Primary Focus: Mandated Benefit-Telehealth
Title/Description: MediCal: Telehealth: Substance Use Disorders
Citation: WIC § 14132.731
Summary: Amends the California Welfare and Institutions Code by adding s a new section to require, upon federal approval, licensed practitioners of the healing arts and certified substance use disorder counselors to be eligible for MediCal reimbursement for covered outpatient counseling services provided through Telehealth for substance use disorder patients.
Notes: Enacted through A.B. 2861
Primary Focus: Mandated Benefit: Visit Limit
Title/Description: Federally Qualified Health Centers and Rural Health Clinic Services
Citation: WIC §14132.100
Summary: This law amends the California Welfare and Institutions Code to authorize reimbursement through Medi-Cal for a maximum of two visits to health care providers taking place on the same day at a single location if after the first visit, the patient needs additional care or has a mental health or dental care visit.
Effective Date: January 1, 2019
Notes: Enacted through S.B. 1125
Primary Focus: General Parity
Title/Description: Medi-cal; Medi-Cal Managed Care Plans
Citation: Cal Health & Saf Code § 128555 and Cal Wel & Inst Code §§ 14197.1, 14197.2, 14197.4
Summary: Section 128555 of the Health and Safety Code and Sections 14197.1, 14197.2 and 14197.4 to the Welfare and Institutions Code are amended and added, respectively, to require that State Department of Health Care Services to ensure that all covered health benefits and substance use disorder benefits are provided in compliance with those revised federal regulations.
Effective Date: October 6, 2017
Notes: The above referenced code provisions was amended by CA S. 171.
Primary Focus: Access
Title/Description: Drug Medi-Cal and Specialty Mental Health Services
Citation: Cal Wel & Inst Code § 14132.100
Summary: Section 14132.100 of the Welfare and Institutions Code is amended to authorize federal qualified health center services (FQHC) and rural health clinics (RHC) to provide Drug Medi-Cal services pursuant to the terms of a mutually agreed upon contract for reimbursement requirements for services. To the extent that federal financial participation is available, such services include specialty mental health services to Medi-Cal beneficiaries as part of a mental health plan’s provider network. The costs associated with providing Drug Medi-Cal services or specialty mental health services are prohibited from being included in the FQHC’s or RHC’s per-visit prospective payment service (PPS) rate, and requires the costs associated with providing Drug Medi-Cal services or specialty mental health services to be adjusted out of the FQHC’s or RHC’s clinic base PPS rate as a scope-of-service change if the costs associated with providing Drug Medi-Cal services or specialty mental health services are within the FQHC’s or RHC’s clinic base PPS rate.
Effective Date: October 6, 2017
Notes: The above referenced code provisions was amended by CA S. 323.
Primary Focus: Medication-Assisted Treatment (MAT)
Title/Description: Substance Use Treatment Providers
Citation: Cal Health & Saf Code §§ 11220, 11839.1, 11839.3, 11839.5, 11839.6 and Cal Wel & Inst Code § 14021.6
Summary: Sections 11220, 11839.1, 11839.3, 11839.5 and 11839.6 of the Health and Safety Code and Section 14021.6 of the Welfare and Institutions Code are amended add the use of medication-assisted treatment as an authorized service by narcotic treatment programs licensed by the department, and would, in that regard, make legislative findings and declarations that it is in the best interest of the health and welfare of the people to also coordinate medication-assisted treatments for substance use disorders. The specific controlled substances authorized for use by licensed narcotic treatment programs for narcotic replacement therapy and medication-assisted treatment are modified to instead allow medication approved by the federal Food and Drug Administration for the purpose of narcotic replacement treatment or medication-assisted treatment for substance use disorders, and refer to medications, rather than controlled substances. Bills for services under Drug Medi-Cal must be submitted no later than 6 months from the date of service.
Effective Date: September 11, 2017
Notes: The above referenced code provisions was amended by CA A. 395.
Primary Focus: General Parity
Title/Description: Health Insurance: Discriminatory Practices
Citation: Cal Ins Code § 10144.4
Summary: Section 10144.4 of the Insurance Code was amended to require large group, individual, and small group health insurance policies to provide all covered mental health and substance use disorder benefits in compliance with those provisions of federal law governing mental health parity.
Effective Date: July 31, 2017
Notes: The above referenced code provision was amended by CA S. 374.
Primary Focus: Health Care Coverage
Title/Description: Health Care Coverage: Autism and Pervasive Disorders
Citation: Cal Health & Saf Code § 1374.73 and Cal Ins Code § 10144.51
Summary: Section 1374.73 of the Health and Safety Code and Section 10144.51 of the Insurance Code were amended to delete the sunset date, January 1, 2017, for the requirement that every health care service plan contract and health insurance policy provide coverage for behavioral health treatment for pervasive development disorder or autism. The deletion of the sunset date extends the operation of this provision indefinitely. Additionally, by extending the operation, violation by a health care service plan would be a crime.
Effective Date: September 23, 2016
Notes: The above referenced code provisions were amended by CA A. 796.
Primary Focus: Health Care Coverage
Title/Description: Health Care Coverage: Essential Health Benefits
Citation: Cal Health & Saf Code § 1367.005 and Cal Ins Code § 10112.27
Summary: Section 1367.005 of the Health and Safety Code and Section 10112.27 of the Insurance Code were amended to prohibit individual or small group health care service plan contracts or individual or small group health insurance policies issued, amended, or renewed on or after January 1, 2017, from combining habilitative and rehabilitative services for essential health benefits. Essential health benefits include mental health and substance use disorder services, including behavioral health treatment. Coverage of mental health and substance use disorder services, along with any scope and duration limits imposed on the benefits, must be in compliance with MHPAEA.
Effective Date: October 8, 2015
Notes: The above referenced code provisions were amended by CA S. 43.
Sponsor: Sen. Torres
Status: Signed into Law 9/2014
Summary: This bill requires providers of insurance plans to maintain a website that details their prescription medication formularies. While this bill is not explicitly about parity, this level of transparency makes it more difficult for insurance plans to have more restrictive medication formularies for behavioral health medications. It also requires insurers to provide a telephone number that patients and providers can call (during normal business hours) to obtain mental health benefits information.
Sponsor: Committee on Budget and Fiscal Review
Status: Signed into Law 6/2014
Summary: This bill added a new section to the Health and Safety Code that requires large group plans, small group plans, and plans offered on the individual market to offer behavioral health benefits that comply with the Federal Parity Law. This bill also authorizes the Department of Managed Health Care (DMHC) to issue guidance to plans about compliance with the Federal Parity Law.
Sponsor: Sen. Leno
Status: Signed into Law 6/2014*
Summary: This bill indicated all funding for parity implementation within the California Department of Insurance (CDI) will be paid for by imposing fees on insurers. *Line item veto placed on this specific provision. Veto reduces state funding by $374,000.
SB AB 1372/SB 126
Sponsor: Asmb. Bonilla and Sen. Steinberg
Status: Signed into Law 10/2013
Summary:This bill extends until January 2017 a requirement in the state parity law that insurance plans cover pervasive development disorders or Autism. This provision of the state law had been set to expire in July 2014.
Sponsor: Sen. Hernandez
Status: Signed into Law 9/2013
Summary:This bill prohibits insurance companies from creating a separate out-of-pocket maximum for behavioral health coverage. It also prohibits insurance companies from denying coverage due to prior existing behavioral health conditions.
AB 1453/SB 951
Sponsor: Asmb. Monning and Sen. Hernandez
Status: Signed into Law 9/2012
Summary:This bill mandates that individual and small group plans comply with the Federal Parity Law and defines the essential benefits that these plans must offer, which includes coverage for behavioral health services. AB 1453 amended the Health and Safety Code while SB 951 amended the Insurance Code.
Sponsor: Sen. Steinberg
Status: Signed into Law 10/2011
Summary: This bill amended state parity law to require plans to cover services for pervasive development disorder and autism spectrum disorder to the Mental Health Parity Laws. This also created the Autism Advisory Task Force to develop recommendations regarding behavioral health treatment that is medically necessary for individuals with autism or pervasive developmental disorder. This law was originally set to expire in July 2014.
There are several sections within California law relevant to parity. There is a section found in the state’s Health and Safety Law and another in the State Insurance Law. These sections require individual plans, small and large employer fully-insured plans to offer coverage for the following behavioral health conditions:
These sections require that coverage for these conditions must be “terms and conditions applied to other medical conditions.” It also specifies several classifications of benefits to which the law applies:
For children, the law goes beyond the nine conditions listed above and applies to any child that “has one or more mental disorders as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) , other than a primary substance use disorder or developmental disorder, that result in behavior inappropriate to the child’s age according to expected developmental norms.”
The law does contain specific language stating insurance plans can require insureds to receive all or part of their mental health services within the geographic region in which they live or work.
There is a section of the Health and Safety Law and a section of the Insurance Law that require plans to comply with the Federal Parity Law and “all rules, regulations, and guidance” issued related to the Federal Parity Law.
There is also a section of the state insurance law mandating that all policies of “disability income insurance, that is of a short-term limited duration of two years or less, that is issued, amended, or renewed on or after July 1, 2014, and that provides disability income benefits shall provide coverage for disability caused by severe mental illnesses.”
There are also additional provisions within the Health and Safety Code and the Insurance Code pertaining to pervasive developmental disorder and autism. These provisions mainly provide definitions for the criteria of a provider being considered “qualified autism service professional” and provide some definitions for treatment. However, these sections also require plans to provide “behavioral health treatment” for autism and reiterates that this treatment must meet the conditions of the parity sections summarized above. For further detail, read this provision in the Health and Safety Code, or read the provision in the Insurance Code.
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