Behavioral health reimbursement.

Plain English Breakdown

The bill text and summaries do not specify which health care plan is involved beyond referring to 'the plan,' making it unclear if this applies to all plans or just one specific plan.

Behavioral Health Reimbursement

AB-1429 requires a specific health care plan to fully reimburse its members for out-of-pocket costs related to behavioral health services from non-plan providers until the department certifies that the plan has completed necessary changes.

What This Bill Does

• Requires a specific health care plan to pay back members who use non-plan providers for mental health or substance use treatment.
• Sets a deadline of May 1, 2022, for when this reimbursement must start and ends it once the department certifies that the plan has finished its corrective actions.
• Specifies that members need to submit certain documents to get their money back within 60 days.
• Adds penalties if the health care plan does not follow these rules, including paying extra interest and a fine.
• Requires the health care plan to report monthly on how it is handling these reimbursements.

Who It Names or Affects

• Enrollees of the specific health care plan who use non-plan providers for behavioral health services.
• The Department of Managed Health Care, which oversees and certifies the health care plan's compliance.

Terms To Know

Behavioral Health

Care related to mental health and substance use disorders.

Out-of-Pocket Costs

Money a person pays for healthcare services not covered by their insurance plan.

Limits and Unknowns

• The bill only applies to one specific health care plan.
• It does not specify what happens after the department certifies that the plan has completed its corrective actions.

Official Summary Text

AB 1429, as amended, Bains.
Behavioral health reimbursement.
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 requires a health care service plan contract 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.
This bill would require
Kaiser Foundation Health Plan
the plan, as defined,
to fully reimburse an enrollee who incurs out-of-pocket
costs for behavioral health care services obtained from
non-Kaiser
nonplan
providers or facilities or mental health prescription medication obtained from a
non-Kaiser
nonplan
pharmacy or
non-Kaiser
nonplan
provider on or after May 1, 2022, until the department certifies to the Legislature that
Kaiser
the plan
has successfully completed implementation of the corrective action work plan resulting from its 2023 settlement agreement with the department. The bill would require an enrollee to submit specified documents for reimbursement and would require
Kaiser
the plan
to pay the reimbursement within 60 calendar days of an enrollee’s submission of documented expenses. If
Kaiser
the plan
fails to provide this reimbursement, the bill would require it to pay the original amount plus 10% per annum interest to the enrollee, as well as a $5,000 fine per incident. The bill would require
Kaiser
the plan
to establish specified procedures, and would require
Kaiser
the plan
to submit a monthly report to the department with specified information. Because a willful violation of the bill’s provisions would be a crime, the bill would impose a state-mandated local program.
This bill would make legislative findings and declarations as to the necessity of a special statute for
Kaiser Foundation Health Plan.
the specified plan.
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.

Current Bill Text

Download Bill PDF