Official Summary Text
AB 2551, as amended, Elhawary.
Behavioral health
Health
care coverage.
Existing
(1) 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.
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 contract or health 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.
This bill would express the intent of the Legislature to enact legislation to require health care service plans and health insurers to survey and publicly report the percentage of enrollees or insureds going in network or out of network for behavioral
health care, among other things. The bill would also make related findings and declarations.
This bill would require health care service plans and health insurers to conduct an annual survey to assess the number and prevalence of enrollees or insureds seeking or accessing behavioral health care services from out-of-network providers, the total expenditures paid out-of-pocket by enrollees and insureds for out-of-network and in-network behavioral health care services, as specified, and the reasons for seeking out-of-network behavioral health services. The bill would require the annual survey to be optional for enrollees or insureds. The bill would require health care service plans and health insurers to report survey findings to the departments on or before May 1, 2028, and annually thereafter. The bill would require the departments to adopt regulations establishing
standard requirements and a survey tool, as specified. The bill would require the departments to develop annual reports based on the annual survey and other data, as specified. Because a willful violation of these requirements by a health care service plan would be a crime, this bill would impose a state-mandated local program.
(2) Existing law requires specified boards, including the Board of Registered Nursing and the Respiratory Care Board of California, to collect certain workforce data from their respective licensees and registrants for future workforce planning at least biennially. Existing law requires other specified boards that regulate healing arts licensees or registrants to request workforce data from their respective licensees and registrants for future workforce planning at least biennially. Existing law requires the
workforce data collected or requested to include specified information, including, among others, the type of employer or classification or primary practice site, as specified. Existing law prohibits a licensee or registrant from being required to provide the information as a condition for license or registration renewal, and prohibits licensees or registrants from being subject to discipline for not providing the information.
This bill would require the information collected or requested by boards to include whether a licensee or registrant is a contracted provider and the types of health care coverage under which contracted services are provided.
(3) 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.