BILL NUMBER: SB 296 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 13, 2009
INTRODUCED BY Senator Lowenthal
FEBRUARY 25, 2009
An act to add Sections 1367.27, 1367.28, and 1367.29 to the Health
and Safety Code, and to add Sections 10123.197, 10123.198, and
10123.199 to the Insurance Code, relating to health care
coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 296, as amended, Lowenthal. Mental health services.
Existing law provides for licensing and regulation of health care
service plans by the Department of Managed Health Care. Existing
law provides for licensing and regulation of health insurers by the
Department of Insurance. A willful violation of provisions
governing health care service plans is a crime. Existing law imposes
certain requirements on health care service plans and
, specialized health care service plans ,
and health insurers that provide coverage for professional
mental health services.
This bill would require every health care service plan, including
a specialized health care service plan, and every health insurer
that offers professional mental health services to direct
those services to be provided in a manner that ensures coordination
of benefits between all mental health care providers and general
physical health care providers. The bill would require these plans
and insurers to establish an Internet Web site
conforming to minimum standards and guidelines established by the
department by an unspecified date, and to issue a benefits
card to enrollees or insureds with specified information.
By imposing new requirements on certain health care service plans,
the willful violation of which 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 1367.27 is added to the Health and Safety Code,
to read:
1367.27. (a) The Legislature finds and declares that coordination
of care between mental health care providers and general physical
health care providers is necessary to optimize the overall health of
a patient.
(b) Every health care service plan that offers professional mental
health services, including a specialized health care service plan
that offers those services, shall direct those services to be
provided in a manner that ensures coordination of benefits between
mental health care providers and general physical health care
providers.
SEC. 2. Section 1367.28 is added to the Health and Safety Code, to
read:
1367.28. (a) On or before January 1, ____, every health care
service plan that offers professional mental health services,
including a specialized health care service plan that offers those
services, shall establish a plan Internet Web site. The purpose of
the plan Internet Web site shall be to provide consumer, patient, and
provider access to plan procedures, policies, and network provider
information.
(b) Each Internet Web site shall, at a minimum, include the plan's
policies and procedures identified in Sections 1363, 1363.5,
1367.01, 1367.23, 1367.26, 1368.015, 1371, 1371.8, 1373.95, 1374.30,
and 1380.
1367.28. (a) The Legislature finds and declares
that health care consumers should be provided important information
regarding health care services in an easily accessible manner. While
most health care service plans are required to maintain Internet Web
sites pursuant to subdivision (f) of Section 1368.015, it is the
intent of this section to improve online access to all policies,
guidelines, disclosure forms, and other materials that health care
service plans are required by law to provide to the department or
consumers.
(b) On or before January 1, 2012, every health care service plan
that offers professional mental health services, including a
specialized health care service plan that offers only those services,
shall establish an Internet Web site. Each Web site shall include,
or provide a link to, information relative to all of the following:
(1) Plan policies and procedures related to:
(A) Modified contracts or coverage as required by Section 1352.1.
(B) Enrollee contract benefits and terms as required by
subdivisions (a) and (b) of Section 1363.
(C) Economic profiling as required by Section 1367.02.
(D) Utilization review and modified coverage as required by
Sections 1363.5 and 1367.01.
(E) Cancellation of contracts as required by Section 1367.23.
(F) Lists of providers as required by Section 1367.26.
(G) Enrollee and subscriber grievances as required by Sections
1368 and 1368.015.
(H) Continuity of care as required by subdivisions (a) and (b) of
Section 1373.95.
(I) Independent medical review as required by subdivision (i) of
Section 1374.30.
(2) The department's final report of the plan's periodic review as
required by subdivision (h) of Section 1380.
(3) All provider manuals, policies, and procedures related to the
terms and conditions of provider contracts, including any material
changes to those manuals, policies, and procedures.
(c) The material described in subdivision (b) shall be updated at
least every month.
(d) On or before January 1, ____, the department shall establish
minimum standards and guidelines for plan Internet Web sites, after
consultation with stakeholder groups, including, but not limited to,
individual, group, and institutional providers and consumer
protection groups. The minimum standards shall be implemented by
plans on or before January 1, ____.
(e)
(d) The department shall include on the department's
Internet Web site a link to each plan Internet Web site.
SEC. 3. Section 1367.29 is added to the Health and Safety Code, to
read:
1367.29. (a) Every health care service plan that offers
professional mental health services, including a specialized health
care service plan that offers those services, shall issue a benefits
card to each enrollee for assistance with mental health benefits
coverage information, in-network provider access information, and
claims processing purposes. The benefits card, at a minimum, shall
include all of the following information:
(1) The name of the benefit administrator or health care service
plan issuing the card, which shall be displayed on the front side of
the card.
(2) The enrollee's identification number, or the subscriber's
identification number when the enrollee is a dependent who accesses
services using the subscriber's identification number. The number
shall be displayed on the front side of the card.
(3) A telephone number that enrollees may call 24 hours a day,
seven days a week, for assistance regarding health benefits coverage
information, in-network provider access information, and claims
processing.
(4) A brief statement indicating that enrollees may call the
telephone number for assistance regarding mental health services and
coverage.
(5) Preauthorization restrictions or requirements.
(6) Information required by the benefits administrator or health
care service plan that is necessary to commence processing a claim,
except as otherwise provided in subdivision (b).
(5) The plan's Internet Web site address.
(b) A health care service plan shall not print any of the
following information on the benefits card:
(1) Any information that may result in fraudulent use of the card.
(2) Any information that is otherwise prohibited from being
included on the card.
(c) On and after July 1, ___ 2011 ,
the benefits card required by this section shall be issued by a
health care service plan or a specialized health care service plan to
an enrollee upon enrollment or upon any change in the enrollee's
coverage that impacts the data content or format of the card.
(d) Nothing in this section requires a health care service plan to
issue a separate benefits card for mental health coverage if the
plan issues a card for health care coverage in general and the card
provides the information required by this section.
(e) If a specialized health care service plan delegates
responsibility for issuing the benefits card to a contractor or
agent, then the contract between the plan and its contractor or agent
shall require compliance with this section.
SEC. 4. Section 10123.197 is added to the
Insurance Code , to read:
10123.197. (a) The Legislature finds and declares that
coordination of care between mental health care providers and general
physical health care providers is necessary to optimize the overall
health of a patient.
(b) Every health insurer that offers professional mental health
services shall direct those services to be provided in a manner that
ensures coordination of benefits between mental health care providers
and general physical health care providers.
SEC. 5. Section 10123.198 is added to the
Insurance Code , to read:
10123.198. (a) The Legislature finds and declares that health
care consumers should be provided important information regarding
health care services in an easily accessible manner. The intent of
this section is to improve online access to all policies, guidelines,
disclosure forms, and other materials that health insurers are
required by law to provide to the commissioner or consumers.
(b) On or before January 1, 2012, every health insurer that offers
professional mental health services shall establish an Internet Web
site. Each Web site shall include, or provide a link to, information
relative to all of the following:
(1) Insurer policies and procedures related to:
(A) Modified contracts or coverage.
(B) Policyholder contract benefits and terms.
(C) Economic profiling as required by Section 10123.36.
(D) Utilization review and modified coverage as required by
Section 10123.135.
(E) Cancellation of contracts as required by Section 10199.44.
(F) Lists of providers as required by Section 10133.1.
(G) Policyholder and insured grievances.
(H) Continuity of care as required by Section 10133.55.
(I) Independent medical review as required by subdivision (i) of
Section 10169.
(2) The results of any market conduct examinations of the insurer
as required by Section 12938.
(3) All provider manuals, policies, and procedures related to the
terms and conditions of provider contracts, including any material
changes to those manuals, policies, and procedures.
(c) The material described in subdivision (b) shall be updated at
least every month.
(d) The commissioner shall include on the department's Internet
Web site, a link to each health insurer's Internet Web site.
SEC. 6. Section 10123.199 is added to the
Insurance Code , to read:
10123.199. (a) Every health insurer that offers professional
mental health services shall issue a benefits card to each insured
for assistance with mental health benefits coverage information,
in-network provider access information, and claims processing
purposes. The benefits card, at a minimum, shall include all of the
following information:
(1) The name of the benefit administrator or health insurer
issuing the card, which shall be displayed on the front side of the
card.
(2) The insured's identification number, or the policyholder's
identification number when the insured is a dependent who accesses
services using the policyholder's identification number. The number
shall be displayed on the front side of the card.
(3) A telephone number that insureds may call 24 hours a day,
seven days a week, for assistance regarding health benefits coverage
information, in-network provider access information, and claims
processing.
(4) A brief statement indicating that insureds may call the
telephone number for assistance regarding mental health services and
coverage.
(5) The health insurer's Internet Web site address.
(b) A health insurer shall not print any of the following
information on the benefits card:
(1) Any information that may result in fraudulent use of the card.
(2) Any information that is otherwise prohibited from being
included on the card.
(c) On and after July 1, 2011, the benefits card required by this
section shall be issued by a health insurer to an insured upon
commencement of coverage or upon any change in the insured's coverage
that impacts the data content or format of the card.
(d) Nothing in this section requires a health insurer to issue a
separate benefits card for mental health coverage if the plan issues
a card for health care coverage in general and the card provides the
information required by this section.
SEC. 4. SEC. 7. 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.