Bill Text: CA AB2384 | 2017-2018 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Medication-assisted treatment.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Vetoed) 2018-09-23 - Vetoed by Governor. [AB2384 Detail]
Download: California-2017-AB2384-Amended.html
include all include, at a minimum, the following medication-assisted treatment prescription drugs approved by the United States Food and Drug Administration (FDA) for the treatment of substance use disorders and for the reversal of overdose. (FDA): include all include, at a minimum, the following medication-assisted treatment prescription drugs approved by the United States Food and Drug Administration (FDA) for the treatment of substance
use disorders and for the reversal of overdose. (FDA):
Bill Title: Medication-assisted treatment.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Vetoed) 2018-09-23 - Vetoed by Governor. [AB2384 Detail]
Download: California-2017-AB2384-Amended.html
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Amended
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May 25, 2018 |
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Amended
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May 01, 2018 |
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Amended
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April 18, 2018 |
CALIFORNIA LEGISLATURE—
2017–2018 REGULAR SESSION
| Assembly Bill | No. 2384 |
| Introduced by Assembly Member Arambula |
February 14, 2018 |
An act to add and repeal Section 1367.207 to of the Health and Safety Code, and to add and repeal Section 10123.204 to of the Insurance Code, relating to medication-assisted treatment.
LEGISLATIVE COUNSEL'S DIGEST
AB 2384, as amended, Arambula.
Medication-assisted treatment.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene), 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 establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law requires the State Department of Health Care Services to license narcotic treatment programs to use narcotic replacement therapy in the treatment of addicted persons. Existing law specifies certain drugs, including
methadone and buprenorphine, that are authorized for use in narcotic replacement therapy and medication-assisted treatment by licensed narcotic treatment programs. Existing law establishes the Drug Medi-Cal Treatment Program, under which the department is authorized to enter into contracts with each county for the provision of various alcohol and drug treatment services, including substance use disorder services, narcotic treatment program services, naltrexone services, and outpatient drug-free services, to Medi-Cal beneficiaries.
This bill bill, until January 1, 2030, would require a drug formulary maintained by a health care service plan, not including a Medi-Cal
managed care plan, or and a health insurer to include all include, at a minimum, specified prescription drugs approved by the United States Food and Drug Administration for the medication-assisted treatment, as defined, of substance use disorders and for the reversal of overdose. disorders. The bill would provide that medication-assisted
treatment is presumed to be medically necessary, and is not subject to specified requirements of a health care service plan or policy of health insurance, including prior authorization and an annual or lifetime dollar limit, as specified. Because a willful violation of the bill’s requirements relative to those provisions by a health care service plans 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: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1367.207 is added to the Health and Safety Code, to read:1367.207.
(a) A health care service plan that provides prescription drug benefits and maintains one or more drug formularies shall(1) Buprenorphine, in both oral and injectable forms.
(2) Methadone.
(3) Naltrexone, in both oral and suspended release injectable forms.
(4) Disulfiram.
(5) Acamprosate.
(6) A combination of buprenorphine and naloxone in both oral and implantable forms.
(7) Naloxone in at least one form of administration.
(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:
(1) Prior authorization.
(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.
(3) A requirement that
the enrollee receives coverage at a facility that exceeds allowable time and distance standards for network adequacy, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.
(4) Financial requirements different than those for other illnesses covered under the health care service plan.
(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.
(c) The requirements of this section shall not be subject to an
enrollee’s prior success or failure with the medication-assisted treatment services provided.
(d) For purposes of this section, the following definitions apply:
(1) “Medication-assisted treatment” means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance use disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without behavioral therapies.
(2) “Pharmacologic therapy” means a prescribed course of
treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance use disorders.
(3) “Behavioral therapy” means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patient’s attitude and behaviors related to substance use disorders, and increase healthy life skills.
(4) “Medically necessary” means the treatment has been determined by the treating physician as meeting the medical needs of the enrollee and the treatment meets one or more of the standards for medical necessity set forth in subdivision
(b) of Section 1374.33.
(5) “Financial requirements” means a deductible, copayment, coinsurance, or out-of-pocket maximum.
(e) For purposes of this section, “health care service plan” includes does not include Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
(f) This section shall remain in effect only until January 1, 2030, and as of that date is repealed.
SEC. 2.
Section 10123.204 is added to the Insurance Code, to read:10123.204.
(a) A health insurer that provides prescription drug benefits and maintains one or more drug formularies shall(1) Buprenorphine, in both oral and injectable forms.
(2) Methadone.
(3) Naltrexone, in both oral and suspended release injectable forms.
(4) Disulfiram.
(5) Acamprosate.
(6) A combination of buprenorphine and naloxone in both oral and implantable forms.
(7) Naloxone in at least one form of
administration.
(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:
(1) Prior authorization.
(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.
(3) A requirement that the insured receives coverage at a facility that exceeds allowable time and distance standards for network adequacy, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.
(4) Financial requirements different
than those for other illnesses covered under the policy of health insurance.
(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.
(c) The requirements of this section shall not be subject to an
insured’s prior success or failure with the medication-assisted treatment services provided.
(d) For purposes of this section, the following definitions apply:
(1) “Medication-assisted treatment” means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance use disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without behavioral therapies.
(2) “Pharmacologic therapy” means a prescribed course of
treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance use disorders.
(3) “Behavioral therapy” means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patient’s attitude and behaviors related to substance use disorders, and increase healthy life skills.
(4) “Medically necessary” means the treatment has been determined by the treating physician as meeting the medical needs of the insured and the treatment meets one or more of the standards for medical necessity set forth in subdivision
(b) of Section 10169.3.
(5) “Financial requirements” means a deductible, copayment, coinsurance, or out-of-pocket maximum.
(e) This section shall remain in effect only until January 1, 2030, and as of that date is repealed.
