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AB-1859 Mental health and substance use disorder treatment.(2021-2022)

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Date Published: 08/29/2022 09:00 PM
AB1859:v96#DOCUMENT

Enrolled  August 29, 2022
Passed  IN  Senate  August 24, 2022
Passed  IN  Assembly  August 25, 2022
Amended  IN  Senate  August 18, 2022
Amended  IN  Senate  June 27, 2022

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 1859

Introduced by Assembly Member Levine

February 08, 2022

An act to add Section 1367.014 to the Health and Safety Code, and to add Section 10112.34 to the Insurance Code, relating to mental health.


LEGISLATIVE COUNSEL'S DIGEST


AB 1859, Levine. Mental health and substance use disorder treatment.
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 also provides for the regulation of health insurers by the Department of Insurance. Existing law requires an individual or small group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2017, to include coverage for essential health benefits, which include mental health services.
Existing law, the Lanterman-Petris-Short Act, sets forth procedures for the involuntary detention, for up to 72 hours for evaluation and treatment, of a person who, as a result of a mental health disorder, is a danger to others or to themselves or is gravely disabled.
This bill would require a health care service plan or a health insurer, for a health care service plan contract or a health insurance policy issued, amended, or renewed on or after July 1, 2023, that includes coverage for mental health services to, among other things, approve the provision of medically necessary treatment of a mental health or substance use disorder for persons who are screened, evaluated, and detained for treatment and evaluation under the Lanterman-Petris-Short Act. The bill would prohibit a noncontracting provider of covered mental health or substance use disorder treatment from billing the previously described enrollee or insured more than the cost-sharing amount the enrollee or insured would pay to a contracting provider for that treatment. Under the bill, if an enrolled or insured is referred for a followup appointment for mental health services on a voluntary basis pursuant to the Lanterman-Petris-Short Act, the bill would require the health care service plan or health insurer to process the referral as a request for an appointment and offer appointments within specified timeframes, and if an appointment is not available in network that meets the geographic and timely access standards set by law, arrange coverage to ensure the delivery of medically necessary out-of-network services, to the extent possible, to meet those geographic and timely access standards. Because a willful violation of the bill’s requirement 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 1367.014 is added to the Health and Safety Code, to read:

1367.014.
 (a) For a health care service plan contract issued, amended, or renewed on or after July 1, 2023, that includes coverage for mental health services, the health care service plan shall do all of the following:
(1) Approve the provision of medically necessary treatment of a mental health or substance use disorder for an enrollee under the plan who is screened, evaluated, and detained for treatment and evaluation pursuant to Article 1 (commencing with Section 5150) of Chapter 2 of Part 1 of Division 5 of the Welfare and Institutions Code.
(2) If the enrollee described in paragraph (1) is referred for a followup appointment for mental health services on a voluntary basis pursuant to the requirements described in subdivision (b) of Section 5152 of the Welfare and Institutions Code, process the referral as a request for an appointment, consistent with paragraph (5) of subdivision (a) of Section 1367.03. For purposes of this section, referral includes an appointment with a licensed mental health professional or substance use treatment professional as part of a discharge plan, unless the enrollee provides a signed waiver that is witnessed by a peer or guardian. The referring facility shall provide notification of the referral to the health care service plan within 48 hours of referral.
(3) If the followup appointment requested in accordance with paragraph (2) is not available in network within the geographic and timely access standards set by law or regulation, arrange coverage to ensure the delivery of medically necessary out-of-network services and any medically necessary followup services that, to the maximum extent possible, meet those geographic and timely access standards. As used in this paragraph, “arrange coverage to ensure the delivery of medically necessary out-of-network services” includes, but is not limited to, providing services to secure medically necessary out-of-network options that are available to the enrollee within geographic and timely access standards.
(4) (A) Ensure that the health care service plan contract provides that if the enrollee described in paragraph (1) receives covered mental health or substance use disorder treatment from a noncontracting provider, the enrollee shall pay no more than the same cost-sharing amount that the enrollee would pay for the same covered treatment received from a contracting provider. This amount shall be referred to as the “in-network cost-sharing amount.”
(B) An enrollee shall not owe the noncontracting provider more than the in-network cost-sharing amount for covered mental health or substance use disorder treatment. At the time of payment by the plan to the noncontracting provider, the plan shall inform the enrollee and the noncontracting provider of the in-network cost-sharing amount owed by the enrollee.
(C) A noncontracting provider shall not bill or collect any amount from the enrollee for covered mental health or substance use disorder treatment, except for the in-network cost-sharing amount.
(b) For purposes of this section, “medically necessary treatment of a mental health or substance use disorder” has the same meaning as defined in paragraph (3) of subdivision (a) of Section 1374.72.
(c) This section does not apply to a health care service plan contract or a Medi-Cal managed care plan contract with the State Department of Health Care Services 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.

SEC. 2.

 Section 10112.34 is added to the Insurance Code, to read:

10112.34.
 (a) For a health insurance policy issued, amended, or renewed on or after July 1, 2023, that includes coverage for mental health services, the health insurer shall do all of the following:
(1) Approve the provision of medically necessary treatment of a mental health or substance use disorder for an insured under the policy who is screened, evaluated, and detained for treatment and evaluation pursuant to Article 1 (commencing with Section 5150) of Chapter 2 of Part 1 of Division 5 of the Welfare and Institutions Code.
(2) If the insured described in paragraph (1) is referred for a followup appointment for mental health services on a voluntary basis pursuant to the requirements described in subdivision (b) of Section 5152 of the Welfare and Institutions Code, process the referral as a request for an appointment, consistent with paragraph (5) of subdivision (a) of Section 10133.54. For purposes of this section, referral includes an appointment with a licensed mental health professional or substance use treatment professional as part of a discharge plan, unless the insured provides a signed waiver and is witnessed by a peer or guardian. The referring facility shall provide notification of the referral to the insurer within 48 hours of referral.
(3) If the followup appointment requested in accordance with paragraph (2) is not available in network within the geographic and timely access standards set by law or regulation, arrange coverage to ensure the delivery of medically necessary out-of-network services and any medically necessary followup services that, to the maximum extent possible, meet those geographic and timely access standards. As used in this subdivision, to “arrange coverage to ensure the delivery of medically necessary out-of-network services” includes, but is not limited to, providing services to secure medically necessary out-of-network options that are available to the insured within geographic and timely access standards.
(4) (A) Ensure that the health insurance policy provides that if the insured described in paragraph (1) receives covered mental health or substance use disorder treatment from a noncontracting provider, the insured shall pay no more than the same cost-sharing amount that the insured would pay for the same covered treatment received from a contracting provider. This amount shall be referred to as the “in-network cost-sharing amount.”
(B) An insured shall not owe the noncontracting provider more than the in-network cost-sharing amount for covered mental health or substance use disorder treatment. At the time of payment by the insurer to the noncontracting provider, the insurer shall inform the insured and the noncontracting provider of the in-network cost-sharing amount owed by the insured.
(C) A noncontracting provider shall not bill or collect any amount from the insured for covered mental health or substance use disorder treatment, except for the in-network cost-sharing amount.
(b) For purposes of this section, “medically necessary treatment of a mental health or substance use disorder” has the same meaning as defined in paragraph (3) of subdivision (a) of Section 10144.5.
(c) This section does not apply to an insurance policy issued, sold, renewed, or offered for health care services or coverage provided in the Medi-Cal program (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).

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.