" means a provider of mental health counseling
services who has completed a specialized course in rape crisis
counseling skills development, participates in continuing education
in rape crisis counseling skills development, and provides rape
crisis counseling in consultation with a mental health practitioner
licensed within the State of California.
(h) This section shall become operative on January 1, 2003.
SEC. 3. Section 13960 of the Government Code, as amended by
Section 1.3 of Chapter 895 of the Statutes of 1998, is amended to
read:
13960. As used in this article:
(a) (1) "Victim" means a resident of the State of California, a
member of the military stationed in California, or a family member
living with a member of the military stationed in California who
sustains injury or death as a direct result of a crime.
(2) "Derivative victim" means a resident of California, or
resident of another state, who is one of the following:
(A) At the time of the crime was the parent, sibling, spouse, or
child of the victim.
(B) At the time of the crime was living in the household of the
victim.
(C) A person who had previously lived in the household of the
victim for a period of not less than two years in a relationship
substantially similar to a relationship listed in subparagraph (A).
(D) Is another family member of the victim, including the victim's
fiance or fiancee, and witnessed the crime.
(E) Is the primary caretaker of a minor victim, but was not the
primary caretaker at the time of the crime.
(b) (1) "Injury" includes physical or emotional injury, or both.
However, this article does not apply to emotional injury unless that
injury is incurred by a victim who also sustains physical injury or
threat of physical injury. For purposes of this article, a victim of
a crime committed in violation of Section 261, 262, 271, 273a, 273d,
278, 278.5, 285, 286, 288, 288a, 288.5, or 289, or subdivision (b)
or (c) of Section 311.4, of the Penal Code, who sustains emotional
injury is presumed to have sustained physical injury. For purposes
of this article, a victim of a crime committed in violation of
Section 270 of the Penal Code, as a result of conduct other than a
failure to pay child support, who sustains emotional injury is
presumed to have sustained physical injury if criminal charges were
filed. For purposes of this article, a victim of a crime committed
in violation of subdivision (d) of Section 261.5 of the Penal Code,
who sustains emotional injury, is presumed to have sustained physical
injury if felony charges were filed.
(2) It is the intent of the Legislature that in order for the
presumption set forth in paragraph (1) relating to a violation of
Section 278 or 278.5 of the Penal Code to apply, the deprivation of
custody as described in those sections shall have endured for not
less than 30 days. For the purposes of this paragraph, the child,
and not the nonoffending parent or other caretaker, shall be deemed
the victim.
(3) A child who has been the witness of a crime or crimes of
domestic violence may be presumed by the board to have sustained
physical injury.
(c) "Crime" means a crime or public offense that would constitute
a misdemeanor or a felony if committed in California by a competent
adult which that results in injury to a
resident of this state, including a crime or public offense,
wherever it may take place, when the resident is temporarily absent
from the state. "Crime" includes an act of terrorism, as defined in
Section 2331 of Title 18 of the United States Code, committed against
a resident of the state, whether or not the act occurs within the
state. No act involving the operation of a motor vehicle, aircraft,
or water vehicle which that results in
injury or death constitutes a crime for the purposes of this article,
except that a crime shall include any of the following:
(1) Injury or death intentionally inflicted through the use of a
motor vehicle, aircraft, or water vehicle.
(2) Injury or death caused by a driver in violation of Section
20001 of the Vehicle Code.
(3) Injury or death caused by a person who is under the influence
of any alcoholic beverage or drug.
(4) Injury or death caused by a driver of a motor vehicle in the
immediate act of fleeing the scene of a crime in which he or she
knowingly and willingly participated.
(5) Injury or death caused by a person in violation of subdivision
(c) of Section 192 or Section 192.5 of the Penal Code.
For the purpose of the limitations imposed by this article, a
crime shall mean one act or series of related acts arising from the
same course of conduct with the same perpetrator or perpetrators
against a victim.
(d) "Pecuniary loss" means the following expenses for which the
victim or derivative victim has not been and will not be reimbursed
from any other source:
(1) The amount of medical or medical-related expenses incurred by
the victim, including inpatient psychological or psychiatric
expenses, and including, but not limited to, eyeglasses, hearing
aids, dentures, or any prosthetic device taken, lost, or destroyed
during the commission of the crime, or the use of which became
necessary as a direct result of the crime.
(2) The amount of outpatient psychiatric, psychological, or other
mental health counseling related expenses which
that became necessary as a direct result of the crime.
These counseling services may only be reimbursed if provided by any
of the following individuals:
(A) A person licensed as a physician who is certified in
psychiatry by the American Board of Psychiatry and Neurology or who
has completed a residency in psychiatry.
(B) A person licensed as a psychologist under Chapter 6.6
(commencing with Section 2900) of Division 2 of the Business and
Professions Code.
(C) A person licensed as a clinical social worker under Article 4
(commencing with Section 4996) of Chapter 14 of Division 2 of the
Business and Professions Code.
(D) A person licensed as a marriage, family, and child counselor
under Chapter 13 (commencing with Section 4980) of Division 2 of the
Business and Professions Code.
(E) A person registered as a psychological assistant who is under
the supervision of a licensed psychologist or board certified
psychiatrist as required by Section 2913 of the Business and
Professions Code.
(F) A person registered with the Board of Psychology who is
providing services in a nonprofit community agency pursuant to
subdivision (d) of Section 2909 of the Business and Professions Code.
(G) A person registered as a marriage, family, and child counselor
intern who is under the supervision of a licensed marriage, family,
and child counselor, a licensed clinical social worker, a licensed
psychologist, or a licensed physician certified in psychiatry, as
specified in Section 4980.44 of the Business and Professions Code.
(H) A person registered as an associate clinical social worker, as
defined in Section 4996.18 of the Business and Professions Code, who
is under the supervision of a licensed clinical social worker, a
licensed psychologist, or a board certified psychiatrist.
(I) A person who qualifies as a psychology intern as described in
Section 2911 of the Business and Professions Code who is under the
supervision of a licensed mental health professional (psychiatrist,
psychologist, or social worker) in a university hospital or
university medical school clinic or a person who has completed the
qualifications described in Section 2911 of the Business and
Professions Code who is pursuing a postdoctoral and training in a
university or university medical school clinic under the supervision
of a licensed mental health professional (psychiatrist, psychologist,
or social worker) for the purpose of achieving higher clinical
competency.
(J) An advanced practice registered nurse certified as a clinical
nurse specialist under Article 9 (commencing with Section 2838) of
Chapter 6 of Division 2 of the Business and Professions Code, who
participates in expert clinical practice in the specialty of
psychiatric-mental health nursing.
(3) The loss of income that the victim or the loss of support that
the derivative victim has incurred or will incur as a direct result
of an injury or death.
(4) Pecuniary loss also includes nonmedical remedial care and
treatment rendered in accordance with a religious method of healing
recognized by state law.
(5) The amount of family psychiatric, psychological, or mental
health counseling expenses necessary as a direct result of the crime
for the successful treatment of the victim, provided to family
members of the victim in the presence of the victim, whether or not
the family member relationship existed at the time of the crime.
(e) "Board" means the State Board of Control.
(f) "Victim centers" means those centers as specified in Section
13835.2 of the Penal Code.
(g) "Peer counselor" means a provider of mental health counseling
services who has completed a specialized course in rape crisis
counseling skills development, participates in continuing education
in rape crisis counseling skills development, and provides rape
crisis counseling in consultation with a mental health practitioner
licensed within the State of California.
(h) This section shall remain in effect only until January 1,
2003, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2003, deletes or extends
that date.
SEC. 4. Section 13960 of the Government Code, as added by Section
2.7 of Chapter 697 of the Statutes of 1998, is amended to read:
13960. As used in this article:
(a) (1) "Victim" means a resident of the State of California, a
member of the military stationed in California, or a family member
living with a member of the military stationed in California who
sustains injury or death as a direct result of a crime.
(2) "Derivative victim" means a resident of California who is one
of the following:
(A) At the time of the crime was the parent, sibling, spouse, or
child of the victim.
(B) At the time of the crime was living in the household of the
victim.
(C) A person who had previously lived in the household of the
victim for a period of not less than two years in a relationship
substantially similar to a relationship listed in subparagraph (A).
(D) Is another family member of the victim, including the victim's
fiance, and witnessed the crime.
(b) "Injury" includes physical or emotional injury, or both.
However, this article does not apply to emotional injury unless that
injury is incurred by a victim who also sustains physical injury or
threat of physical injury. For purposes of this article, a victim of
a crime committed in violation of Section 261, 262, 271, 273a, 273d,
285, 286, 288, 288a, 288.5, or 289, or subdivision (b) or (c) of
Section 311.4, of the Penal Code, who sustains emotional injury is
presumed to have sustained physical injury. For purposes of this
article, a victim of a crime committed in violation of Section 270 of
the Penal Code, as a result of conduct other than a failure to pay
child support, who sustains emotional injury is presumed to have
sustained physical injury if criminal charges were filed or a
prosecuting attorney expresses the opinion that the child is a victim
of that section.
(c) "Crime" means a crime or public offense that would constitute
a misdemeanor or a felony if committed in California by a competent
adult which that results in injury to a
resident of this state, including a crime or public offense,
wherever it may take place, when the resident is temporarily absent
from the state. "Crime" includes an act of terrorism, as defined in
Section 2331 of Title 18 of the United States Code, committed against
a resident of the state, whether or not the act occurs within the
state. No act involving the operation of a motor vehicle, aircraft,
or water vehicle which that results in
injury or death constitutes a crime for the purposes of this article,
except that a crime shall include any of the following:
(1) Injury or death intentionally inflicted through the use of a
motor vehicle, aircraft, or water vehicle.
(2) Injury or death caused by a driver in violation of Section
20001 of the Vehicle Code.
(3) Injury or death caused by a person who is under the influence
of any alcoholic beverage or drug.
(4) Injury or death caused by a driver of a motor vehicle in the
immediate act of fleeing the scene of a crime in which he or she
knowingly and willingly participated.
For the purpose of the limitations imposed by this article, a
crime shall mean one act or series of related acts arising from the
same course of conduct with the same perpetrator or perpetrators.
(d) "Pecuniary loss" means the following expenses for which the
victim or derivative victim has not been and will not be reimbursed
from any other source:
(1) The amount of medical or medical-related expenses incurred by
the victim, including inpatient psychological or psychiatric
expenses, and including, but not limited to, eyeglasses, hearing
aids, dentures, or any prosthetic device taken, lost, or destroyed
during the commission of the crime, or the use of which became
necessary as a direct result of the crime.
(2) The amount of outpatient psychiatric, psychological, or other
mental health counseling related expenses which
that became necessary as a direct result of the crime.
These counseling services may only be reimbursed if provided by any
of the following individuals:
(A) A person licensed as a physician who is certified in
psychiatry by the American Board of Psychiatry and Neurology or who
has completed a residency in psychiatry.
(B) A person licensed as a psychologist under Chapter 6.6
(commencing with Section 2900) of Division 2 of the Business and
Professions Code.
(C) A person licensed as a clinical social worker under Article 4
(commencing with Section 4996) of Chapter 14 of Division 2 of the
Business and Professions Code.
(D) A person licensed as a marriage, family, and child counselor
under Chapter 13 (commencing with Section 4980) of Division 2 of the
Business and Professions Code.
(E) A person registered as a psychological assistant who is under
the supervision of a licensed psychologist or board certified
psychiatrist as required by Section 2913 of the Business and
Professions Code.
(F) A person registered with the Board of Psychology who is
providing services in a nonprofit community agency pursuant to
subdivision (d) of Section 2909 of the Business and Professions Code.
(G) A person registered as a marriage, family, and child counselor
intern who is under the supervision of a licensed marriage, family,
and child counselor, a licensed clinical social worker, a licensed
psychologist, or a licensed physician certified in psychiatry, as
specified in Section 4980.44 of the Business and Professions Code.
(H) A person registered as an associate clinical social worker, as
defined in Section 4996.18 of the Business and Professions Code, who
is under the supervision of a licensed clinical social worker, a
licensed psychologist, or a board certified psychiatrist.
(I) An advanced practice registered nurse certified as a clinical
nurse specialist under Article 9 (commencing with Section 2838) of
Chapter 6 of Division 2 of the Business and Professions Code, who
participates in expert clinical practice in the specialty of
psychiatric-mental health nursing.
(3) The loss of income that the victim or the loss of support that
the derivative victim has incurred or will incur as a direct result
of an injury or death.
(4) Pecuniary loss also includes nonmedical remedial care and
treatment rendered in accordance with a religious method of healing
recognized by state law.
(5) The amount of family psychiatric, psychological, or mental
health counseling expenses necessary as a direct result of the crime
for the successful treatment of the victim, provided to family
members of the victim in the presence of the victim, whether or not
the family member relationship existed at the time of the crime.
(e) "Board" means the State Board of Control.
(f) "Victim centers" means those centers as specified in Section
13835.2 of the Penal Code.
(g) "Peer counselor" means a
provider of mental health counseling services who has completed a
specialized course in rape crisis counseling skills development,
participates in continuing education in rape crisis counseling skills
development, and provides rape crisis counseling in consultation
with a mental health practitioner licensed within the State of
California.
(h) This section shall become operative on January 1, 2003.
SEC. 5. Section 1373 of the Health and Safety Code is amended to
read:
1373. (a) A plan contract may not provide an exception for other
coverage where if the other coverage is
entitlement to Medi-Cal benefits under 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, or medicaid
benefits under Subchapter 19 (commencing with Section 1396) of
Chapter 7 of Title 42 of the United States Code.
Each plan contract shall be interpreted not to provide an
exception for the Medi-Cal or medicaid benefits.
A plan contract shall not provide an exemption for enrollment
because of an applicant's entitlement to Medi-Cal benefits under
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, or medicaid benefits under Subchapter 19
(commencing with Section 1396) of Chapter 7 of Title 42 of the United
States Code.
A plan contract may not provide that the benefits payable
thereunder are subject to reduction if the individual insured has
entitlement to the Medi-Cal or medicaid benefits.
(b) A plan contract that provides coverage, whether by specific
benefit or by the effect of general wording, for sterilization
operations or procedures shall not impose any disclaimer, restriction
on, or limitation of, coverage relative to the covered individual's
reason for sterilization.
As used in this section, "sterilization operations or procedures"
shall have the same meaning as that specified in Section 10120 of the
Insurance Code.
(c) Every plan contract that provides coverage to the spouse or
dependents of the subscriber or spouse shall grant immediate accident
and sickness coverage, from and after the moment of birth, to each
newborn infant of any subscriber or spouse covered and to each minor
child placed for adoption from and after the date on which the
adoptive child's birth parent or other appropriate legal authority
signs a written document, including, but not limited to, a health
facility minor release report, a medical authorization form, or a
relinquishment form, granting the subscriber or spouse the right to
control health care for the adoptive child or, absent this written
document, on the date there exists evidence of the subscriber's or
spouse's right to control the health care of the child placed for
adoption. No such plan may be entered into or amended if it contains
any disclaimer, waiver, or other limitation of coverage relative to
the coverage or insurability of newborn infants of, or children
placed for adoption with, a subscriber or spouse covered as required
by this subdivision.
(d) Every plan contract that provides that coverage of a dependent
child of a subscriber shall terminate upon attainment of the
limiting age for dependent children specified in the plan, shall also
provide in substance that attainment of the limiting age shall not
operate to terminate the coverage of the child while the child is and
continues to be both (1) incapable of self-sustaining employment by
reason of mental retardation or physical handicap and (2) chiefly
dependent upon the subscriber for support and maintenance, provided
proof of the incapacity and dependency is furnished to the plan by
the member within 31 days of the request for the information by the
plan or group plan contractholder and subsequently as may be required
by the plan or group plan contractholder, but not more frequently
than annually after the two-year period following the child's
attainment of the limiting age.
(e) A plan contract which that
provides coverage, whether by specific benefit or by the effect of
general wording, for both an employee and one or more covered persons
dependent upon the employee and provides for an extension of the
coverage for any period following a termination of employment of the
employee shall also provide that this extension of coverage shall
apply to dependents upon the same terms and conditions precedent as
applied to the covered employee, for the same period of time, subject
to payment of premiums, if any, as required by the terms of the
policy and subject to any applicable collective bargaining agreement.
(f) A group contract shall not discriminate against handicapped
persons or against groups containing handicapped persons. Nothing in
this subdivision shall preclude reasonable provisions in a plan
contract against liability for services or reimbursement of the
handicap condition or conditions relating thereto, as may be allowed
by rules of the director.
(g) Every group contract shall set forth the terms and conditions
under which subscribers and enrollees may remain in the plan in the
event the group ceases to exist, the group contract is terminated or
an individual subscriber leaves the group, or the enrollees'
eligibility status changes.
(h) (1) A health care service plan or specialized health care
service plan may provide for coverage of, or for payment for,
professional mental health services, or vision care services, or for
the exclusion of these services. If the terms and conditions include
coverage for services provided in a general acute care hospital or
an acute psychiatric hospital as defined in Section 1250 and do not
restrict or modify the choice of providers, the coverage shall extend
to care provided by a psychiatric health facility as defined in
Section 1250.2 operating pursuant to licensure by the State
Department of Mental Health. A health care service plan that offers
outpatient mental health services but does not cover these services
in all of its group contracts shall communicate to prospective group
contractholders as to the availability of outpatient coverage for the
treatment of mental or nervous disorders.
(2) No plan shall prohibit the member from selecting any
psychologist who is licensed pursuant to the Psychology Licensing Law
(Chapter 6.6 (commencing with Section 2900) of Division 2 of the
Business and Professions Code), any optometrist who is the holder of
a certificate issued pursuant to Chapter 7 (commencing with Section
3000) of Division 2 of the Business and Professions Code or, upon
referral by a physician and surgeon licensed pursuant to the Medical
Practice Act (Chapter 5 (commencing with Section 2000) of Division 2
of the Business and Professions Code), (i) any marriage, family, and
child counselor who is the holder of a license under Section 4980.50
of the Business and Professions Code, (ii) any licensed clinical
social worker who is the holder of a license under Section 4996 of
the Business and Professions Code, or (iii) any advanced
practice registered nurse licensed
certified as a clinical nurse specialist pursuant to
Article 9 (commencing with Section 2838) of Chapter 6
(commencing with Section 2700) of Division 2 of the
Business and Professions Code who possesses a master's
degree in participates in expert clinical practice in
the specialty of psychiatric-mental health nursing and
two years of supervised experience in psychiatric-mental health
nursing, at the time that the State Board of Registered Nurses
produces and maintains a list of those psychiatric-mental health
nurses who possess a master's degree in psychiatric-mental health
nursing and two years of supervised experience in psychiatric-mental
health nursing , to perform the particular services covered
under the terms of the plan, and the certificate holder is expressly
authorized by law to perform these services.
(3) Nothing in this section shall be construed to allow any
certificate holder or licensee enumerated in this section to perform
professional mental health services beyond his or her field or fields
of competence as established by his or her education, training and
experience.
(4) For the purposes of this section, "marriage, family, and child
counselor" means a licensed marriage, family, and child counselor
who has received specific instruction in assessment, diagnosis,
prognosis, and counseling, and psychotherapeutic treatment of
premarital, marriage, family, and child relationship dysfunctions
which is equivalent to the instruction required for licensure on
January 1, 1981.
(5) Nothing in this section shall be construed to allow a member
to select and obtain mental health or psychological or vision care
services from a certificate or licenseholder who is not directly
affiliated with or under contract to the health care service plan or
specialized health care service plan to which the member belongs.
All health care service plans and individual practice associations
that offer mental health benefits shall make reasonable efforts to
make available to their members the services of licensed
psychologists. However, a failure of a plan or association to comply
with the requirements of the preceding sentence shall not constitute
a misdemeanor.
(6) As used in this subdivision, "individual practice association"
means an entity as defined in subsection (5) of Section 1307 of the
federal Public Health Service Act (42 U.S.C. Sec. 300e-1, subsec.
(5)).
(7) Health care service plan coverage for professional mental
health services may include community residential treatment services
that are alternatives to inpatient care and which
that are directly affiliated with the plan or to which
enrollees are referred by providers affiliated with the plan.
(i) If the plan utilizes arbitration to settle disputes, the plan
contracts shall set forth the type of disputes subject to
arbitration, the process to be utilized, and how it is to be
initiated.
(j) A plan contract which that
provides benefits that accrue after a certain time of confinement in
a health care facility shall specify what constitutes a day of
confinement or the number of consecutive hours of confinement that
are requisite to the commencement of benefits.
SEC. 6. Section 1373.8 of the Health and Safety Code is amended to
read:
1373.8. A health care service plan contract where the plan is
licensed to do business in this state and the plan provides coverage
which that includes California
residents but which that may be written
or issued for delivery outside of California and where benefits are
provided within the scope of practice of a licensed clinical social
worker, a an advanced practice
registered nurse licensed who is certified as
a clinical nurse specialist pursuant to Article 9
(commencing with Section 2838) of Chapter 6
(commencing with Section 2700) of Division 2 of the
Business and Professions Code who possesses a master's
degree in participates in expert clinical practice in
the specialty of psychiatric-mental health nursing and
two years of supervised experience in psychiatric-mental health
nursing , or a marriage, family, and child counselor who is
the holder of a license under Section 17805
4980.50 of the Business and Professions Code, shall not be
deemed to prohibit persons covered under the contract from selecting
those licensed persons in California to perform the services in
California which that are within the
terms of the contract even though the licensees are not licensed in
the state where the contract is written or issued for delivery.
It is the intent of the Legislature in amending this section in
the 1984 portion of the 1983-84 Legislative Session that persons
covered by the contract and those providers of health care specified
in this section who are licensed in California should be entitled to
the benefits provided by the plan for services of those providers
rendered to those persons.
SEC. 7. Section 10176 of the Insurance Code is amended to read:
10176. In disability insurance, the policy may provide for
payment of medical, surgical, chiropractic, physical therapy, speech
pathology, audiology, acupuncture, professional mental health,
dental, hospital, or optometric expenses upon a reimbursement basis,
or for the exclusion of any of those services, and provision may be
made therein for payment of all or a portion of the amount of charge
for these services without requiring that the insured first pay the
expenses. No such policy shall prohibit the insured from selecting
any psychologist or other person who is the holder of a certificate
or license under Section 1000, 1634, 2050, 2472, 2553, 2630, 2948,
3055, or 4938 of the Business and Professions Code, to perform the
particular services covered under the terms of the policy, the
certificate holder or licensee being expressly authorized by law to
perform those services.
If the insured selects any person who is a holder of a certificate
under Section 4938 of the Business and Professions Code, a
disability insurer or nonprofit hospital service plan shall pay the
bona fide claim of an acupuncturist holding a certificate pursuant to
Section 4938 of the Business and Professions Code for the treatment
of an insured person only if the insured's policy or contract
expressly includes acupuncture as a benefit and includes coverage for
the injury or illness treated. Unless the policy or contract
expressly includes acupuncture as a benefit, no person who is the
holder of any license or certificate set forth in this section shall
be paid or reimbursed under the policy for acupuncture.
Nor shall any such policy prohibit the insured, upon referral by a
physician and surgeon licensed under Section 2050 of the Business
and Professions Code, from selecting any licensed clinical social
worker who is the holder of a license issued under Section 4996 of
the Business and Professions Code or any occupational therapist as
specified in Section 2570 2570.2 of the
Business and Professions Code, or any marriage, family and child
counselor who is the holder of a license under Section 4980.50 of the
Business and Professions Code, to perform the particular services
covered under the terms of the policy, or from selecting any
speech speech-language pathologist or
audiologist licensed under Section 2530 2532
of the Business and Professions Code or any advanced
practice registered nurse licensed
certified as a clinical nurse specialist pursuant to
Article 9 (commencing with Section 2838) of Chapter 6
(commencing with Section 2700) of Division 2 of the
Business and Professions Code who possesses a master's
degree in participates in expert clinical practice in
the specialty of psychiatric-mental health nursing and
two years of supervised experience in psychiatric-mental health
nursing, at such time as the State Board of Registered Nurses
produces and maintains a list of those psychiatric-mental health
nurses who possess a master's degree in psychiatric-mental health
nursing and two years of supervised experience in psychiatric-mental
health nursing , or any respiratory care practitioner
certified pursuant to Chapter 8.3 (commencing with Section 3700) of
Division 2 of the Business and Professions Code to perform services
deemed necessary by the referring physician, that certificate holder,
licensee or otherwise regulated person, being expressly authorized
by law to perform the services.
Nothing in this section shall be construed to allow any
certificate holder or licensee enumerated in this section to perform
professional mental health services beyond his or her field or
fields of competence as established by his or her education,
training, and experience. For the purposes of this section,
"marriage, family and child counselor" means a licensed marriage,
family and child counselor who has received specific instruction in
assessment, diagnosis, prognosis, and counseling, and
psychotherapeutic treatment of premarital, marriage, family, and
child relationship dysfunctions which that
is equivalent to the instruction required for licensure on
January 1, 1981.
An individual disability insurance policy, which is issued,
renewed, or amended on or after January 1, 1988, which includes
mental health services coverage may not include a lifetime waiver for
that coverage with respect to any applicant. The lifetime waiver of
coverage provision shall be deemed unenforceable.
SEC. 8. Section 10177 of the Insurance Code is amended to read:
10177. A self-insured employee welfare benefit plan may provide
for payment of professional mental health expenses upon a
reimbursement basis, or for the exclusion of such
those services, and provision may be made therein for
payment of all or a portion of the amount of charge for such
those services without requiring that the
employee first pay such expenses. No such plan shall prohibit the
employee from selecting any psychologist who is the holder of a
certificate issued under Section 2948 of the Business and Professions
Code or, upon referral by a physician and surgeon licensed under
Section 2135 of the Business and Professions Code, any licensed
clinical social worker who is the holder of a license issued under
Section 4996 of the Business and Professions Code or any marriage,
family, and child counselor who is the holder of a certificate or
license under Section 4980.50 of the Business and Professions Code,
or any advanced practice registered nurse
licensed certified as a clinical nurse specialist
pursuant to Article 9 (commencing with Section 2838) of
Chapter 6 (commencing with Section 2700) of
Division 2 of the Business and Professions Code who
possesses a master's degree in participates in expert
clinical practice in the specialty of psychiatric-mental health
nursing and two years of supervised experience in
psychiatric-mental health nursing, at such time as the State Board of
Registered Nurses produces and maintains a list of those
psychiatric-mental health nurses who possess a master's degree in
psychiatric-mental health nursing and two years of supervised
experience in psychiatric-mental health nursing , to
perform the particular services covered under the terms of the plan,
such certificate or license holder being expressly authorized by law
to perform such services.
Nothing in this section shall be construed to allow any
certificate holder or licensee enumerated in this section to perform
professional services beyond his or her field or fields of competence
as established by his or her education, training, and experience.
For the purposes of this section, "marriage, family, and child
counselor" shall mean a licensed marriage, family, and child
counselor who has received specific instruction in assessment,
diagnosis, prognosis, and counseling, and psychotherapeutic treatment
of premarital, marriage, family, and child relationship dysfunctions
which is equivalent to the instruction required for licensure on
January 1, 1981.
A self-insured employee welfare benefit plan, which is issued,
renewed, or amended on or after January 1, 1988, which
that includes mental health services coverage in
nongroup contracts may not include a lifetime waiver for that
coverage with respect to any employee. The lifetime waiver of
coverage provision shall be deemed unenforceable.