SB 855

  • California Senate Bill
  • 2019-2020 Regular Session
  • Introduced in Senate Jan 14, 2020
  • Passed Senate Jun 25, 2020
  • Passed Assembly Aug 26, 2020
  • Signed by Governor Sep 25, 2020

Health coverage: mental health or substance use disorders.

Abstract

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.

Bill Sponsors (14)

Votes


Actions


Sep 25, 2020

California State Legislature

Approved by the Governor.

California State Legislature

Chaptered by Secretary of State. Chapter 151, Statutes of 2020.

Sep 09, 2020

California State Legislature

Enrolled and presented to the Governor at 3 p.m.

Aug 30, 2020

Senate

Assembly amendments concurred in. (Ayes 30. Noes 8.) Ordered to engrossing and enrolling.

Senate

Assembly amendments concurred in. (Ayes 31. Noes 7.) Ordered to engrossing and enrolling.

Senate

Reconsideration granted. (Ayes 39. Noes 0.)

Senate

Motion to reconsider made by Senator Wiener.

Aug 28, 2020

Senate

In Senate. Concurrence in Assembly amendments pending.

Aug 26, 2020

Assembly

Read third time. Passed. (Ayes 63. Noes 1. Page 5221.) Ordered to the Senate.

Aug 25, 2020

Assembly

Read second time. Ordered to third reading.

Aug 24, 2020

Assembly

Read second time and amended. Ordered to second reading.

Aug 20, 2020

Assembly

From committee: Do pass as amended. (Ayes 14. Noes 1.) (August 20).

Aug 18, 2020

Assembly

August 18 set for first hearing. Placed on suspense file.

Aug 07, 2020

Assembly

Coauthors revised.

Aug 06, 2020

Assembly

Read second time and amended. Re-referred to Com. on APPR.

  • Reading-1
  • Reading-2
  • Amendment-Passage
  • Referral-Committee
Com. on APPR.

Aug 05, 2020

Assembly

From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 13. Noes 0.) (August 4).

Jul 27, 2020

Assembly

From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

  • Reading-1
  • Reading-2
  • Amendment-Passage
  • Committee-Passage
  • Referral-Committee
Com. on HEALTH.

Jun 29, 2020

Assembly

Referred to Com. on HEALTH.

  • Referral-Committee
Com. on HEALTH.

Jun 25, 2020

Assembly

In Assembly. Read first time. Held at Desk.

Senate

Read third time. Passed. (Ayes 30. Noes 5. Page 3862.) Ordered to the Assembly.

Jun 22, 2020

Senate

Read second time. Ordered to third reading.

Jun 18, 2020

Senate

Read second time and amended. Ordered to second reading.

Senate

From committee: Do pass as amended. (Ayes 5. Noes 2. Page 3766.) (June 18).

Jun 11, 2020

Senate

Set for hearing June 18.

Jun 09, 2020

Senate

June 9 hearing: Placed on APPR. suspense file.

Jun 03, 2020

Senate

Set for hearing June 9.

Jun 02, 2020

Senate

Hearing rescheduled due to Capitol closure.

May 26, 2020

Senate

Set for hearing June 1.

May 19, 2020

Senate

Read second time and amended. Re-referred to Com. on APPR.

  • Reading-1
  • Reading-2
  • Amendment-Passage
  • Referral-Committee
Com. on APPR.

May 18, 2020

Senate

From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 7. Noes 2. Page 3533.) (May 13).

May 12, 2020

Senate

Referral to Com. on JUD. rescinded due to the shortened 2020 Legislative Calendar.

May 11, 2020

Senate

Set for hearing May 13.

May 05, 2020

Senate

From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

  • Reading-1
  • Reading-2
  • Amendment-Passage
  • Committee-Passage
  • Referral-Committee
Com. on HEALTH.

Jan 22, 2020

Senate

Referred to Coms. on HEALTH and JUD.

  • Referral-Committee
Coms. on HEALTH and JUD.

Jan 15, 2020

Senate

From printer. May be acted upon on or after February 14.

Jan 14, 2020

Senate

Introduced. Read first time. To Com. on RLS. for assignment. To print.

Bill Text

Bill Text Versions Format
SB855 HTML
01/14/20 - Introduced PDF
05/05/20 - Amended Senate PDF
05/19/20 - Amended Senate PDF
06/18/20 - Amended Senate PDF
07/27/20 - Amended Assembly PDF
08/06/20 - Amended Assembly PDF
08/24/20 - Amended Assembly PDF
09/03/20 - Enrolled PDF
09/25/20 - Chaptered PDF

Related Documents

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Sources

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