Scott Wiener
- Democratic
- Senator
- District 11
Author
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 disability insurers by the Department of Insurance. Existing law, known as the California Mental Health Parity Act, requires every health care service plan contract or disability insurance policy issued, amended, or renewed on or after July 1, 2000, that provides hospital, medical, or surgical coverage to provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age, and of serious emotional disturbances of a child under the same terms and conditions applied to other medical conditions, as specified. Existing law requires those benefits to include, among other things, outpatient services, inpatient hospital services, partial hospital services, and prescription drugs, if the plan contract or policy includes coverage for prescription drugs. This bill would revise and recast those provisions, and would instead require a health care service plan contract or disability insurance policy issued, amended, or renewed on or after January 1, 2021, to provide coverage for medically necessary treatment of mental health and substance use disorders, as defined, under the same terms and conditions applied to other medical conditions. The bill would prohibit a health care service plan or disability insurer from limiting benefits or coverage for mental health and substance use disorders to short-term or acute treatment. The bill would revise the covered benefits to include basic health care services, as defined, intermediate services, and prescription drugs. This bill would require a health care service plan or disability insurer that provides hospital, medical, or surgical coverage to base medical necessity determinations and the utilization review criteria the plan or insurer, and any entity acting on the plan's or insurer's behalf, applies to determine the medical necessity of health care services and benefits for the diagnosis, prevention, and treatment of mental health and substance use disorders, on current generally accepted standards of mental health and substance use disorder care. The bill would require the health care service plan or insurer to apply specified clinical criteria and guidelines in conducting utilization review of the covered health care services and benefits and would prohibit the plan or insurer from applying different, additional, or conflicting criteria than the criteria and guidelines in the specified sources. The bill would authorize the Director of the Department of Managed Health Care or the Insurance Commissioner, as applicable, to assess administrative or civil penalties, as specified, for violation of the requirements relating to utilization review. The bill would make any provision in a health care service plan issued, delivered, amended, or renewed on or after January 1, 2021, that reserves discretionary authority to the plan, or an agent of the plan, to determine eligibility for benefits or coverage, interprets the terms of the contract, or provides standards of interpretation or review that are inconsistent with California law, void and unenforceable, as specified. The bill would declare that its provisions are severable. Because a willful violation of these requirements with respect to health care service plans 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.
Approved by the Governor.
Chaptered by Secretary of State. Chapter 151, Statutes of 2020.
Enrolled and presented to the Governor at 3 p.m.
Assembly amendments concurred in. (Ayes 30. Noes 8.) Ordered to engrossing and enrolling.
Assembly amendments concurred in. (Ayes 31. Noes 7.) Ordered to engrossing and enrolling.
Reconsideration granted. (Ayes 39. Noes 0.)
Motion to reconsider made by Senator Wiener.
In Senate. Concurrence in Assembly amendments pending.
Read third time. Passed. (Ayes 63. Noes 1. Page 5221.) Ordered to the Senate.
Read second time. Ordered to third reading.
Read second time and amended. Ordered to second reading.
From committee: Do pass as amended. (Ayes 14. Noes 1.) (August 20).
August 18 set for first hearing. Placed on suspense file.
Coauthors revised.
Read second time and amended. Re-referred to Com. on APPR.
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 13. Noes 0.) (August 4).
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
In Assembly. Read first time. Held at Desk.
Read third time. Passed. (Ayes 30. Noes 5. Page 3862.) Ordered to the Assembly.
Read second time. Ordered to third reading.
Read second time and amended. Ordered to second reading.
From committee: Do pass as amended. (Ayes 5. Noes 2. Page 3766.) (June 18).
Set for hearing June 18.
June 9 hearing: Placed on APPR. suspense file.
Set for hearing June 9.
Hearing rescheduled due to Capitol closure.
Set for hearing June 1.
Read second time and amended. Re-referred to Com. on APPR.
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 7. Noes 2. Page 3533.) (May 13).
Referral to Com. on JUD. rescinded due to the shortened 2020 Legislative Calendar.
Set for hearing May 13.
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
From printer. May be acted upon on or after February 14.
Introduced. Read first time. To Com. on RLS. for assignment. To print.
| Bill Text Versions | Format |
|---|---|
| SB855 | HTML |
| 01/14/20 - Introduced | |
| 05/05/20 - Amended Senate | |
| 05/19/20 - Amended Senate | |
| 06/18/20 - Amended Senate | |
| 07/27/20 - Amended Assembly | |
| 08/06/20 - Amended Assembly | |
| 08/24/20 - Amended Assembly | |
| 09/03/20 - Enrolled | |
| 09/25/20 - Chaptered |
| Document | Format |
|---|---|
| No related documents. |
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