BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 296|
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UNFINISHED BUSINESS
Bill No: SB 296
Author: Lowenthal (D)
Amended: 8/17/09
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
SENATE FLOOR : 25-12, 5/14/09
AYES: Aanestad, Alquist, Calderon, Corbett, Correa, Cox,
DeSaulnier, Florez, Hancock, Kehoe, Leno, Liu, Lowenthal,
Maldonado, Negrete McLeod, Oropeza, Padilla, Pavley,
Romero, Simitian, Steinberg, Wiggins, Wolk, Wright, Yee
NOES: Ashburn, Benoit, Cogdill, Denham, Dutton, Harman,
Hollingsworth, Huff, Runner, Strickland, Walters, Wyland
NO VOTE RECORDED: Cedillo, Ducheny, Vacancy
ASSEMBLY FLOOR : 74-0, 8/27/09 - See last page for vote
SUBJECT : Mental health services
SOURCE : California Psychiatric Association
California Society for Clinical Social Work
DIGEST : This bill requires health care service plans and
health insurers that provide professional mental health
CONTINUED
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services to issue identification cards to all enrollees and
insured containing specified information by July 1, 2011,
and provide specified information relating to their
policies and procedures on their Internet web sites by
January 1, 2012.
Assembly Amendments revise and recast the bill with a
similar intent as it left the Senate.
ANALYSIS :
Existing Law
1.Provides for the regulation of health care service plans
(health plans) by the Department of Managed Health Care
(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, as defined,
and of serious emotional disturbances 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, on or before July 1, 2011, every health plan,
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including a specialized health plan, and health insurer
that provides coverage for professional mental health
services to issue an identification card to each
enrollee and insured to assist the enrollee or insured
with accessing health benefits coverage information,
including, but not limited to, in-network provider
access information, and claims processing information.
2.Specifies that the identification card must at least
include the following:
A. The name of the health plan or health insurer
issuing the card.
B. The enrollee's or insured's identification number.
C. A telephone number that enrollees or insured may
call for assistance with health coverage information
described in #1 above, and when assessment services
are provided by the health care service plan, access
to assessment services for the purpose of referral to
an appropriate level of care or appropriate health
provider.
D. The health plan's or health insurers Internet web
site address.
3.Requires the identification card required by this bill
to be issued by a health plan, a specialized health
plan, or health insurer to an enrollee upon enrollment
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.
4.Specifies the term "identification card" includes other
technology that performs substantially the same function
as an identification card.
5.Specifies that nothing in this bill requires a health
plan or health insurer to issue a separate
identification card for professional mental health
services coverage if a card for health care coverage in
general is already issued and the card complies with the
information required by this bill.
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6.Directs the contractor or agent that is delegated by a
health plan, specialized health plan, or health insurer
to issue the identification card required by this bill
to comply with the requirements of this bill.
7.Specifies that this bill does not apply to Medicare
supplement, Employee Assistance Programs, short-term
limited duration health insurance, Civilian health and
Medical Program of the Uniformed Services
(CHAMPUS)-supplement insurance, TRI-CARE supplement, or
to hospital indemnity, accident-only, and specified
disease insurance, as well as specialized health care
service plans, except behavioral health-only plans.
8.Specifies that this bill does not apply to a behavioral
health-only plan that provides coverage for professional
mental health services pursuant to a contract with a
health care service plan or insurer if that plan or
insurer issues an identification card to its subscribers
or insureds.
9.Clarifies that nothing in this bill be construed to
prohibit a health plan, specialized health plan, or
health insurer from meeting the standards of the
Workgroup for Electronic Data Interchange (WEDI) or
other national uniform standards with respect to
identification cards, as long as the minimum
requirements in this bill have been met.
10.Requires, on or before January 1, 2012, every health
plan and health insurer, including a specialized health
plan, that covers professional mental health services,
to disclose on its Internet web site, or provide a link
to, the following information:
A. A telephone number that the enrollee or provider
can call, during normal business hours, for
assistance obtaining mental health benefits coverage
information, including the extent to which benefits
have been exhausted, in-network provider access
information, and claims processing information.
B. A link to prescription drug formularies, as
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specified.
C. A detailed summary describing the process by which
the plan reviews and authorizes or approves,
modifies, or denies requests for health care
services, as specified.
D. Lists of in-network providers.
E. A detailed summary of the enrollee grievance
process required under existing law.
F. A detailed summary of how an enrollee may request
continuity of care, as specified.
G. Information concerning the right, and applicable
procedure, of an enrollee to request an independent
medical review pursuant to existing law.
H. A link to the DMHC's final report on the plan's
periodic review, or to DOI's market conduct
examination, as specified.
I. Provider manual templates containing specified
information.
11.Requires the material described in #10(I) above to be
updated within 30 days of any material change and an
electronic notification of materials changes to be
communicated to applicable contract providers
immediately.
12.Requires the information prescribed in #10 above to be
updated at least quarterly, to be made available through
a secured Internet web site accessible only to
enrollees, and to be made available to enrollees in hard
copy upon request.
13.Clarifies that nothing in this bill precludes a health
plan or health insurer from including additional
information on its Internet web site, as specified.
14.Requires DMHC and DOI to include on their respective
Internet web sites a link to the Internet web site of
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each health plan, specialized health plan, or health
insurer.
15.Requires, on or before January 1, 2012, every health
insurer that covers professional mental health services
to establish an Internet web site that must include
information similar to the Internet web site disclosures
required for every health plan that covers professional
mental health services in #10 above.
16.Exempts from the provisions of this bill specialized
health insurance policies, except for behavioral
health-only policies, Medicare supplement, short-term
limited duration health insurance, vision-only,
CHAMPUS-supplement insurance, TRI-CARE supplement, or
hospital indemnity, accident-only, and specified disease
insurance.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 8/27/09)
California Psychiatric Association (co-source)
California Society for Clinical Social Work (co-source)
Board of Behavioral Sciences
California Association of Marriage and Family Therapists
California Psychological Association
NAMI California
National Association of Social Workers, California Chapter
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
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.
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ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,
DeVore, Duvall, Emmerson, Eng, Feuer, Fletcher, Fong,
Fuller, Furutani, Gaines, Galgiani, Garrick, Gilmore,
Hagman, Harkey, Hayashi, Hernandez, Hill, Huber, Huffman,
Jeffries, Jones, Knight, Krekorian, Lieu, Logue, Bonnie
Lowenthal, Ma, Mendoza, Miller, Monning, Nava, Nestande,
Niello, Nielsen, John A. Perez, V. Manuel Perez,
Portantino, Ruskin, Salas, Silva, Skinner, Smyth,
Solorio, Audra Strickland, Swanson, Torlakson, Torres,
Torrico, Tran, Villines, Yamada
NO VOTE RECORDED: Evans, Fuentes, Hall, Saldana, Bass,
Vacancy
JJA:cm 8/28/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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