Bill Full Text
Home
-
Bills
-
Bill
-
Authors
-
Dates
-
Locations
-
Analyses
-
Organizations
<?xml version="1.0" ?>
<ns0:MeasureDoc xmlns:html="http://www.w3.org/1999/xhtml" xmlns:ns0="http://lc.ca.gov/legalservices/schemas/caml.1#" xmlns:ns3="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" version="1.0" xsi:schemaLocation="http://lc.ca.gov/legalservices/schemas/caml.1# xca.1.xsd">
<ns0:Description>
<ns0:Id>20250AB__255198AMD</ns0:Id>
<ns0:VersionNum>98</ns0:VersionNum>
<ns0:History>
<ns0:Action>
<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2026-02-20</ns0:ActionDate>
</ns0:Action>
<ns0:Action>
<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
<ns0:ActionDate>2026-03-19</ns0:ActionDate>
</ns0:Action>
</ns0:History>
<ns0:LegislativeInfo>
<ns0:SessionYear>2025</ns0:SessionYear>
<ns0:SessionNum>0</ns0:SessionNum>
<ns0:MeasureType>AB</ns0:MeasureType>
<ns0:MeasureNum>2551</ns0:MeasureNum>
<ns0:MeasureState>AMD</ns0:MeasureState>
</ns0:LegislativeInfo>
<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Elhawary</ns0:AuthorText>
<ns0:Authors>
<ns0:Legislator>
<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Elhawary</ns0:Name>
</ns0:Legislator>
</ns0:Authors>
<ns0:Title> An act to amend Section 502 of the Business and Professions Code, to add Section 1374.199 to the Health and Safety Code, and to add Section 10127.22 to the Insurance Code, relating to health care coverage. </ns0:Title>
<ns0:RelatingClause>health care coverage</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Health care coverage. </ns0:Subject>
</ns0:GeneralSubject>
<ns0:DigestText>
<html:p>
(1)
<html:span class="EnSpace"/>
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 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.
</html:p>
<html:p>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. </html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
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.
</html:p>
<html:p>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.</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
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.
</html:p>
<html:p>This bill would provide that no reimbursement is required by this act for a specified reason.</html:p>
</ns0:DigestText>
<ns0:DigestKey>
<ns0:VoteRequired>MAJORITY</ns0:VoteRequired>
<ns0:Appropriation>NO</ns0:Appropriation>
<ns0:FiscalCommittee>YES</ns0:FiscalCommittee>
<ns0:LocalProgram>YES</ns0:LocalProgram>
</ns0:DigestKey>
<ns0:MeasureIndicators>
<ns0:ImmediateEffect>NO</ns0:ImmediateEffect>
<ns0:ImmediateEffectFlags>
<ns0:Urgency>NO</ns0:Urgency>
<ns0:TaxLevy>NO</ns0:TaxLevy>
<ns0:Election>NO</ns0:Election>
<ns0:UsualCurrentExpenses>NO</ns0:UsualCurrentExpenses>
<ns0:BudgetBill>NO</ns0:BudgetBill>
<ns0:Prop25TrailerBill>NO</ns0:Prop25TrailerBill>
</ns0:ImmediateEffectFlags>
</ns0:MeasureIndicators>
</ns0:Description>
<ns0:Bill id="bill">
<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
<ns0:BillSection id="id_2F92AF28-0C08-42EA-9EA9-BDAD5ABEFCB2">
<ns0:Num>SECTION 1.</ns0:Num>
<ns0:Content>
<html:p>The Legislature finds and declares all of the following: </html:p>
<html:p>
(a)
<html:span class="EnSpace"/>
Access to behavioral health care is at a crisis point in California and the nation. Despite billions of dollars in state investment in the public mental health safety net and updated laws requiring health care service plans and health insurers to provide necessary care, too many Californians report struggling to access effective behavioral health services.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Communities of color face particular challenges with access to care and report some of the lowest rates of utilization of mental health services.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
For Californians who speak a language other than English, finding behavioral health care that meets their needs is particularly daunting.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
LGBTQIA+ individuals within Black, Indigenous, and People of Color (BIPOC) communities, in particular, face distinct challenges that compound the barriers to equitable mental health care. Navigating the health system to find and access a culturally affirming provider can feel like an impossibility, forcing many to seek care outside of their plan or policy or to forgo care entirely because they cannot afford to pay out of pocket.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
Since passage of the federal Patient Protection and Affordable Care Act, health care service plans and health insurers have been required to
provide medically necessary mental health services for their enrollees and insureds. Additionally, in 2020, the Legislature took action to ensure strong enforcement of the Paul Wellstone and Pete Domenici Mental Health Parity Addiction Equity Act of 2008, which requires health care service plan contracts and health insurance policies to provide mental health and substance use disorder coverage that is no more restrictive or costly than coverage for physical health for medical or surgical conditions.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
California consumers are increasingly forced to go out of network to access behavioral health care. Nationally, consumers pay $15 billion in out-of-pocket expenses for treatment for mental health disorders.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
Individuals seeking mental health services are six times more
likely to have to go out of network for care compared to other services, and in one-third of these cases, they bear the full cost themselves.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
Behavioral health out-of-pocket spending rose at double the rate by 2022 of other medical costs for children, causing major family financial strain.
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
Despite legislation, Department of Managed Health Care behavioral health investigations have found contracted providers are increasingly dissatisfied with network access. Low reimbursement rates, onerous health care service plan processes for authorizing payment, and burdensome contracting terms are the dominant reasons for the shortage of in-network mental health providers. Though the number of therapists who accept health care coverage isn’t tracked by a single organization, one
estimate suggests 42 percent of therapists in California don’t accept health care coverage at all.
</html:p>
<html:p>
(j)
<html:span class="EnSpace"/>
Without the financial help of health care coverage, clients pay an average of $130 out of pocket per session or higher in major cities.
</html:p>
</ns0:Content>
</ns0:BillSection>
<ns0:BillSection id="id_A1F33468-534D-4071-92E1-C29DAC07EF33">
<ns0:Num>SEC. 2.</ns0:Num>
<ns0:Content>
<html:p>It is the intent of the Legislature that this act do all of the following:</html:p>
<html:p>
(a)
<html:span class="EnSpace"/>
Require health care service plans and health insurers to survey and publicly report the number and prevalence of enrollees or insureds going
out of network for behavioral health
care, the total expenditures paid out-of-pocket by enrollees for out-of-network and in-network behavioral health care services after copayments, coinsurance, and applicable deductibles are applied, and the reasons, including lack of access to affordable, timely, geographically accessible, and culturally and linguistically responsive care delivered in person or via telehealth.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Require the Department of Managed Health Care to develop an annual report that summarizes health plan survey findings on the prevalence of, and the reasons for, out-of-network utilization and out-of-pocket enrollee costs. Additionally, reports
would include data already submitted on the number of enrollee requests for network and nonnetwork behavioral health providers and determinations submitted pursuant to existing reporting requirements.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Add an optional question on licensing renewal forms for providers of the healing arts to state whether they are currently contracting with a
health care service
plan or health insurer and the type of plan or insurer so California regulators can more readily monitor trends in provider contracting by region, language spoken, and provider type, amongst other categories.
</html:p>
</ns0:Content>
</ns0:BillSection>
<ns0:BillSection id="id_DF5EA38A-D08E-4BA7-8E2A-DCB7F25EFCA0">
<ns0:Num>SEC. 3.</ns0:Num>
<ns0:ActionLine action="IS_AMENDED" ns3:href="urn:caml:codes:BPC:caml#xpointer(%2Fcaml%3ALawDoc%2Fcaml%3ACode%2Fcaml%3ALawHeading%5B%40type%3D'DIVISION'%20and%20caml%3ANum%3D'2.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'CHAPTER'%20and%20caml%3ANum%3D'1.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'ARTICLE'%20and%20caml%3ANum%3D'1.'%5D%2Fcaml%3ALawSection%5Bcaml%3ANum%3D'502.'%5D)" ns3:label="fractionType: LAW_SECTION" ns3:type="locator">
Section 502 of the
<ns0:DocName>Business and Professions Code</ns0:DocName>
is amended to read:
</ns0:ActionLine>
<ns0:Fragment>
<ns0:LawSection id="id_6286AE6D-6F09-474D-9233-403BED25CD81">
<ns0:Num>502.</ns0:Num>
<ns0:LawSectionVersion id="id_06861A67-D130-4A2D-A33E-F3CCB2DDCC76">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
Notwithstanding any other law, both of the following apply:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The Board of Registered Nursing, the Board of Vocational Nursing and Psychiatric Technicians of the State of California, the Physician Assistant Board, and the Respiratory Care Board of California shall collect workforce data from their respective licensees and registrants as specified in subdivision (b) for future workforce planning at least biennially. The data shall be collected at the time of electronic license or registration renewal for those boards that utilize electronic renewals for licensees or registrants.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
All other boards that are not listed in paragraph (1) that regulate healing arts licensees or registrants under
this division shall request workforce data from their respective licensees and registrants as specified in subdivision (b) for future workforce planning at least biennially. The data shall be requested at the time of electronic license or registration renewal for those boards that utilize electronic renewals for licensees or registrants.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
In conformance with specifications under subdivision (d), the workforce data collected or requested by each board about its licensees and registrants shall include, at a minimum, all of the following information:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Anticipated year of retirement.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Area of practice or specialty.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
City, county, and ZIP Code of practice.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Date of birth.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
Educational background and the highest level attained at time of licensure or registration.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
Gender or gender identity.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
Hours spent in direct patient care, including telehealth hours as a subcategory, training, research, and administration.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
Languages spoken.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
National Provider Identifier.
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
Race or ethnicity.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
Type of employer or classification of primary practice site among the types of practice sites specified by the board, including, but not limited to, clinic, hospital, managed care organization, or private practice.
</html:p>
<html:p>
(12)
<html:span class="EnSpace"/>
Work hours.
</html:p>
<html:p>
(13)
<html:span class="EnSpace"/>
Sexual orientation.
</html:p>
<html:p>
(14)
<html:span class="EnSpace"/>
Disability status.
</html:p>
<html:p>
(15)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
Whether the licensee or registrant is a contracted provider with a health care service plan or health insurer to provide services, including through an individual contract or through employment with an organization that contracts with a health care service plan or health insurer.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Type of health care service plans or health insurers under which contracted services are provided, including commercial coverage, Medi-Cal, and Medicare.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Each board shall maintain the confidentiality of the information it receives from licensees and registrants under this section and shall only release information in an aggregate form that cannot be used to identify an individual other than as specified in subdivision (e).
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
The Department of Consumer Affairs, in consultation with the Department of Health Care Access and Information, shall specify for each board subject to this section the specific information and data that will be collected or requested pursuant to subdivision (b). The Department of Consumer Affairs’ identification and specification of this information and data shall be exempt until June 30, 2023, from the requirements of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
Each board, or the Department of Consumer Affairs on its behalf, shall, beginning on July 1, 2022, and quarterly thereafter, provide the individual licensee and registrant data it collects pursuant to this section to the Department of Health Care Access and Information in a manner directed by the Department of Health Care Access and Information, including license or registration number and associated license or registration information. The Department of Health Care Access and Information shall maintain the confidentiality of the licensee and registrant information it receives and shall only release information in an aggregate form that cannot be used to identify an individual.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
A licensee or registrant shall not be required to provide the information listed in subdivision (b) as a condition for license or registration renewal, and licensees or registrants shall not be subject to
discipline for not providing the information listed in subdivision (b).
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
This section does not alter or affect mandatory reporting requirements for licensees or registrants established pursuant to this division, including, but not limited to, Sections 1715.5, 1902.2, 2425.3, and 2455.2.
</html:p>
</ns0:Content>
</ns0:LawSectionVersion>
</ns0:LawSection>
</ns0:Fragment>
</ns0:BillSection>
<ns0:BillSection id="id_44DA4FBA-A328-42CD-8556-10FC7F090F57">
<ns0:Num>SEC. 4.</ns0:Num>
<ns0:ActionLine action="IS_ADDED" ns3:href="urn:caml:codes:HSC:caml#xpointer(%2Fcaml%3ALawDoc%2Fcaml%3ACode%2F%2Fcaml%3ALawSection%5Bcaml%3ANum%3D'1374.199'%5D)" ns3:label="fractionType: LAW_SECTION" ns3:type="locator">
Section 1374.199 is added to the
<ns0:DocName>Health and Safety Code</ns0:DocName>
, to read:
</ns0:ActionLine>
<ns0:Fragment>
<ns0:LawSection id="id_4F1EAA5B-4AF0-4B31-8E60-115AD24E7BF7">
<ns0:Num>1374.199.</ns0:Num>
<ns0:LawSectionVersion id="id_5726FFDE-51EA-4A8A-9C07-1FFA178505F4">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
A health care service plan shall conduct an annual survey of all enrollees in order to assess all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Number and prevalence of enrollees seeking or accessing behavioral health care services from out-of-network providers.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Total expenditures paid out-of-pocket by enrollees for out-of-network behavioral health care services and in-network behavioral health care services after copayments, coinsurance, and applicable deductibles are applied.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The reasons for seeking or accessing out-of-network providers and paying out-of-pocket for behavioral health care
services, including, but not limited to, lack of access to affordable, timely, geographically accessible, and culturally and linguistically competent care delivered in person or via telehealth.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The annual survey shall be optional for enrollees to complete.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
To the extent practicable, a health care service plan may incorporate questions to fulfill these requirements into enrollee surveys already conducted by the plan.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
A health care service plan shall report survey findings to the department on or before May 1, 2028, and annually thereafter.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
In implementing this section, the department shall develop and adopt regulations establishing standard requirements and a survey tool for health plans to use in order to comply
with subdivision (a).
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The regulations shall include standards and guidelines for health care service plans to collect and report accurate and complete member-level demographic data to more effectively assess and report disparities in the number and prevalence of enrollees and enrollees’ reasons for going out of network and paying out-of-pocket for behavioral health care services, and the total expenditures paid out-of-pocket by enrollees, by utilizing survey best practice methods compatible with identifying disparities for smaller populations, including, but not limited to, all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Asian, Native Hawaiian and Pacific Islander, or American Indian or Alaska Native populations.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Lesbian, gay, bisexual, transgender, or queer+ populations.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Persons with disabilities, including cognitive or functional disabilities, or persons with accommodation needs.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Other historically disadvantaged populations.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The department shall consult with the Department of Insurance regarding development of the regulations required by this subdivision.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
The department shall additionally seek public input from a wide range of interested parties through existing advisory bodies established by the director.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The department shall finalize these regulations and standards by July 1, 2027, and plans shall be required to utilize these standards by October 1, 2027.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
The department shall develop an annual report based on data
submitted pursuant to both of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The department’s Annual Network Report submissions of network and nonnetwork behavioral health provider requests and determinations.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The annual survey described in paragraph (1) of subdivision (a).
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
For purposes of this section, the following definitions apply:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
“Culturally and linguistically competent care” means the ability of health care providers and systems to adhere to the National Standards for Culturally and Linguistically Appropriate Services in order to provide respectful, effective, and understandable care and services that honor diverse patient cultural health beliefs and practices, language needs, health literacy, and other communication needs of patients. At a minimum, “culturally
and linguistically competent care” includes all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Applying linguistic skills, including American Sign Language, to communicate effectively with the target population.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Utilizing cultural information to establish therapeutic relationships.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Eliciting and incorporating pertinent cultural data compatible with patient backgrounds, beliefs, and life experiences in diagnosis and treatment.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Understanding and applying culturally, ethnically, and sociologically inclusive data to the process of clinical care, including, as appropriate, information and evidence-based cultural competency training pertinent to the treatment of, and provision of care to, individuals from racially and ethnically diverse cultural and linguistic backgrounds
and who identify as lesbian, gay, bisexual, transgender, queer or questioning, asexual, intersex, or gender diverse. This subparagraph includes processes specific to those seeking gender-affirming care services.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
“Disparity” means variation in behavioral health care access, utilization, and costs between population groups by age, geographic area, primary language, race, ethnicity, sex, gender identity, sexual orientation, and disability status.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
“In-network” has the same meaning as “in-network coverage or services,” as defined in Section 1374.60.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
“Member-level demographic data” means information specific to an individual enrollee that is self-reported by the enrollee about their own race, ethnicity, language, sex, gender identity, sexual orientation, disability status, and other characteristics.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
“Out-of-network” or “out of network” has the same meaning as “out-of-network coverage or services,” as defined in Section 1374.60.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
“Out-of-pocket” refers to copayments, coinsurance, and the applicable deductible, plus all costs for health care services that are not covered by the plan.
</html:p>
</ns0:Content>
</ns0:LawSectionVersion>
</ns0:LawSection>
</ns0:Fragment>
</ns0:BillSection>
<ns0:BillSection id="id_08A6B102-F7EB-4C1E-ADB5-0FBACAAF7268">
<ns0:Num>SEC. 5.</ns0:Num>
<ns0:ActionLine action="IS_ADDED" ns3:href="urn:caml:codes:INS:caml#xpointer(%2Fcaml%3ALawDoc%2Fcaml%3ACode%2F%2Fcaml%3ALawSection%5Bcaml%3ANum%3D'10127.22'%5D)" ns3:label="fractionType: LAW_SECTION" ns3:type="locator">
Section 10127.22 is added to the
<ns0:DocName>Insurance Code</ns0:DocName>
, to read:
</ns0:ActionLine>
<ns0:Fragment>
<ns0:LawSection id="id_5CCB1C9F-8F2E-4682-8535-F404800D534B">
<ns0:Num>10127.22.</ns0:Num>
<ns0:LawSectionVersion id="id_746A9B2A-9AAA-4F09-B7CF-BB64E2A8401A">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
A health insurer shall conduct an annual survey of all insureds in order to assess all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Number and prevalence of insureds seeking or accessing behavioral health care services from out-of-network providers.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Total expenditures paid out-of-pocket by insureds for out-of-network behavioral health care services and in-network behavioral health care services after copayments, coinsurance, and applicable deductibles are applied.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The reasons for seeking or accessing out-of-network providers and paying out-of-pocket for behavioral health care services, including,
but not limited to, lack of access to affordable, timely, geographically accessible, and culturally and linguistically competent care delivered in person or via telehealth.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The annual survey shall be optional for insureds to complete.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
To the extent practicable, a health insurer may incorporate questions to fulfill these requirements into insured surveys already conducted by the insurer.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
A health insurer shall report survey findings to the department on or before May 1, 2028, and annually thereafter.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
In implementing this section, the department shall develop and adopt regulations establishing standard requirements and a survey tool for health plans to use in order to comply with subdivision (a).
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The regulations shall include standards and guidelines for health insurers to collect and report accurate and complete member-level demographic data to more effectively assess and report disparities in the number and prevalence of insureds and insureds’ reasons for going out of network and paying out-of-pocket for behavioral health care services, and the total expenditures paid out-of-pocket by insureds, by utilizing survey best practice methods compatible with identifying disparities for smaller populations, including, but not limited to, all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Asian, Native Hawaiian and Pacific Islander, or American Indian or Alaska Native populations.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Lesbian, gay, bisexual, transgender, or queer+ populations.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Persons with disabilities,
including cognitive or functional disabilities, or persons with accommodation needs.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Other historically disadvantaged populations.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The department shall consult with the Department of Managed Health Care regarding development of the regulations required by this subdivision.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
The department shall additionally seek public input from a wide range of interested parties through existing advisory bodies established by the commissioner.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The department shall finalize these regulations and standards by July 1, 2027, and insurers shall be required to utilize these standards by October 1, 2027.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
The department shall develop an annual report based on data submitted pursuant to both of
the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Health insurer network adequacy reporting, including submissions of network and nonnetwork behavioral health provider requests and determinations.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The annual survey described in paragraph (1) of subdivision (a).
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
For purposes of this section, the following definitions apply:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
“Culturally and linguistically competent care” means the ability of health care providers and systems to adhere to the National Standards for Culturally and Linguistically Appropriate Services in order to provide respectful, effective, and understandable care and services that honor diverse patient cultural health beliefs and practices, language needs, health literacy, and other communication needs of patients. At a minimum, “culturally and
linguistically competent care” includes all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Applying linguistic skills, including American Sign Language, to communicate effectively with the target population.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Utilizing cultural information to establish therapeutic relationships.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Eliciting and incorporating pertinent cultural data compatible with patient backgrounds, beliefs, and life experiences in diagnosis and treatment.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Understanding and applying culturally, ethnically, and sociologically inclusive data to the process of clinical care, including, as appropriate, information and evidence-based cultural competency training pertinent to the treatment of, and provision of care to, individuals from racially and ethnically diverse cultural and linguistic backgrounds and
who identify as lesbian, gay, bisexual, transgender, queer or questioning, asexual, intersex, or gender diverse. This subparagraph includes processes specific to those seeking gender-affirming care services.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
“Disparity” means variation in behavioral health care access, utilization, and costs between population groups by age, geographic area, primary language, race, ethnicity, sex, gender identity, sexual orientation, and disability status.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
“In-network” means all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
All of the health care services provided or offered under the requirements of this chapter that are received from a provider employed by, under contract with, or otherwise affiliated with the health insurer and in accordance with the procedures set forth in the insurer’s approved evidence of coverage.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Health care services received from a provider not affiliated with the health insurer when the plan arranges for the insured to receive services from that provider.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Out-of-area emergency care provided in accordance with the procedures set by the health insurer to be followed in securing these services.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
“Member-level demographic data” means information specific to an individual insured that is self-reported by the insured about their own race, ethnicity, language, sex, gender identity, sexual orientation, disability status, and other characteristics.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
“Out-of-network” or “out of network” means health care services received from either of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Providers who are not
employed by, under contract with, or otherwise affiliated with the health insurer, except for health care services received from these providers in an emergency or when referred or authorized by the plan under procedures specifically reviewed and approved by the commissioner.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Providers who are employed by, under contract with, or otherwise affiliated with a health insurer in instances when the “in-network coverage or services” requirements for care set forth in the health insurer’s approved evidence of coverage are not met.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
“Out-of-pocket” refers to copayments, coinsurance, and the applicable deductible, plus all costs for health care services that are not covered by the insurer.
</html:p>
</ns0:Content>
</ns0:LawSectionVersion>
</ns0:LawSection>
</ns0:Fragment>
</ns0:BillSection>
<ns0:BillSection id="id_2D1318A2-1B57-4AD9-A8A0-7FB1C0FEA7F5">
<ns0:Num>SEC. 6.</ns0:Num>
<ns0:Content>
<html:p>
No reimbursement is required by this act pursuant to Section 6 of Article XIII
<html:span class="ThinSpace"/>
B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII
<html:span class="ThinSpace"/>
B of the California Constitution.
</html:p>
</ns0:Content>
</ns0:BillSection>
</ns0:Bill>
</ns0:MeasureDoc>