BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 296|
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THIRD READING
Bill No: SB 296
Author: Lowenthal (D)
Amended: 4/13/09
Vote: 21
SENATE HEALTH COMMITTEE : 10-1, 04/22/09
AYES: Alquist, Aanestad, Cedillo, Cox, DeSaulnier, Leno,
Maldonado, Negrete McLeod, Pavley, Wolk
NOES: Strickland
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SUBJECT : Mental health services
SOURCE : California Psychiatric Association
DIGEST : This bill requires health plans, including
specialized health plans, and insurers that offer
professional mental health services to direct those
services to be provided in a coordinated manner, establish
web sites that contain particular information by January 1,
2012, and provide benefit cards by July 1, 2011, as
specified.
ANALYSIS :
Existing Law
1.Provides for the regulation of health care service plans
(health plans) by the Department of Managed Health Care
CONTINUED
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(DMHC) and regulation of disability insurers who sell
health insurance (health insurers) by the Department of
Insurance (DOI).
2.Requires full service health plans licensed by DMHC to
provide basic health care services, as defined.
3.Requires health care service plans and health insurers to
comply with certain administrative requirements, premium
requirements, patient protection requirements, fiduciary
and financial requirements, provider access requirements,
and to provide certain mandated benefits to enrollees.
4.Requires health plans and health insurers to provide
coverage for the diagnosis and medically necessary
treatment of certain severe mental illnesses (SMI), as
defined, and of serious emotional disturbances (SED) of a
child, as defined, under the same terms and conditions
applied to other medical conditions.
5.Requires web sites of health plans that provide coverage
for professional mental health services to include, but
not be limited to, providing information for subscribers,
enrollees, and providers on accessing mental health
services.
This bill:
1.Requires health plans, including specialized health
plans and insurers that offer professional mental health
services, to 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.
2.Requires, on or before January 1, 2012, health plans and
insurers that offer professional mental health services,
including a specialized health care service plan, to
establish a web site that includes or provides a link to
information on:
A. Plan and insurer policies and procedures related to
modified contracts or coverage; enrollee or policy
contract benefits and terms; economic profiling;
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utilization review and modified coverage; cancellation
of contracts; lists of providers, enrollee and
subscriber, or policyholder and insured, grievances;
continuity of care; and independent medical review.
B. 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.
3.Requires each health plan web site to include the DMHC's
final report of the plan's periodic review, and each
insurer web site to include the results of any market
conduct examinations of the insurer.
4.Requires this material to be updated at least every
month.
5.Requires DMHC to include a link to include a link to
each plan's web site on the DMHC web site.
6.Requires the Commissioner of DOI (Commissioner) to
include a link to each health insurer's website on the
DOI web site.
7.Requires health plans, including specialized health care
plans, and insurers that offer professional mental
health services, to issue a benefits card to each
enrollee and insured for assistance with mental health
benefits coverage information, in-network provider
access information, and claims processing purposes.
8.Requires the card, at a minimum to include:
A. The benefit administrator or health plan or insurer
issuing the card.
B. The enrollee or insured's identification number.
C. The subscriber or policyholder's identification number
when the enrollee or insured is a dependent who accesses
services using the subscriber or policyholder's
identification number.
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D. A telephone number that enrollees or insured's 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.
E. A brief statement indicating that enrollees and
insured's may call the telephone number for assistance
regarding mental health services and coverage.
F. The plan or health insurer's web site address.
9.Provides that a health plan or insurer shall not print
any information that may result in fraudulent use of the
card, or any information that is otherwise prohibited
from being included on the card.
10.Requires, on or after July 1, 2011, the benefits card to
be issued by a health plan or insurer to an enrollee or
insured upon commencement of coverage, or upon any
change in the enrollee's or insured's coverage that
impacts the data content or format of the card.
11.Provides that a health plan or insurer is not required
to issue a separate benefits card for mental health
coverage if the health plan or insurer issues a card for
health care coverage in general, and the card provides
the information required by this bill.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 5/5/09)
California Psychiatric Association (source)
California Association of Marriage and Family Therapists
OPPOSITION : (Verified 5/5/09)
California Association of Health Plans
ARGUMENTS IN SUPPORT : The California Psychiatric
Association (CPA), the sponsor of this bill, states that
the changes suggested by this bill can be valuable to the
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patient and increase their access to information and
services. CPA argues that requiring a specific number on a
benefits card related to mental health services can help
avoid situations in which the complexity of phone trees and
call transfers between different corporate entities cause
consumers to simply hang up and forego access to
information and/or services.
ARGUMENTS IN OPPOSITION : The California Association of
Health Plans (CAHP) states that this bill would require
extensive web site disclosure by plans, increase
administrative costs for health plans and would not provide
meaningful information to enrollees. CAHP states that it
is unclear how this information will help consumers or be
in a format that is easily understandable.
CTW:cm 5/5/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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