Bill Text

Bill Information

PDF |Add To My Favorites |Track Bill | print page

SB-636 Addiction treatment: advertising: payment.(2017-2018)

SHARE THIS:share this bill in Facebookshare this bill in Twitter
Date Published: 02/17/2017 09:00 PM
SB636:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 636


Introduced by Senator Bradford

February 17, 2017


An act to add Section 1371.33 to, and to add Chapter 15 (commencing with Section 11859) to Part 2 of Division 10.5 of, the Health and Safety Code, and to add Section 10133.75 to the Insurance Code, relating to public health.


LEGISLATIVE COUNSEL'S DIGEST


SB 636, as introduced, Bradford. Addiction treatment: advertising: payment.
Existing law provides for the licensure and regulation by the State Department of Health Care Services of adult alcoholism and drug abuse recovery and treatment facilities. The department also requires that an individual providing counseling services working within an alcohol and drug abuse recovery and treatment program be registered with or certified by a certifying organization approved by the department to register and certify counselors.
This bill, among other things, would prohibit any alcohol drug treatment program or any certified alcohol drug counselor from offering, delivering, receiving, or accepting any rebate, refund, commission, preference, patronage dividend, discount, or other consideration, whether in the form of money or otherwise, as compensation or inducement for referring patients, clients, or customers to any person or certified or licensed program. A violation of these provisions would be a misdemeanor and would also be punishable by a fine not exceeding $2,500 per violation. The bill would prohibit a licensed or certified alcohol and drug treatment program or any certified alcohol and drug counselor from participating in, or operating, a group advertising and referral service for addiction treatment services unless specified conditions are met, including, but not limited to, that the service register with the department, that the service not employ a solicitor to solicit prospective patients or clients, and that the service file a copy of its standard form contract with the department, which would be kept confidential. The bill would make it a misdemeanor for a person to operate a group advertising and referral service for alcohol and drug treatment programs or counselors without registering with the department. The bill would provide that a violation of the applicable provisions by a certified person or a licensee would be grounds for disciplinary action, as provided. Because a violation of the above-specified provisions would be a crime, the bill would impose a state-mandated local program.
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 group health care service plans to authorize and permit assignment of a Medi-Cal beneficiary’s right to reimbursement for covered services to the State Department of Health Care Services, except as specified. Existing law also provides for the direct payment of group insurance medical benefits by a health insurer to the person or persons furnishing or paying for hospitalization or medical or surgical aid or, in the case of a Medi-Cal beneficiary, to the State Department of Health Care Services, as specified.
This bill would impose that assignment requirement on a group or individual health care service plan or health insurer and would also require those plans and insurers to authorize and permit assignment of an enrollee’s, subscriber’s, or insured’s right to reimbursement for covered addiction treatment services to the provider furnishing those services. The bill would require the provider to provide the plan or insurer with certain information in order to receive reimbursement. The bill would also limit the amount of the reimbursement, where the health care coverage is a health insurance policy, to the amount of the benefit covered by the policy.
Because a willful violation of the bill’s provisions by a health care service plan would be a crime, this bill would impose a state-mandated local program.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
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 1371.33 is added to the Health and Safety Code, to read:

1371.33.
 (a) On and after January 1, 2018, a health care service plan that provides hospital, medical, or surgical expense benefits for plan members and their dependents shall authorize and permit assignment of the enrollee’s or subscriber’s right to any reimbursement for addiction treatment services covered under the plan contract to the provider who furnished the addiction treatment services.
(b) When seeking payment from a health care service plan pursuant to subdivision (a), a provider shall provide the plan with the provider’s itemized bill for service, the name and address of the person to be reimbursed, and the name and contract number of the enrollee.

SEC. 2.

 Chapter 15 (commencing with Section 11859) is added to Part 2 of Division 10.5 of the Health and Safety Code, to read:
CHAPTER  15. The California Comprehensive Addiction Recovery Act: Payment Reform

11859.
 This chapter shall be known, and may be cited, as the California Comprehensive Addiction Recovery Act: Payment Reform.

11859.1.
 The offer, delivery, receipt, or acceptance by any alcohol drug treatment program or any certified alcohol drug counselor of any rebate, refund, commission, preference, patronage dividend, discount, or other consideration, whether in the form of money or otherwise, as compensation or inducement for referring patients, clients, or customers to any person or certified or licensed program, irrespective of any membership, proprietary interest, or coownership in or with any person or program to whom these patients, clients, or customers are referred is unlawful.

11859.2.
 (a) A licensed or certified alcohol and drug treatment program or any certified alcohol and drug counselor shall not participate in, or operate, a group advertising and referral service for addiction treatment services unless all of the following conditions are met:
(1) The patient or client referrals by the service are the result of patient or client-initiated responses to service advertising.
(2) The service advertises, if at all, in conformity with Section 651 of, and subdivision (p) of Section 4982 of, the Business and Professions Code.
(3) The service does not employ a solicitor to solicit prospective patients or clients.
(4) The service does not impose a fee on the alcohol and drug treatment program or counselor that is dependent upon the number of referrals or amount of professional fees paid by the patient or client to the program or counselor.
(5) Participating alcohol and drug treatment programs or counselors charge no more than their usual and customary fees to any patient or client referred.
(6) The service registers with the State Department of Health Care Services, providing its name, street address, and telephone number.
(7) The service files with the department a copy of the standard form contract that regulates its relationship with alcohol and drug treatment programs or counselors, and that contract shall be confidential and not open to public inspection.
(8) If more than 50 percent of its referrals are made to one individual, association, partnership, corporation, or group of three or more alcohol and drug treatment programs or counselors, the service shall disclose that fact in all public communications, including, but not limited to, communications by means of television, radio, motion picture, newspaper, book, list, or directory of healing arts practitioners.
(9) (A) When member alcohol and drug treatment programs or counselors pay any fee to the service, any advertisement by the service shall clearly and conspicuously disclose that fact by including a statement as follows:
“Paid for by participating alcohol and drug treatment programs or counselors.”
(i) In print advertisements, the required statement shall be in at least 9-point type.
(ii) In radio advertisements, the required statement shall be articulated so as to be clearly audible and understandable by the radio audience.
(iii) In television advertisements, the required statement shall be either clearly audible and understandable to the television audience or displayed in a written form that remains clearly visible to the television audience for at least five seconds.
(B) The department may suspend or revoke the registration of any service that fails to comply with subparagraph (A). A service may not reregister with the department if its registration is currently under suspension for a violation of subparagraph (A), nor may a service reregister with the department for a period of one year after it has had a registration revoked by the department for a violation of subparagraph (A).
(b) The department may adopt regulations necessary to enforce and administer this section.
(c) The department may petition the superior court of any county for the issuance of an injunction restraining any conduct that constitutes a violation of this section.
(d) It is unlawful and shall constitute a misdemeanor for a person to operate a group advertising and referral service for alcohol and drug treatment programs or counselors without registering with, and providing his or her name, address, and telephone number to, the department.
(e) It is the intent of the Legislature in enacting this section not to otherwise affect the prohibitions of Section 11859.1. The Legislature intends to allow the pooling of resources by alcohol and drug treatment programs, or counselors, or both, for the purpose of advertising.
(f) This section shall not be construed in any manner that would authorize a group advertising and referral service to engage in the practice of addiction treatment.

11859.3.
 (a) A violation of this chapter, in the case of a certified person, constitutes unprofessional conduct and grounds for suspension or revocation of his or her certification by the certifying organization through whom he or she is certified, or if a license has been issued in connection with a place of business, then for the suspension or revocation of the license of the place of business in connection with which the violation occurs.
(b) The proceedings for suspension or revocation of a license shall be conducted in accordance with the provisions of Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code, and the department shall have all the powers granted by those provisions.
(c) A violation of this chapter constitutes a misdemeanor as to any and all persons offering, delivering, receiving, accepting, or participating in any rebate, refund, commission, preference, patronage dividend, unearned discount, or consideration, and is also punishable by a fine not exceeding two thousand five hundred dollars ($2,500) per violation.

SEC. 3.

 Section 10133.75 is added to the Insurance Code, to read:

10133.75.
 (a) On and after January 1, 2018, a health insurer shall pay insurance benefits contingent upon, or for expenses incurred on account of, addiction treatment services covered under the health insurance policy to the person or persons having provided the addiction treatment services where that person has qualified for reimbursement by submitting the items and information specified in subdivision (b). The amount of that payment shall not exceed the amount of the benefit covered by the policy. Payment so made shall discharge the insurer’s obligation with respect to the amount so paid.
(b) When seeking payment from a disability insurer pursuant to subdivision (a), a person shall provide the insurer with the provider’s itemized bill for service, the name and address of the person to be reimbursed, and the name and policy number of the insured.

SEC. 4.

 The Legislature finds and declares that Section 2 of this act, which adds Section 11859.2 to the Health and Safety Code, imposes a limitation on the public’s right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest:
In order to protect the proprietary, confidential information of a group advertising and referral service, it is necessary that this act limit the public’s right of access to that information.

SEC. 5.

 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.