AB 2581: Health care coverage: mental health and substance use disorders: provider credentials.
- Session Year: 2021-2022
- House: Assembly
- Latest Version Date: 2022-09-25
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 also provides for the regulation of disability insurers by the Department of Insurance. Existing law requires a health care service plan contract or disability 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.
For provider contracts issued, amended, or renewed on and after January 1, 2023, this bill would require a health care service plan or disability insurer that provides coverage for mental health and substance use disorders and credentials health care providers of those services for the health care service plans or disability insurers networks, to assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application. Because a violation of the bills requirements 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.
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 also provides for the regulation of disability insurers by the Department of Insurance. Existing law requires a health care service plan contract or disability 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.
For provider contracts issued, amended, or renewed on and after January 1, 2023, this bill would require a health care service plan or disability insurer that provides coverage for mental health and substance use disorders and credentials health care providers of those services for the health care service plans or disability insurers networks, to assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application. Because a violation of the bills requirements 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.
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 also provides for the regulation of disability insurers by the Department of Insurance. Existing law requires a health care service plan contract or disability 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.
For provider contracts issued, amended, or renewed on and after January 1, 2023, this bill would require a health care service plan or disability insurer that provides coverage for mental health and substance use disorders and credentials health care providers of those services for the health care service plans or disability insurers networks, to assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application. Because a violation of the bills requirements 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.
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 also provides for the regulation of disability insurers by the Department of Insurance. Existing law requires a health care service plan contract or disability 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.
For provider contracts issued, amended, or renewed on and after January 1, 2023, this bill would require a health care service plan or disability insurer that provides coverage for mental health and substance use disorders and credentials health care providers of those services for the health care service plans or disability insurers networks, to assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application. Because a violation of the bills requirements 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.
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, 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.
For provider contracts issued, amended, or renewed on and after January 1, 2023, this bill would require a health care service plan that provides coverage for mental health and substance use disorders and credentials health care providers of those services for the health care service plans networks, to assess and verify the qualifications of a health care provider within 45 60 days after receiving a completed provider credentialing application. The bill would authorize an applicant to make a written request for a temporary credential if the health care service plan has not approved or denied the completed application within 45 days of receipt, and would require the health care service plan to issue the temporary credential, unless the applicant has reported a history of malpractice, substance abuse or mental health issues, or disciplinary action on their application. Because a violation of the bills requirements 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.
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, 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.
For provider contracts issued, amended, or renewed on and after January 1, 2023, this bill would require a health care service plan that provides coverage for mental health and substance use disorders and credentials health care providers of those services for the health care service plans networks, to assess and verify the qualifications of a health care provider within 45 days after receiving a completed provider credentialing application. The bill would authorize an applicant to make a written request for a temporary credential if the health care service plan has not approved or denied the completed application within 45 days of receipt, and would require the health care service plan to issue the temporary credential, unless the applicant has reported a history of malpractice, substance abuse or mental health issues, or disciplinary action on their application. Because a violation of the bills requirements 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.
(a)For provider contracts issued, amended, or renewed on and after January 1, 2023, a health care service plan that provides coverage for mental health and substance use disorders and that credentials health care providers of those services for its networks shall assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application. Upon receipt of the application by the credentialing department, the health care service plan shall notify the applicant within seven business days, to verify receipt and inform the applicant whether the application is complete. The 60-day timeline shall apply only to the credentialing process and does not include contracting completion.
(b)For the purposes of this section, mental health and substance use disorder and health care provider have the same meanings as defined in Section 1374.72.
SEC. 2.Section 10144.56 is added to the Insurance Code, to read:10144.56.(a)For provider contracts issued, amended, or renewed on and after January 1, 2023, a disability insurer that provides coverage for mental health and substance use disorders and that credentials health care providers of those services for its networks shall assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application. Upon receipt of the application by the credentialing department, the disability insurer shall notify the applicant within seven business days, to verify receipt and inform the applicant whether the application is complete. The 60-day timeline shall apply only to the credentialing process and does not include contracting completion.
(b)For the purposes of this section, mental health and substance use disorder and health care provider have the same meanings as defined in Section 10144.5.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
(a)For provider contracts issued, amended, or renewed on and after January 1, 2023, a health care service plan that provides coverage for mental health and substance use disorders and that credentials health care providers of those services for its networks shall assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application. Upon receipt of the application by the credentialing department, the health care service plan shall notify the applicant within seven business days, to verify receipt and inform the applicant whether the application is complete. The 60-day timeline shall apply only to the credentialing process and does not include contracting completion.
(b)For the purposes of this section, mental health and substance use disorder and health care provider have the same meanings as defined in Section 1374.72.
SEC. 2.Section 10144.56 is added to the Insurance Code, to read:10144.56.(a)For provider contracts issued, amended, or renewed on and after January 1, 2023, a disability insurer that provides coverage for mental health and substance use disorders and that credentials health care providers of those services for its networks shall assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application. Upon receipt of the application by the credentialing department, the disability insurer shall notify the applicant within seven business days, to verify receipt and inform the applicant whether the application is complete. The 60-day timeline shall apply only to the credentialing process and does not include contracting completion.
(b)For the purposes of this section, mental health and substance use disorder and health care provider have the same meanings as defined in Section 10144.5.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
(a)For provider contracts issued, amended, or renewed on and after January 1, 2023, a health care service plan that provides coverage for mental health and substance use disorders and that credentials health care providers of those services for its networks shall assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application. Upon receipt of the application by the credentialing department, the health care service plan shall notify the applicant within seven business days, to verify receipt and inform the applicant whether the application is complete. The 60-day timeline shall apply only to the credentialing process and does not include contracting completion.
(b)For the purposes of this section, mental health and substance use disorder and health care provider have the same meanings as defined in Section 1374.72.
SEC. 2.Section 10144.56 is added to the Insurance Code, to read:10144.56.(a)For provider contracts issued, amended, or renewed on and after January 1, 2023, a disability insurer that provides coverage for mental health and substance use disorders and that credentials health care providers of those services for its networks shall assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application. Upon receipt of the application by the credentialing department, the disability insurer shall notify the applicant within seven business days, to verify receipt and inform the applicant whether the application is complete. The 60-day timeline shall apply only to the credentialing process and does not include contracting completion.
(b)For the purposes of this section, mental health and substance use disorder and health care provider have the same meanings as defined in Section 10144.5.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
(a)For provider contracts issued, amended, or renewed on and after January 1, 2023, a health care service plan that provides coverage for mental health and substance use disorders and that credentials health care providers of those services for its networks shall assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application. Upon receipt of the application by the credentialing department, the health care service plan shall notify the applicant within seven business days, to verify receipt and inform the applicant whether the application is complete. The 60-day timeline shall apply only to the credentialing process and does not include contracting completion.
(b)For the purposes of this section, mental health and substance use disorder and health care provider shall have the same meanings as defined in Section 1374.72.
SEC. 2.Section 10144.56 is added to the Insurance Code, to read:10144.56.(a)For provider contracts issued, amended, or renewed on and after January 1, 2023, a disability insurer that provides coverage for mental health and substance use disorders and that credentials health care providers of those services for its networks shall assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application. Upon receipt of the application by the credentialing department, the disability insurer shall notify the applicant within seven business days, to verify receipt and inform the applicant whether the application is complete. The 60-day timeline shall apply only to the credentialing process and does not include contracting completion.
(b)For the purposes of this section, mental health and substance use disorder and health care provider have the same meanings as defined in Section 10144.5.
SEC. 2.SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
(a) For provider contracts issued, amended, or renewed on and after January 1, 2023, a health care service plan that provides coverage for mental health and substance use disorders and that credentials health care providers of those services for its networks shall assess and verify the qualifications of a health care provider within 45 60 days after receiving a completed provider credentialing application. Upon receipt of the application, application by the credentialing department, the health care service plan shall notify the applicant within five seven business days, to verify receipt and inform the applicant whether the application is complete. The 60-day timeline shall apply only to the credentialing process and does not include contracting completion.
(1)If the health care service plan has not approved or denied a completed provider credentialing application within 45 days of receipt, the applicant may make a written request for a temporary credential, provided that the applicant has a valid license or other required professional certification to provide the health care services to which the credential would apply. Within five business days after receiving the applicants written request, the health care service plan shall issue the applicant a temporary credential, subject to paragraph (2). (2)The health care service plan shall not issue a temporary credential pursuant to paragraph (1) if the applicant has reported on the application a history of medical malpractice claims, a history of substance abuse or mental health issues, or a history of disciplinary action. The temporary credential shall be effective upon issuance, and shall remain in effect until the providers credentialing application is approved or denied by the health care services plan.(b)For the purposes of this section, mental health and substance use disorder and health care provider shall have the same meanings as defined in Section 1374.72.
SEC. 2.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
(a) For provider contracts issued, amended, or renewed on and after January 1, 2023, a health care service plan that provides coverage for mental health and substance use disorders and that credentials health care providers of those services for its networks shall assess and verify the qualifications of a health care provider within 45 days after receiving a completed provider credentialing application. Upon receipt of the application, the health care service plan shall notify the applicant within five business days, to verify receipt and inform the applicant whether the application is complete.
(1)If the health care service plan has not approved or denied a completed provider credentialing application within 45 days of receipt, the applicant may make a written request for a temporary credential, provided that the applicant has a valid license or other required professional certification to provide the health care services to which the credential would apply. Within five business days after receiving the applicants written request, the health care service plan shall issue the applicant a temporary credential, subject to paragraph (2).
(2)The health care service plan shall not issue a temporary credential pursuant to paragraph (1) if the applicant has reported on the application a history of medical malpractice claims, a history of substance abuse or mental health issues, or a history of disciplinary action. The temporary credential shall be effective upon issuance, and shall remain in effect until the providers credentialing application is approved or denied by the health care services plan.
(b)For the purposes of this section, mental health and substance use disorder and health care provider shall have the same meanings as defined in Section 1374.72.
SEC. 2.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
|
Date
|
Status
|
|---|---|
| Sep 25, 2022 | Chaptered by Secretary of State - Chapter 533, Statutes of 2022. |
| Sep 25, 2022 | Approved by the Governor. |
| Aug 31, 2022 | Enrolled and presented to the Governor at 4 p.m. |
| Aug 24, 2022 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 75. Noes 0.). |
| Aug 24, 2022 | Assembly Rule 77(a) suspended. |
| Aug 23, 2022 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after August 25 pursuant to Assembly Rule 77. |
| Aug 23, 2022 | Read third time. Passed. Ordered to the Assembly. (Ayes 40. Noes 0. Page 4981.). |
| Aug 22, 2022 | Ordered to special consent calendar. |
| Aug 18, 2022 | Read second time. Ordered to third reading. |
| Aug 17, 2022 | Read third time and amended. Ordered to second reading. |
| Aug 11, 2022 | From committee: Do pass. (Ayes 7. Noes 0.) (August 11). |
| Jun 27, 2022 | In committee: Referred to suspense file. |
| Jun 13, 2022 | Read second time and amended. Re-referred to Com. on APPR. |
| Jun 9, 2022 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR with recommendation: To Consent Calendar. (Ayes 9. Noes 0.) (June 8). |
| Jun 1, 2022 | Referred to Com. on HEALTH. |
| May 24, 2022 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 23, 2022 | Read third time. Passed. Ordered to the Senate. (Ayes 74. Noes 0. Page 4857.) |
| May 19, 2022 | From committee: Do pass. (Ayes 16. Noes 0.) (May 19). |
| May 19, 2022 | Joint Rule 62(a), file notice suspended. (Page 4736.) |
| May 18, 2022 | In committee: Set, first hearing. Referred to suspense file. |
| Apr 27, 2022 | From committee: Do pass and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 14. Noes 0.) (April 26). Re-referred to Com. on APPR. |
| Apr 19, 2022 | Re-referred to Com. on HEALTH. |
| Apr 18, 2022 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Mar 10, 2022 | Referred to Com. on HEALTH. |
| Feb 19, 2022 | From printer. May be heard in committee March 21. |
| Feb 18, 2022 | Introduced. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 24, 2022 | AB 2581 Salas Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Aug 23, 2022 | Special Consent AB2581 | Senate Floor |
Passed |
|
| May 23, 2022 | AB 2581 Salas Assembly Third Reading | Assembly Floor |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
Bill Author
Bill Co-Author(s):