California Senate Bill SB296 Amended / Bill

 BILL NUMBER: SB 296AMENDED BILL TEXT AMENDED IN ASSEMBLY JUNE 30, 2009 AMENDED IN SENATE APRIL 13, 2009 INTRODUCED BY Senator Lowenthal FEBRUARY 25, 2009  An act to add Sections 1367.27, 1367.28, and 1367.29 to the Health and Safety Code, and to add Sections 10123.197, 10123.198, and   An act to amend Se   ction 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, as amended, Lowenthal. Mental health services. Existing law provides for licensing and regulation of health care service plans by the Department of Managed Health Care. Existing law provides for  licensing and  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 Med-Cal or Healthy Family Program enrollees, to maintain an Internet Web site.  This bill would  require every health care service plan, including a specialized health care service plan, and every health insurer that offers professional mental health services to direct those services to be provided in a manner that ensures coordination of benefits between all mental health care providers and general physical health care providers. The bill would require these plans and insurers to establish an Internet Web site and to issue a benefits card to enrollees or insureds with specified information.   ,   on and after July 1, 2011, require every health care service plan, including a specialized health care service plan, and health insurer th   at provides professional mental health services to issue an identification card to each enrollee in order to assist the enrollee with accessing health benefits coverage information. 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 would require those insurers to establish Internet Web sites for that purpose. 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. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes. 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 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. (4) A telephone number that enrollees may call to access assessment services for the purpose of referral to an appropriate level of care or an appropriate health care provider. (5) 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 or other national uniform standards with respect to identification cards, as long as the minimum requirements described in subdivision (a) have been met.   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  a   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  a   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  a   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  a   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  a   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)  "Web   "Internet Web  site" means a site or location on the World Wide Web. (f) Every health care service plan, except a plan that primarily serves Medi-Cal or Healthy Families Program enrollees, shall maintain a  Internet  Web site. For a health care service plan that provides coverage for professional mental health services, the  Inter   net  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  .  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 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 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. (8) A link to the department's final report of the plan's periodic review as described in subdivision (h) of Section 1380. (9) Provider manual templates containing nonproprietary information provided to individual, group, and institutional providers who contract with the plan. The material described in this paragraph shall be updated within 30 days of any material change. An electronic notification of material changes shall be communicated to applicable contract providers immediately. (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 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).   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 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. (4) A telephone number that insureds may call to access assessment services for the purpose of referral to an appropriate level of care or an appropriate health care provider. (5) 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 or other national uniform standards with respect to identification cards, as long as the minimum requirements described in subdivision (a) have been met. (f) This section shall not apply to Medicare supplement, short-term limited duration health insurance, Champus-supplement insurance, TRI-CARE supplement, 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.   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. (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 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. (8) A link to the results of any market conduct examinations of the insurer as required by Section 12938. (9) Provider manual templates containing nonproprietary information provided to individual, group, and institutional providers who contract with the insurer. The material described in this paragraph shall be updated within 30 days of any material change. An electronic notification of material changes shall be communicated to applicable contract providers immediately. (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, short-term limited duration health insurance, Champus-supplement insurance, TRI-CARE supplement, 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.   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.   SECTION 1.   Section 1367.27 is added to the Health and Safety Code, to read: 1367.27. (a) The Legislature finds and declares that coordination of care between mental health care providers and general physical health care providers is necessary to optimize the overall health of a patient. (b) Every health care service plan that offers professional mental health services, including a specialized health care service plan that offers those services, shall direct those services to be provided in a manner that ensures coordination of benefits between mental health care providers and general physical health care providers.   SEC. 2.   Section 1367.28 is added to the Health and Safety Code, to read: 1367.28. (a) The Legislature finds and declares that health care consumers should be provided important information regarding health care services in an easily accessible manner. While most health care service plans are required to maintain Internet Web sites pursuant to subdivision (f) of Section 1368.015, it is the intent of this section to improve online access to all policies, guidelines, disclosure forms, and other materials that health care service plans are required by law to provide to the department or consumers. (b) On or before January 1, 2012, every health care service plan that offers professional mental health services, including a specialized health care service plan that offers only those services, shall establish an Internet Web site. Each Web site shall include, or provide a link to, information relative to all of the following: (1) Plan policies and procedures related to: (A) Modified contracts or coverage as required by Section 1352.1. (B) Enrollee contract benefits and terms as required by subdivisions (a) and (b) of Section 1363. (C) Economic profiling as required by Section 1367.02. (D) Utilization review and modified coverage as required by Sections 1363.5 and 1367.01. (E) Cancellation of contracts as required by Section 1367.23. (F) Lists of providers as required by Section 1367.26. (G) Enrollee and subscriber grievances as required by Sections 1368 and 1368.015. (H) Continuity of care as required by subdivisions (a) and (b) of Section 1373.95. (I) Independent medical review as required by subdivision (i) of Section 1374.30. (2) The department's final report of the plan's periodic review as required by subdivision (h) of Section 1380. (3) All provider manuals, policies, and procedures related to the terms and conditions of provider contracts, including any material changes to those manuals, policies, and procedures. (c) The material described in subdivision (b) shall be updated at least every month. (d) The department shall include on the department's Internet Web site a link to each plan Internet Web site.   SEC. 3.   Section 1367.29 is added to the Health and Safety Code, to read: 1367.29. (a) Every health care service plan that offers professional mental health services, including a specialized health care service plan that offers those services, shall issue a benefits card to each enrollee for assistance with mental health benefits coverage information, in-network provider access information, and claims processing purposes. The benefits card, at a minimum, shall include all of the following information: (1) The name of the benefit administrator or health care service plan issuing the card, which shall be displayed on the front side of the card. (2) The enrollee's identification number, or the subscriber's identification number when the enrollee is a dependent who accesses services using the subscriber's identification number. The number shall be displayed on the front side of the card. (3) A telephone number that enrollees may call 24 hours a day, seven days a week, for assistance regarding health benefits coverage information, in-network provider access information, and claims processing. (4) A brief statement indicating that enrollees may call the telephone number for assistance regarding mental health services and coverage. (5) The plan's Internet Web site address. (b) A health care service plan shall not print any of the following information on the benefits card: (1) Any information that may result in fraudulent use of the card. (2) Any information that is otherwise prohibited from being included on the card. (c) On and after July 1, 2011, the benefits 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. (d) Nothing in this section requires a health care service plan to issue a separate benefits card for mental health coverage if the plan issues a card for health care coverage in general and the card provides the information required by this section. (e) If a specialized health care service plan delegates responsibility for issuing the benefits card to a contractor or agent, then the contract between the plan and its contractor or agent shall require compliance with this section.   SEC. 4.   Section 10123.197 is added to the Insurance Code, to read: 10123.197. (a) The Legislature finds and declares that coordination of care between mental health care providers and general physical health care providers is necessary to optimize the overall health of a patient. (b) Every health insurer that offers professional mental health services shall direct those services to be provided in a manner that ensures coordination of benefits between mental health care providers and general physical health care providers.   SEC. 5.   Section 10123.198 is added to the Insurance Code, to read: 10123.198. (a) The Legislature finds and declares that health care consumers should be provided important information regarding health care services in an easily accessible manner. The intent of this section is to improve online access to all policies, guidelines, disclosure forms, and other materials that health insurers are required by law to provide to the commissioner or consumers. (b) On or before January 1, 2012, every health insurer that offers professional mental health services shall establish an Internet Web site. Each Web site shall include, or provide a link to, information relative to all of the following: (1) Insurer policies and procedures related to: (A) Modified contracts or coverage. (B) Policyholder contract benefits and terms. (C) Economic profiling as required by Section 10123.36. (D) Utilization review and modified coverage as required by Section 10123.135. (E) Cancellation of contracts as required by Section 10199.44. (F) Lists of providers as required by Section 10133.1. (G) Policyholder and insured grievances. (H) Continuity of care as required by Section 10133.55. (I) Independent medical review as required by subdivision (i) of Section 10169. (2) The results of any market conduct examinations of the insurer as required by Section 12938. (3) All provider manuals, policies, and procedures related to the terms and conditions of provider contracts, including any material changes to those manuals, policies, and procedures. (c) The material described in subdivision (b) shall be updated at least every month. (d) The commissioner shall include on the department's Internet Web site, a link to each health insurer's Internet Web site.   SEC. 6.   Section 10123.199 is added to the Insurance Code, to read: 10123.199. (a) Every health insurer that offers professional mental health services shall issue a benefits card to each insured for assistance with mental health benefits coverage information, in-network provider access information, and claims processing purposes. The benefits card, at a minimum, shall include all of the following information: (1) The name of the benefit administrator or health insurer issuing the card, which shall be displayed on the front side of the card. (2) The insured's identification number, or the policyholder's identification number when the insured is a dependent who accesses services using the policyholder's identification number. The number shall be displayed on the front side of the card. (3) A telephone number that insureds may call 24 hours a day, seven days a week, for assistance regarding health benefits coverage information, in-network provider access information, and claims processing. (4) A brief statement indicating that insureds may call the telephone number for assistance regarding mental health services and coverage. (5) The health insurer's Internet Web site address. (b) A health insurer shall not print any of the following information on the benefits card: (1) Any information that may result in fraudulent use of the card. (2) Any information that is otherwise prohibited from being included on the card. (c) On and after July 1, 2011, the benefits 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. (d) Nothing in this section requires a health insurer to issue a separate benefits card for mental health coverage if the plan issues a card for health care coverage in general and the card provides the information required by this section.   SEC. 7.   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.