Enrolled September 12, 2023 Passed IN Senate September 07, 2023 Passed IN Assembly September 11, 2023 Amended IN Senate July 13, 2023 Amended IN Assembly May 18, 2023 Amended IN Assembly May 01, 2023 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 1451Introduced by Assembly Member JacksonFebruary 17, 2023 An act to add Section 1374.725 to the Health and Safety Code, and to add Section 10144.58 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTAB 1451, Jackson. Urgent and emergency 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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer that provides hospital, medical, or surgical coverage shall provide coverage for medically necessary treatment of mental health and substance use disorders, under the same terms and conditions applied to other medical conditions, as specified. Existing law also includes requirements for timely access to care, including mental health services, including a requirement that a health care service plan or health insurer provide or arrange for the provision of covered health care services in a timely manner appropriate for the nature of the enrollees or insureds condition consistent with good professional practice.This bill would require a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, to provide coverage for treatment of urgent and emergency mental health and substance use disorders. The bill would require the treatment to be provided without preauthorization, and to be reimbursed in a timely manner, pursuant to specified provisions. The bills provisions would only be implemented upon appropriation by the Legislature for administrative costs of the departments. The bill would clarify that it would not relieve a health plan or insurer of existing obligations, as specified. Because a violation of the bills requirements 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1374.725 is added to the Health and Safety Code, to read:1374.725. (a) A health care service plan contract issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.(b) Treatment for urgent and emergency mental health and substance use disorders pursuant to this section shall not require preauthorization.(c) A health care service plan shall provide reimbursement for services provided pursuant to this section in compliance with the requirements for timely payment of claims, as required by this chapter.(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.(e) Nothing in this section shall relieve a health plan of its existing obligations under Sections 1374.72 and 1374.724.SEC. 2. Section 10144.58 is added to the Insurance Code, to read:10144.58. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.(b) Treatment for urgent and emergency mental health and substance use disorders shall not require preauthorization.(c) A health insurer shall provide reimbursement for services provided pursuant to this section in compliance with Section 10123.13.(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.(e) Nothing in this section shall relieve an insurer of its existing obligations under Sections 10144.5 and 10144.57.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
Enrolled September 12, 2023 Passed IN Senate September 07, 2023 Passed IN Assembly September 11, 2023 Amended IN Senate July 13, 2023 Amended IN Assembly May 18, 2023 Amended IN Assembly May 01, 2023 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 1451Introduced by Assembly Member JacksonFebruary 17, 2023 An act to add Section 1374.725 to the Health and Safety Code, and to add Section 10144.58 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTAB 1451, Jackson. Urgent and emergency 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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer that provides hospital, medical, or surgical coverage shall provide coverage for medically necessary treatment of mental health and substance use disorders, under the same terms and conditions applied to other medical conditions, as specified. Existing law also includes requirements for timely access to care, including mental health services, including a requirement that a health care service plan or health insurer provide or arrange for the provision of covered health care services in a timely manner appropriate for the nature of the enrollees or insureds condition consistent with good professional practice.This bill would require a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, to provide coverage for treatment of urgent and emergency mental health and substance use disorders. The bill would require the treatment to be provided without preauthorization, and to be reimbursed in a timely manner, pursuant to specified provisions. The bills provisions would only be implemented upon appropriation by the Legislature for administrative costs of the departments. The bill would clarify that it would not relieve a health plan or insurer of existing obligations, as specified. Because a violation of the bills requirements 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES
Enrolled September 12, 2023 Passed IN Senate September 07, 2023 Passed IN Assembly September 11, 2023 Amended IN Senate July 13, 2023 Amended IN Assembly May 18, 2023 Amended IN Assembly May 01, 2023
Enrolled September 12, 2023
Passed IN Senate September 07, 2023
Passed IN Assembly September 11, 2023
Amended IN Senate July 13, 2023
Amended IN Assembly May 18, 2023
Amended IN Assembly May 01, 2023
CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION
Assembly Bill
No. 1451
Introduced by Assembly Member JacksonFebruary 17, 2023
Introduced by Assembly Member Jackson
February 17, 2023
An act to add Section 1374.725 to the Health and Safety Code, and to add Section 10144.58 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 1451, Jackson. Urgent and emergency 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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer that provides hospital, medical, or surgical coverage shall provide coverage for medically necessary treatment of mental health and substance use disorders, under the same terms and conditions applied to other medical conditions, as specified. Existing law also includes requirements for timely access to care, including mental health services, including a requirement that a health care service plan or health insurer provide or arrange for the provision of covered health care services in a timely manner appropriate for the nature of the enrollees or insureds condition consistent with good professional practice.This bill would require a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, to provide coverage for treatment of urgent and emergency mental health and substance use disorders. The bill would require the treatment to be provided without preauthorization, and to be reimbursed in a timely manner, pursuant to specified provisions. The bills provisions would only be implemented upon appropriation by the Legislature for administrative costs of the departments. The bill would clarify that it would not relieve a health plan or insurer of existing obligations, as specified. Because a violation of the bills requirements 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.
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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer that provides hospital, medical, or surgical coverage shall provide coverage for medically necessary treatment of mental health and substance use disorders, under the same terms and conditions applied to other medical conditions, as specified. Existing law also includes requirements for timely access to care, including mental health services, including a requirement that a health care service plan or health insurer provide or arrange for the provision of covered health care services in a timely manner appropriate for the nature of the enrollees or insureds condition consistent with good professional practice.
This bill would require a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, to provide coverage for treatment of urgent and emergency mental health and substance use disorders. The bill would require the treatment to be provided without preauthorization, and to be reimbursed in a timely manner, pursuant to specified provisions. The bills provisions would only be implemented upon appropriation by the Legislature for administrative costs of the departments. The bill would clarify that it would not relieve a health plan or insurer of existing obligations, as specified. Because a violation of the bills requirements 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.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 1374.725 is added to the Health and Safety Code, to read:1374.725. (a) A health care service plan contract issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.(b) Treatment for urgent and emergency mental health and substance use disorders pursuant to this section shall not require preauthorization.(c) A health care service plan shall provide reimbursement for services provided pursuant to this section in compliance with the requirements for timely payment of claims, as required by this chapter.(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.(e) Nothing in this section shall relieve a health plan of its existing obligations under Sections 1374.72 and 1374.724.SEC. 2. Section 10144.58 is added to the Insurance Code, to read:10144.58. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.(b) Treatment for urgent and emergency mental health and substance use disorders shall not require preauthorization.(c) A health insurer shall provide reimbursement for services provided pursuant to this section in compliance with Section 10123.13.(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.(e) Nothing in this section shall relieve an insurer of its existing obligations under Sections 10144.5 and 10144.57.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 1374.725 is added to the Health and Safety Code, to read:1374.725. (a) A health care service plan contract issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.(b) Treatment for urgent and emergency mental health and substance use disorders pursuant to this section shall not require preauthorization.(c) A health care service plan shall provide reimbursement for services provided pursuant to this section in compliance with the requirements for timely payment of claims, as required by this chapter.(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.(e) Nothing in this section shall relieve a health plan of its existing obligations under Sections 1374.72 and 1374.724.
SECTION 1. Section 1374.725 is added to the Health and Safety Code, to read:
### SECTION 1.
1374.725. (a) A health care service plan contract issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.(b) Treatment for urgent and emergency mental health and substance use disorders pursuant to this section shall not require preauthorization.(c) A health care service plan shall provide reimbursement for services provided pursuant to this section in compliance with the requirements for timely payment of claims, as required by this chapter.(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.(e) Nothing in this section shall relieve a health plan of its existing obligations under Sections 1374.72 and 1374.724.
1374.725. (a) A health care service plan contract issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.(b) Treatment for urgent and emergency mental health and substance use disorders pursuant to this section shall not require preauthorization.(c) A health care service plan shall provide reimbursement for services provided pursuant to this section in compliance with the requirements for timely payment of claims, as required by this chapter.(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.(e) Nothing in this section shall relieve a health plan of its existing obligations under Sections 1374.72 and 1374.724.
1374.725. (a) A health care service plan contract issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.(b) Treatment for urgent and emergency mental health and substance use disorders pursuant to this section shall not require preauthorization.(c) A health care service plan shall provide reimbursement for services provided pursuant to this section in compliance with the requirements for timely payment of claims, as required by this chapter.(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.(e) Nothing in this section shall relieve a health plan of its existing obligations under Sections 1374.72 and 1374.724.
1374.725. (a) A health care service plan contract issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.
(b) Treatment for urgent and emergency mental health and substance use disorders pursuant to this section shall not require preauthorization.
(c) A health care service plan shall provide reimbursement for services provided pursuant to this section in compliance with the requirements for timely payment of claims, as required by this chapter.
(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.
(e) Nothing in this section shall relieve a health plan of its existing obligations under Sections 1374.72 and 1374.724.
SEC. 2. Section 10144.58 is added to the Insurance Code, to read:10144.58. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.(b) Treatment for urgent and emergency mental health and substance use disorders shall not require preauthorization.(c) A health insurer shall provide reimbursement for services provided pursuant to this section in compliance with Section 10123.13.(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.(e) Nothing in this section shall relieve an insurer of its existing obligations under Sections 10144.5 and 10144.57.
SEC. 2. Section 10144.58 is added to the Insurance Code, to read:
### SEC. 2.
10144.58. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.(b) Treatment for urgent and emergency mental health and substance use disorders shall not require preauthorization.(c) A health insurer shall provide reimbursement for services provided pursuant to this section in compliance with Section 10123.13.(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.(e) Nothing in this section shall relieve an insurer of its existing obligations under Sections 10144.5 and 10144.57.
10144.58. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.(b) Treatment for urgent and emergency mental health and substance use disorders shall not require preauthorization.(c) A health insurer shall provide reimbursement for services provided pursuant to this section in compliance with Section 10123.13.(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.(e) Nothing in this section shall relieve an insurer of its existing obligations under Sections 10144.5 and 10144.57.
10144.58. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.(b) Treatment for urgent and emergency mental health and substance use disorders shall not require preauthorization.(c) A health insurer shall provide reimbursement for services provided pursuant to this section in compliance with Section 10123.13.(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.(e) Nothing in this section shall relieve an insurer of its existing obligations under Sections 10144.5 and 10144.57.
10144.58. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders shall cover treatment for urgent and emergency mental health and substance use disorders as provided in this section, consistent with other provisions of this article.
(b) Treatment for urgent and emergency mental health and substance use disorders shall not require preauthorization.
(c) A health insurer shall provide reimbursement for services provided pursuant to this section in compliance with Section 10123.13.
(d) This section shall only be implemented upon appropriation by the Legislature for administrative costs of the department.
(e) Nothing in this section shall relieve an insurer of its existing obligations under Sections 10144.5 and 10144.57.
SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
### SEC. 3.