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SB-22 Health care coverage: mental health parity.(2013-2014)

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SB22:v94#DOCUMENT

Amended  IN  Assembly  July 02, 2013
Amended  IN  Assembly  June 14, 2013
Amended  IN  Senate  May 28, 2013
Amended  IN  Senate  April 02, 2013
Amended  IN  Senate  February 26, 2013

CALIFORNIA LEGISLATURE— 2013–2014 REGULAR SESSION

Senate Bill No. 22


Introduced by Senator Beall
(Coauthors: Senators Correa, De León, DeSaulnier, and Yee)
(Coauthors: Assembly Members Ammiano and Chesbro)

December 03, 2012


An act to add Section 1374.18 to the Health and Safety Code, and to add Section 10144.53 to the Insurance Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


SB 22, as amended, Beall. Health care coverage: mental health parity.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts or health insurance policies issued, amended, or renewed on or after July 1, 2000, to provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses, as defined, and of serious emotional disturbances of a child, as specified, under the same terms and conditions applied to other medical conditions.
Existing federal law, the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements and treatment limitations applicable to mental health or substance use disorder benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical and surgical benefits. Existing state law requires individual and small group health care service plan contracts and health insurance policies issued, amended, or renewed on or after January 1, 2014, to comply with MHPAEA.
This bill would, on or after July October 1, 2014, require every health care service plan that provides hospital, medical, or surgical coverage, every specialized mental health care service plan that contracts with a health care service plan to provide mental health services, and every health insurer to submit an annual report to the Department of Managed Health Care or the Department of Insurance, as appropriate, certifying compliance with specified state laws and the MHPAEA, except as provided. The bill would require the departments to collaborate with each other and consult with experts and stakeholders to create the standards for the form and content of those reports on or before July 1, 2014. The bill would require those departments to report to the Legislature on or before January 1, 2020, on the information obtained through those annual reports. The bill would require the reports to be a public record made available upon request and to be published on the respective department’s departments Internet Web site sites. The bill would require those plans and insurers to provide an analysis of the entity’s compliance with the law using certain mental health parity standards and to conduct surveys of enrollees, insureds, and providers as part of the report, as specified. The bill would prohibit the inclusion of any information that may individually identify enrollees or insureds in the reports submitted to the respective departments pursuant to the provisions described above. Because a willful violation of the bill’s provisions by a health care service plan 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   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1374.18 is added to the Health and Safety Code, to read:

1374.18.
 (a) This section shall apply to every health care service plan that provides hospital, medical, or surgical coverage or any specialized mental health care service plan that contracts with a health care service plan to provide mental health services.
(b) On and after July October 1, 2014, every plan described in subdivision (a) shall submit an annual report to the department certifying compliance with Section 1374.72 and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343), hereafter referred to as the MHPAEA, its implementing regulations, and all related federal guidance. The annual report shall be a public record made available upon request and shall be published on the department’s Internet Web site. The department may hold public hearings on the reports at its discretion.

(c)The report shall provide an analysis of the compliance by the plan described in subdivision (a) with Section 1374.72 and the MHPAEA using all of the elements set forth in those provisions of law, as well as in standards P-MHP 1, P-MHP 2, and P-MHP 3 of the American Accreditation HealthCare Commission (URAC) Health Plan Accreditation Guide, Version 7, or any subsequent versions.

(d)(1)

(c) As part of the report, the plan described in subdivision (a) shall conduct both of the following:

(A)

(1) A survey of enrollees to collect responses pertaining to enrollee experiences with mental health and substance use care.

(B)

(2) A survey of providers to collect responses pertaining to provider experiences with providing mental health and substance use care.

(2)The plan described in subdivision (a) shall use the compliance criteria set forth in the URAC mental health parity standards described in subdivision (c) to structure the surveys.

(d) On or before July 1, 2014, the department shall collaborate with the Department of Insurance and consult with experts and stakeholders to create standards for the form and content of information to be reported pursuant to subdivision (b). These standards shall ensure that data reported, including the results of surveys conducted pursuant to subdivision (c), are standardized and intercomparable. For the creation of standards for certifying compliance with MHPAEA, the department shall consider national mental health parity compliance standards, including, but not limited to, the standards P-MHP-1, P-MHP-2, and P-MHP-3 of the American Accreditation HealthCare Commission (URAC) Health Plan Accreditation Guide, Version 7, or any subsequent versions.
(e) On or before January 1, 2020, the department shall report to the Legislature on the information obtained through the annual reports in subdivision (b). The report shall include a summary of any regulatory actions taken as a result of information gathered through the reports.

(e)

(f) A report submitted to the department pursuant to this section shall not include any information that may individually identify enrollees, including, but not limited to, medical record numbers, names, and addresses.

(f)

(g) This section shall not apply to contracts entered into pursuant to 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, between the State Department of Health Care Services and a health care service plan for enrolled Medi-Cal beneficiaries.

SEC. 2.

 Section 10144.53 is added to the Insurance Code, to read:

10144.53.
 (a) On and after July October 1, 2014, every health insurer shall submit a consolidated annual report to the Department of Insurance certifying that each of its health insurance policies comply with Section 10144.5 and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343), hereafter referred to as the MHPAEA, its implementing regulations, and all related federal guidance. The annual report shall be a public record made available upon request and shall be published on the department’s Internet Web site. The department may hold public hearings on the reports at its discretion.

(b)The report shall provide an analysis of the insurer’s compliance with Section 10144.5 and the MHPAEA using all of the elements set forth in those provisions of law, as well as in standards P-MHP 1, P-MHP 2, and P-MHP 3 of the American Accreditation HealthCare Commission (URAC) Health Plan Accreditation Guide, Version 7, or any subsequent versions.

(c)(1)

(b) As part of the report, an insurer shall conduct both of the following:

(A)

(1) A survey of insureds to collect responses pertaining to insured’s experiences with mental health and substance use care.

(B)

(2) A survey of providers to collect responses pertaining to provider experiences with providing mental health and substance use care.

(2)The insurer shall use the compliance criteria set forth in the URAC mental health parity standards described in subdivision (b) to structure the surveys.

(c) On or before July 1, 2014, the department shall collaborate with the Department of Managed Health Care and consult with experts and stakeholders to create standards for the form and content of information to be reported pursuant to subdivision (a). These standards shall ensure that data reported, including the results of surveys conducted pursuant to subdivision (b), are standardized and intercomparable. For the creation of standards for certifying compliance with MHPAEA, the department shall consider national mental health parity compliance standards, including, but not limited to, the standards P-MHP-1, P-MHP-2, and P-MHP-3 of the American Accreditation HealthCare Commission (URAC) Health Plan Accreditation Guide, Version 7, or any subsequent versions.
(d) On or before January 1, 2020, the department shall report to the Legislature on the information obtained through the annual reports in subdivision (a). The report shall include a summary of any regulatory actions taken as a result of information gathered through the reports.

(d)

(e) A report submitted to the department pursuant to this section shall not include any information that may individually identify insureds, including, but not limited to, medical record numbers, names, and addresses.

(e)

(f) This section shall not apply to policies or health benefit plans issued pursuant to 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, between the State Department of Health Care Services and an insurance policy or health benefit plan for enrolled Medi-Cal beneficiaries.

SEC. 3.

 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.