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

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Date Published: 09/07/2017 09:00 PM
SB636:v97#DOCUMENT

Amended  IN  Senate  September 07, 2017
Amended  IN  Senate  March 29, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 636


Introduced by Senator Bradford

February 17, 2017


An act to add Sections 1371.33, 11833.1, and 11833.2 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. An act to add Section 650.5 to the Business and Professions Code, to add Title 23 (commencing with Section 110000) to the Government Code, and to add Sections 11833.1 and 11833.2 to the Health and Safety Code, relating to public health.


LEGISLATIVE COUNSEL'S DIGEST


SB 636, as amended, Bradford. Addiction treatment: advertising: payment.
Existing law makes it a crime to operate a group advertising and referral service for specified licensed professionals, except as provided.
This bill would prohibit a person, firm, partnership, association, or corporation, or an agent or employee thereof, from making payments for services that recommend any form of medical care or treatment that is provided by an alcohol-related or narcotic-related program, or an alcoholism or drug abuse recovery or treatment program, facility, or dispensary. The bill would also prohibit a person, firm, partnership, association, or corporation, or an agent or employee thereof, from using runners, cappers, steerers, or other persons to procure clients, patients, or customers for any form of medical care or treatment provided by an alcohol-related or narcotic-related program, facility, or dispensary.
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 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.

This bill would also prohibit certain persons, programs, or entities, including an alcoholism or drug abuse recovery and a substance use disorder treatment program and persons employed by that program, from giving or receiving remuneration or anything of value for the referral of a person who is seeking alcoholism or drug abuse recovery and substance use disorder treatment services and would authorize the department to investigate and take specified disciplinary action against those persons or programs for violating those prohibitions.

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, only with respect to services provided by an out-of-network provider, that assignment requirement on a group or individual health care service plan or health insurer and would also require those plans to authorize and permit, upon request of the enrollee or subscriber, the assignment of an enrollee’s or subscriber’s right to reimbursement, or, upon request of the insured, the payment of insurance benefits, as specified, 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, if 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.

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.

The bill would make a person who violates these provisions subject to a civil penalty not to exceed $10,000 for the first violation, and not more than $100,000 for each subsequent violation, as specified. The bill would also make a person who commits a knowing and willful violation of these provisions subject to a civil penalty in an amount not to exceed $50,000 for the first violation, and not more than $250,000 for each subsequent knowing and willful violation, as specified.
The bill would also include a statement of legislative intent.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YESNO  

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, upon request of the enrollee or subscriber, 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.

(c)This section only applies to services provided by an out-of-network provider.

SECTION 1.

 Section 650.5 is added to the Business and Professions Code, to read:

650.5.
 (a) A person, firm, partnership, association, or corporation, or an agent or employee thereof, shall not make payments for services that recommend any form of medical care or treatment that is provided by an alcohol-related or narcotic-related program, or an alcoholism or drug abuse recovery or treatment program, facility, or dispensary.
(b) A person, firm, partnership, association, or corporation, or agent or employee thereof, shall not use runners, cappers, steerers, or other persons to procure clients, patients, or customers for any form of medical care or treatment provided by an alcohol-related or narcotic-related program, facility, or dispensary.
(c) A referral service for any form of medical care or treatment that is provided by an alcohol-related or narcotic-related program, or an alcoholism or drug abuse recovery or treatment program, facility, or dispensary shall have a written contract.
(d) Subdivision (a) does not apply to any payments made pursuant to a written contract for a referral service if that contract specifies a fixed amount to be paid by a treatment provider, regardless of the number of patients referred.
(e) A person who violates this section is subject to a civil penalty as described in Title 23 (commencing with Section 110000) of the Government Code.

SEC. 2.

 Title 23 (commencing with Section 110000) is added to the Government Code, to read:

TITLE 23. California Alcohol and Narcotic Treatment Referral Protection Enforcement

110000.
 (a) A person who violates Section 650.5 of the Business and Professions Code or Section 11833.1 of the Health and Safety Code is subject to a civil penalty in an amount not to exceed ten thousand dollars ($10,000) for the first violation, and not more than one hundred thousand dollars ($100,000) for each subsequent violation. A subsequent violation is any violation after the first violation.
(b) In addition to all other penalties, a person, firm, partnership, association, or corporation, or an agent or employee thereof, that knowingly and willfully violates a requirement of this title is subject to a civil penalty in an amount not to exceed fifty thousand dollars ($50,000) for the first violation, and not more than two hundred fifty thousand dollars ($250,000) for each subsequent knowing and willful violation. A subsequent knowing and willful violation is any knowing and willful violation after the first knowing and willful violation.
(c) Each violation of a requirement of this title is a separate violation and each day of the violation is a separate violation that is subject to a civil penalty pursuant to this section.
(d) In determining the amount of a civil penalty for multiple separate violations against a person, firm, partnership, association, or corporation, or agent or employee thereof, which has not previously been subject to a civil penalty pursuant to this section, the court shall consider whether the conduct was done in good faith or in an attempt to substantially comply with the law.

110001.
 (a) Except as otherwise provided in this title, this title does not affect any civil remedies otherwise provided by law, nor does this title create any new civil remedies for injuries or damages.
(b) This title does not limit a grant of governmental immunity to a state or local agency and does not impose any liability or duty of care not otherwise imposed by law upon a state or local agency.
(c) In addition to any other penalty under this section, a court may issue a prohibitory injunction against the person, firm, partnership, association, or corporation, or agent or employee thereof, to prevent the continued occurrence of the prohibited conduct.
(d) An action may be brought by the Attorney General or the district attorney in the name of the people of the State of California for the enforcement of the civil penalty pursuant to this section. The Department of Health Care Services may refer complaints or evidence of a violation of this section to the Attorney General or the district attorney of the county in which the alleged offense occurred to take action to assess a civil penalty pursuant to this section. If penalties are collected as a result of a civil suit brought by the Attorney General or a district attorney for the collection of those civil penalties, the penalties imposed shall be paid to the prosecuting agency. If more than one agency is involved in enforcement, the penalties imposed shall be apportioned among them in a manner that will fairly offset the relative costs incurred by the agencies in collecting these fees.

SEC. 2.SEC. 3.

 Section 11833.1 is added to the Health and Safety Code, to read:

11833.1.
 The following persons, programs, or entities shall not give or receive remuneration or anything of value for the referral of a person who is seeking alcoholism or drug abuse recovery and substance use disorder treatment services:
(a) An alcoholism or drug abuse recovery and A substance use disorder treatment program licensed under this part.
(b) An owner, partner, officer, or director, or a shareholder who holds an interest of at least 10 percent in an alcoholism or drug abuse recovery and a substance use disorder treatment program licensed under this part.
(c) A person employed by, or working for, an alcoholism or drug abuse recovery and a substance use disorder treatment program licensed or certified under this part, including registered and certified counselors and licensed professionals providing counseling services.
(d) A person who violates this section is subject to a civil penalty as described in Title 23 (commencing with Section 110000) of the Government Code.

SEC. 3.SEC. 4.

 Section 11833.2 is added to the Health and Safety Code, to read:

11833.2.
 (a) The department may investigate allegations and assess a penalty upon an alcoholism or drug abuse recovery and a substance use disorder treatment program licensed or certified under this part, suspend or revoke the license or certification of the program, and suspend or revoke the registration or certification of a counselor for, a violation of Section 11833.1.
(b) The department may investigate allegations against a licensed professional providing counseling services at an alcoholism or drug abuse recovery and a substance use disorder treatment program licensed, certified, or funded under this part, and recommend disciplinary actions, including, but not limited to, termination of employment at a program and suspension and revocation of licensure by the respective licensing board.

SEC. 4.Chapter 15 (commencing with Section 11859) is added to Part 2 of Division 10.5 of the Health and Safety Code, to read:
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.

11859.3.

(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, or accepting 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. 5.Section 10133.75 is added to the Insurance Code, to read:
10133.75.

(a)On and after January 1, 2018, a health insurer shall, upon request of the insured, 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 if 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.

(c)This section only applies to services provided by an out-of-network provider.

SEC. 6.

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.

SEC. 5.

 (a) It is the intent of the Legislature that nonmedical, subacute treatment programs that provide alcohol addiction or narcotic addiction treatment receive information from health insurance providers regarding coverage of treatment services for patients, clients, or customers, including all of the following:
(1) That verification that services are covered, orally or in writing, or both, constitutes an intent to cover the costs of those services, subject to the limitations expressed in the enrollee’s or subscriber’s policy.
(2) That an authorization of services constitutes an affirmative representation that the services are covered and treatment providers are entitled to rely on that authorization.
(3) That after the service has been initiated, any verification, orally or in writing, or both, that the cost of extending the duration of the services will be covered, constitutes an intent to cover the cost of those services, subject to the limitations expressed in the enrollee’s or subscriber’s policy.
(4) That the health insurance provider will rely on the definition of medical necessity as defined in the American Society of Addiction Medicine or the most current Diagnostic and Statistical Manual of Mental Disorders.
(b) This section does not expand or alter the benefits available to the enrollee or subscriber under a plan.