Bill Text: CA SB1207 | 2021-2022 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health care coverage: maternal and pandemic-related mental health conditions.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2022-09-27 - Chaptered by Secretary of State. Chapter 618, Statutes of 2022. [SB1207 Detail]
Download: California-2021-SB1207-Amended.html
Bill Title: Health care coverage: maternal and pandemic-related mental health conditions.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2022-09-27 - Chaptered by Secretary of State. Chapter 618, Statutes of 2022. [SB1207 Detail]
Download: California-2021-SB1207-Amended.html
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Amended
IN
Assembly
August 24, 2022 |
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Amended
IN
Senate
April 07, 2022 |
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Amended
IN
Senate
March 16, 2022 |
CALIFORNIA LEGISLATURE—
2021–2022 REGULAR SESSION
Senate Bill
No. 1207
| Introduced by Senator Portantino |
February 17, 2022 |
An act to amend Section 1367.625 of the Health and Safety Code, and to amend Section 10123.867 of the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 1207, as amended, Portantino.
Health care coverage: maternal and pandemic-related mental health conditions.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of that act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers to provide specified mental health and substance use disorder coverage, and requires a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2021, that provides hospital, medical, or surgical coverage to 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 requires health care service plans and health
insurers, by July 1, 2019, to develop, consistent with sound clinical principles and processes, a maternal mental health program designed to promote quality and cost-effective outcomes, as specified.
This bill would make findings and declarations relating to the effect of the COVID-19 pandemic on mental health in California and the importance of outreach, education, and access to quality mental health treatment. The bill would extend the deadline for establishment of the maternal mental health program to July 1, 2023. The bill would revise the requirements of the program to include quality measures to encourage screening, diagnosis, treatment, and referral. The bill also would encourage health care service plans and health insurers to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize
training opportunities for contracting obstetric providers, and educate enrollees and insureds about the program. The bill would define “health care service plan” to include specified Medi-Cal managed health care plans, as specified, and would require those plans to continue to comply with any quality measures required or adopted by the State Department of Health Care Services, notwithstanding the requirements of the bill. Because a violation of the bill 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: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
The Legislature finds and declares as follows:(a) California law requires health care coverage for medically necessary treatment of mental health and substance use disorders, under the same terms and conditions applied to other medical conditions.
(b) The challenges of the COVID-19 pandemic have impacted the mental health of many Californians, including, but not limited to, mothers experiencing postpartum depression and other maternal mental health conditions.
(c) Therefore, it is the intent of the Legislature, now more
than ever, for government, health care service plans, insurers, and health care providers to work cooperatively to provide outreach, education, and access to quality mental health treatment to support all Californians.
SEC. 2.
Section 1367.625 of the Health and Safety Code is amended to read:1367.625.
(a) By July 1, 2023, a health care service plan shall develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall be developed consistent with sound clinical principles and processes, and shall include quality measures to encourage screening, diagnosis, treatment, and referral. The program guidelines and criteria shall be provided to relevant medical providers, including all contracting obstetric providers. As part of a maternal mental health program the health care service plan is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate enrollees about the program.(b) For the purposes of this section, the following terms have the following meanings:
(1) “Contracting obstetric provider” means an individual who is certified or licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act
referred to in that division, and who is contracted with the enrollee’s health care service plan to provide services under the enrollee’s plan contract.
(2) “Maternal mental health” means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.
(c) This section shall not apply to specialized health care service plans, except specialized behavioral health-only plans offering professional mental health services.
(d) For purposes of this section, “health care service plan” shall 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. The State Department of Health Care Services shall seek any federal approvals it deems necessary to implement this section. This section shall apply to Medi-Cal managed care plan contracts only to the extent that the State Department of Health Care Services obtains any necessary federal approvals, and federal financial participation under the Medi-Cal program is available and not otherwise jeopardized.
(e) Notwithstanding subdivision (a), a Medi-Cal managed care plan shall continue to comply with any quality measures required or adopted by the State Department of Health Care Services. Quality measures included in a Medi-Cal managed care plan’s maternal mental health program shall not be
inconsistent with quality measures required or adopted by the State Department of Health Care Services.
SEC. 3.
Section 10123.867 of the Insurance Code is amended to read:10123.867.
(a) By July 1, 2023, a health insurer shall develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall be developed consistent with sound clinical principles and processes, and shall include quality measures to encourage screening, diagnosis, treatment, and referral. The program guidelines and criteria shall be provided to relevant medical providers, including all contracting obstetric providers. As part of the maternal mental health program, a health insurer is encouraged to improve screening, treatment, and referral to maternal mental health services, include coverage for doulas, incentivize training opportunities for contracting obstetric providers, and educate insureds about the program.(b) For the purposes of this section, the following terms have the following meanings:
(1) “Contracting obstetric provider” means an individual who is certified or licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act referred to in
that division, and who is contracted with the insured’s health insurer to provide services under the insured’s health insurance policy.
(2) “Maternal mental health” means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.
(c) This section shall not apply to specialized health insurers, except behavioral health-only insurers that provide coverage for professional mental health services.
