Today's Law As Amended

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SB-11 Health care coverage: mental health parity.(2019-2020)



SECTION 1.

 Section 1374.77 is added to the Health and Safety Code, to read:

1374.77.
 (a) The department shall annually report to the Legislature information obtained through all activities taken to enforce Sections 1374.72, 1374.76, and 1374.78 and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343), its implementing regulations, and all related federal guidance.
(b) A report to be submitted pursuant to subdivision (a) shall be submitted in compliance with Section 9795 of the Government Code.

SEC. 2.

 Section 1374.78 is added to the Health and Safety Code, to read:

1374.78.
 Notwithstanding any other law, a health care service plan that provides prescription drug benefits for the treatment of substance use disorders shall place all prescription medications approved by the federal Food and Drug Administration (FDA) for the treatment of substance use disorders on the lowest tier of the drug formulary developed and maintained by the health care service plan, and shall not do any of the following:
(a) Impose any prior authorization requirements on any prescription medication approved by FDA for the treatment of substance use disorders.
(b) Impose any step therapy requirements before authorizing coverage for a prescription medication approved by the FDA for the treatment of substance use disorders.
(c) Exclude coverage for any prescription medication approved by the FDA for the treatment of substance use disorders and any associated counseling or wraparound services on the grounds that those medications and services were court ordered.

SEC. 3.

 Section 10144.41 is added to the Insurance Code, to read:

10144.41.
 (a) The department shall annually report to the Legislature information obtained through all activities taken to enforce Sections 10144.4, 10144.42, and 10144.5 and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343), its implementing regulations, and all related federal guidance.
(b) A report to be submitted pursuant to subdivision (a) shall be submitted in compliance with Section 9795 of the Government Code.

SEC. 4.

 Section 10144.42 is added to the Insurance Code, to read:

10144.42.
 Notwithstanding any other law, a health insurer that provides prescription drug benefits for the treatment of substance use disorders shall place all prescription medications approved by the federal Food and Drug Administration (FDA) for the treatment of substance use disorders on the lowest tier of the drug formulary developed and maintained by the health insurer, and shall not do any of the following:
(a) Impose any prior authorization requirements on any prescription medication approved by FDA for the treatment of substance use disorders.
(b) Impose any step therapy requirements before authorizing coverage for a prescription medication approved by the FDA for the treatment of substance use disorders.
(c) Exclude coverage for any prescription medication approved by the FDA for the treatment of substance use disorders and any associated counseling or wraparound services on the grounds that those medications and services were court ordered.
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.