BILL NUMBER: SB 296 CHAPTERED
BILL TEXT
CHAPTER 575
FILED WITH SECRETARY OF STATE OCTOBER 11, 2009
APPROVED BY GOVERNOR OCTOBER 11, 2009
PASSED THE SENATE SEPTEMBER 2, 2009
PASSED THE ASSEMBLY AUGUST 27, 2009
AMENDED IN ASSEMBLY AUGUST 17, 2009
AMENDED IN ASSEMBLY JULY 14, 2009
AMENDED IN ASSEMBLY JUNE 30, 2009
AMENDED IN SENATE APRIL 13, 2009
INTRODUCED BY Senator Lowenthal
FEBRUARY 25, 2009
An act to amend Section 1368.015 of, and to add Sections 1367.29
and 1368.016 to, the Health and Safety Code, and to add Sections
10123.198 and 10123.199 to the Insurance Code, relating to health
care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 296, Lowenthal. Mental health services.
Existing law provides for the licensing and regulation of health
care service plans by the Department of Managed Health Care. Existing
law provides for the regulation of health insurers by the Department
of Insurance. A willful violation of provisions governing health
care service plans is a crime. Existing law imposes certain
requirements on health care service plans, specialized health care
service plans, and health insurers that provide coverage for
professional mental health services. Existing law also requires every
health care service plan, other than a plan that primarily serves
Medi-Cal or Healthy Family Program enrollees, to maintain an Internet
Web site.
This bill would, on and after July 1, 2011, require every health
care service plan, including a specialized health care service plan,
and health insurer that provides professional mental health services
to issue an identification card, as specified, to each enrollee in
order to assist the enrollee with accessing health benefits coverage
information and other information, with specified exceptions. The
bill would require the identification card to be issued upon
enrollment or commencement of coverage or upon any change in the
enrollee's coverage that impacts the data content or format of the
card. The bill would also require those plans and insurers to
provide, on or before January 1, 2012, specified information on their
Internet Web sites, to be updated as specified and made available in
hard copy upon request, and would require those insurers to
establish Internet Web sites for that purpose. The bill would exempt
from those requirements specified plans or insurers that contract
with another entity to provide coverage for mental health services,
provided that the plan or insurer provides a link on its Internet Web
site to the entity's Internet Web site and that entity complies with
the above-described information requirements. The bill would also
require the departments to include on their Internet Web sites a link
to the Internet Web site of each of those plans or insurers. The
bill would also make changes to related provisions.
By imposing new requirements on certain health care service plans,
the willful violation of which 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.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1367.29 is added to the Health and Safety Code,
to read:
1367.29. (a) On and after July 1, 2011, in accordance with the
requirements of subdivision (b), every health care service plan that
provides coverage for professional mental health services, including
a specialized health care service plan that provides coverage for
professional mental health services, shall issue an identification
card to each enrollee in order to assist the enrollee with accessing
health benefits coverage information, including, but not limited to,
in-network provider access information, and claims processing
purposes. The identification card, at a minimum, shall include all of
the following information:
(1) The name of the health care service plan issuing the
identification card.
(2) The enrollee's identification number.
(3) A telephone number that enrollees or providers may call for
assistance with health benefits coverage information, in-network
provider access information, and claims processing information, and
when assessment services are provided by the health care service
plan, access to assessment services for the purpose of referral to an
appropriate level of care or an appropriate health care provider.
(4) The health care service plan's Internet Web site address.
(b) The identification card required by this section shall be
issued by a health care service plan or a specialized health care
service plan to an enrollee upon enrollment or upon any change in the
enrollee's coverage that impacts the data content or format of the
card.
(c) Nothing in this section requires a health care service plan to
issue a separate identification card for professional mental health
services coverage if the plan issues a card for health care coverage
in general and the card provides the information required by this
section.
(d) If a health care service plan or a specialized health care
service plan, as described in subdivision (a), delegates
responsibility for issuing the identification card to a contractor or
an agent, the contractor or agent shall be required to comply with
this section.
(e) Nothing in this section shall be construed to prohibit a
health care service plan or a specialized health care service plan
from meeting the standards of the Workgroup for Electronic Data
Interchange (WEDI) or other national uniform standards with respect
to identification cards, and a health care service plan shall be
deemed compliant with this section if the plan conforms with these
standards, as long as the minimum requirements described in
subdivision (a) have been met.
(f) For the purposes of this section, "identification card"
includes other technology that performs substantially the same
function as an identification card.
(g) (1) This section shall not apply to Medicare supplement
insurance, Employee Assistance Programs, short-term limited duration
health insurance, Champus-supplement insurance, or TRI-CARE
supplement insurance, or to hospital indemnity, accident-only, and
specified disease insurance. This section shall also not apply to
specialized health care service plans, except behavioral health-only
plans.
(2) Notwithstanding paragraph (1), this section shall not apply to
a behavioral health-only plan that provides coverage for
professional mental health services pursuant to a contract with a
health care service plan or insurer if that plan or insurer issues an
identification card to its subscribers or insureds pursuant to this
section or Section 10123.198 of the Insurance Code.
SEC. 2. Section 1368.015 of the Health and Safety Code is amended
to read:
1368.015. (a) Effective July 1, 2003, every plan with an Internet
Web site shall provide an online form through its Internet Web site
that subscribers or enrollees can use to file with the plan a
grievance, as described in Section 1368, online.
(b) The Internet Web site shall have an easily accessible online
grievance submission procedure that shall be accessible through a
hyperlink on the Internet Web site's home page or member services
portal clearly identified as "GRIEVANCE FORM." All information
submitted through this process shall be processed through a secure
server.
(c) The online grievance submission process shall be approved by
the Department of Managed Health Care and shall meet the following
requirements:
(1) It shall utilize an online grievance form in HTML format that
allows the user to enter required information directly into the form.
(2) It shall allow the subscriber or enrollee to preview the
grievance that will be submitted, including the opportunity to edit
the form prior to submittal.
(3) It shall include a current hyperlink to the California
Department of Managed Health Care Internet Web site, and shall
include a statement in a legible font that is clearly distinguishable
from other content on the page and is in a legible size and type,
containing the following language:
"The California Department of Managed Health Care is responsible
for regulating health care service plans. If you have a grievance
against your health plan, you should first telephone your health plan
at (insert health plan's telephone number) and use your health plan'
s grievance process before contacting the department. Utilizing this
grievance procedure does not prohibit any potential legal rights or
remedies that may be available to you. If you need help with a
grievance involving an emergency, a grievance that has not been
satisfactorily resolved by your health plan, or a grievance that has
remained unresolved for more than 30 days, you may call the
department for assistance. You may also be eligible for an
Independent Medical Review (IMR). If you are eligible for IMR, the
IMR process will provide an impartial review of medical decisions
made by a health plan related to the medical necessity of a proposed
service or treatment, coverage decisions for treatments that are
experimental or investigational in nature and payment disputes for
emergency or urgent medical services. The department also has a
toll-free telephone number (1-888-HMO-2219) and a TDD line
(1-877-688-9891) for the hearing and speech impaired. The department'
s Internet Web site http://www.hmohelp.ca.gov has complaint forms,
IMR application forms and instructions online."
The plan shall update the URL, hyperlink, and telephone numbers in
this statement as necessary.
(d) A plan that utilizes a hardware system that does not have the
minimum system requirements to support the software necessary to meet
the requirements of this section is exempt from these requirements
until January 1, 2006.
(e) For purposes of this section, the following terms shall have
the following meanings:
(1) "Homepage" means the first page or welcome page of an Internet
Web site that serves as a starting point for navigation of the
Internet Web site.
(2) "HTML" means Hypertext Markup Language, the authoring language
used to create documents on the World Wide Web, which defines the
structure and layout of a Web document.
(3) "Hyperlink" means a special HTML code that allows text or
graphics to serve as a link that, when clicked on, takes a user to
another place in the same document, to another document, or to
another Internet Web site or Web page.
(4) "Member services portal" means the first page or welcome page
of an Internet Web site that can be reached directly by the Internet
Web site's homepage and that serves as a starting point for a
navigation of member services available on the Internet Web site.
(5) "Secure server" means an Internet connection to an Internet
Web site that encrypts and decrypts transmissions, protecting them
against third-party tampering and allowing for the secure transfer of
data.
(6) "URL" or "Uniform Resource Locator" means the address of an
Internet Web site or the location of a resource on the World Wide Web
that allows a browser to locate and retrieve the Internet Web site
or the resource.
(7) "Internet Web site" means a site or location on the World Wide
Web.
(f) (1) Every health care service plan, except a plan that
primarily serves Medi-Cal or Healthy Families Program enrollees,
shall maintain an Internet Web site. For a health care service plan
that provides coverage for professional mental health services, the
Internet Web site shall include, but not be limited to, providing
information to subscribers, enrollees, and providers that will assist
subscribers and enrollees in accessing mental health services as
well as the information described in Section 1368.016.
(2) The provision in paragraph (1) that requires compliance with
Section 1368.016 shall not apply to a health care service plan that
contracts with a specialized health care service plan, insurer, or
other entity to cover professional mental health services for its
enrollees, provided that the health care service plan provides a link
on its Internet Web site to an Internet Web site operated by the
specialized health care service plan, insurer, or other entity with
which it contracts, and that plan, insurer, or other entity complies
with Section 1368.016.
SEC. 3. Section 1368.016 is added to the Health and Safety Code,
to read:
1368.016. (a) On or before January 1, 2012, every health care
service plan that provides coverage for professional mental health
services, including a specialized health care service plan that
provides coverage for professional mental health services, shall,
pursuant to subdivision (f) of Section 1368.015, include on its
Internet Web site, or provide a link to, the following information:
(1) A telephone number that the enrollee or provider can call,
during normal business hours, for assistance obtaining mental health
benefits coverage information, including the extent to which benefits
have been exhausted, in-network provider access information, and
claims processing information.
(2) A link to prescription drug formularies or instructions on how
to obtain the formulary, as described in Section 1367.20.
(3) A detailed summary that describes the process by which the
plan reviews and authorizes or approves, modifies, or denies requests
for health care services as described in Sections 1363.5 and
1367.01.
(4) Lists of providers or instructions on how to obtain the
provider list, as required by Section 1367.26.
(5) A detailed summary of the enrollee grievance process as
described in Sections 1368 and 1368.015.
(6) A detailed description of how an enrollee may request
continuity of care pursuant to subdivisions (a) and (b) of Section
1373.95.
(7) Information concerning the right, and applicable procedure, of
an enrollee to request an independent medical review pursuant to
Section 1374.30.
(b) Any modified material described in subdivision (a) shall be
updated at least quarterly.
(c) The information described in subdivision (a) may be made
available through a secured Internet Web site that is only accessible
to enrollees.
(d) The material described in subdivision (a) shall also be made
available to enrollees in hard copy upon request.
(e) Nothing in this article shall preclude a health care service
plan from including additional information on its Internet Web site
for applicants, enrollees or subscribers, or providers, including,
but not limited to, the cost of procedures or services by health care
providers in a plan's network.
(f) The department shall include on the department's Internet Web
site a link to the Internet Web site of each health care service plan
and specialized health care service plan described in subdivision
(a).
(g) This section shall not apply to Medicare supplement insurance,
Employee Assistance Programs, short-term limited duration health
insurance, Champus-supplement insurance, or TRI-CARE supplement
insurance, or to hospital indemnity, accident-only, and specified
disease insurance. This section shall also not apply to specialized
health care service plans, except behavioral health-only plans.
(h) This section shall not apply to a health care service plan
that contracts with a specialized health care service plan, insurer,
or other entity to cover professional mental health services for its
enrollees, provided that the health care service plan provides a link
on its Internet Web site to an Internet Web site operated by the
specialized health care service plan, insurer, or other entity with
which it contracts, and that plan, insurer, or other entity complies
with this section or Section 10123.199 of the Insurance Code.
SEC. 4. Section 10123.198 is added to the Insurance Code, to read:
10123.198. (a) On and after July 1, 2011, in accordance with the
requirements of subdivision (b), every health insurer that provides
coverage for professional mental health services shall issue an
identification card to each insured in order to assist the insured
with accessing health benefits coverage information, including, but
not limited to, in-network provider access information, and claims
processing purposes. The identification card, at a minimum, shall
include all of the following information:
(1) The name of the health insurer issuing the identification
card.
(2) The insured's identification number.
(3) A telephone number that insureds or providers may call for
assistance with health benefits coverage information, in-network
provider access information, and claims processing information, and
when assessment services are provided by the health insurer, access
to assessment services for the purpose of referral to an appropriate
level of care or an appropriate health care provider.
(4) The health insurer's Internet Web site address.
(b) The identification card required by this section shall be
issued by a health insurer to an insured upon commencement of
coverage or upon any change in the insured's coverage that impacts
the data content or format of the card.
(c) Nothing in this section requires a health insurer to issue a
separate identification card for professional mental health coverage
if the insurer issues a card for health care coverage in general and
the card provides the information required by this section.
(d) If a health insurer, as described in subdivision (a),
delegates responsibility for issuing the card to a contractor or
agent, the contractor or agent shall be required to comply with this
section.
(e) Nothing in this section shall be construed to prohibit a
health insurer from meeting the standards of the Workgroup for
Electronic Data Interchange (WEDI) or other national uniform
standards with respect to identification cards, and a health insurer
shall be deemed compliant with this section if the insurer conforms
with these standards, as long as the minimum requirements described
in subdivision (a) have been met.
(f) For the purposes of this section, "identification card"
includes other technology that performs substantially the same
function as an identification card.
(g) (1) This section shall not apply to Medicare supplement
insurance, Employee Assistance Programs, short-term limited duration
health insurance, Champus-supplement insurance, or TRI-CARE
supplement insurance, or to hospital indemnity, accident-only, and
specified disease insurance. This section shall also not apply to
specialized health insurance policies, except behavioral health-only
policies.
(2) Notwithstanding paragraph (1), this section shall not apply to
a behavioral health-only policy that provides coverage for
professional mental health services pursuant to a contract with a
health care service plan or insurer if that plan or insurer issues an
identification card to its subscribers or insureds pursuant to this
section or Section 1367.29 of the Health and Safety Code.
SEC. 5. Section 10123.199 is added to the Insurance Code, to read:
10123.199. (a) On or before January 1, 2012, every health insurer
that provides coverage for professional mental health services shall
establish an Internet Web site. Each Internet Web site shall
include, or provide a link to, the following information:
(1) A telephone number that the insured or provider can call,
during normal business hours, for assistance obtaining mental health
benefits coverage information, including the extent to which benefits
have been exhausted, in-network provider access information, and
claims processing information.
(2) A link to prescription drug formularies or instructions on how
to obtain formulary information.
(3) A detailed summary description of the process by which the
insurer reviews and approves, modifies, or denies requests for health
care services as described in Section 10123.135.
(4) Lists of providers or instructions on how to obtain a provider
list as required by Section 10133.1.
(5) A detailed summary of the health insurer's grievance process.
(6) A detailed description of how the insured may request
continuity of care as described in Section 10133.55.
(7) Information concerning the right, and applicable procedure, of
the insured to request an independent medical review pursuant to
subdivision (i) of Section 10169.
(b) Except as otherwise specified, the material described in
subdivision (a) shall be updated at least quarterly.
(c) The information described in subdivision (a) may be made
available through a secured Internet Web site that is only accessible
to the insured.
(d) The material described in subdivision (a) shall also be made
available to insureds in hard copy upon request.
(e) Nothing in this article shall preclude an insurer from
including additional information on its Internet Web site for
applicants or insureds, including, but not limited to, the cost of
procedures or services by health care providers in an insurer's
network.
(f) The department shall include on the department's Internet Web
site, a link to the Internet Web site of each health insurer
described in subdivision (a).
(g) This section shall not apply to Medicare supplement insurance,
Employee Assistance Programs, short-term limited duration health
insurance, Champus-supplement insurance, or TRI-CARE supplement
insurance, or to hospital indemnity, accident-only, and specified
disease insurance. This section shall also not apply to specialized
health insurance policies, except behavioral health-only policies.
(h) This section shall not apply to a health insurer that
contracts with a specialized health care service plan, insurer, or
other entity to cover professional mental health services for its
insureds, provided that the health insurer provides a link on its
Internet Web site to an Internet Web site operated by the specialized
health care service plan, insurer, or other entity with which it
contracts, and that plan, insurer, or other entity complies with this
section or Section 1368.016 of the Health and Safety Code.
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.