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SB 221

Title: Health care coverage: timely access to care.
Author: Scott D. Wiener

Summary
SB 221, Wiener. Health care coverage: timely access to care. 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. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires each department to develop and adopt regulations to ensure that enrollees and insureds have access to needed health care services in a timely manner. Under existing law, a Medi-Cal managed care plan is required to comply with timely access standards developed by the department.Existing regulations require a health care service plan or an insurer to ensure that their contracted provider networks have adequate capacity and availability of licensed health care providers to offer enrollees and insureds appointments that meet specified timeframes. Existing regulations require a health care service plan or an insurer to ensure that for an enrollee requesting a nonurgent appointment with a nonphysician mental health care provider, or an insured requesting a nonurgent appointment with a nonphysician mental health care or substance use disorder provider, appointments are offered within 10 business days of the request for an appointment. Existing regulations also authorize appointments for preventive care services and periodic followup care, including periodic office visits to monitor and treat mental health or substance use disorder conditions, as specified, to be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed health care provider acting within the provider’s scope of practice. These regulations of the Department of Managed Health Care are limited in application to mental health care providers, while those regulations of the Department of Insurance are applicable to both mental health care and substance use disorder providers.This bill would codify the regulations adopted by the Department of Managed Health Care and the Department of Insurance to provide timely access standards for health care service plans and insurers for nonemergency health care services. The bill would require both a health care service plan and a health insurer, including a Medi-Cal Managed Care Plan, to ensure that appointments with nonphysician mental health and substance use disorder providers are subject to the timely access requirements, as specified. The bill would additionally require, commencing July 1, 2022, a health care service plan and a health insurer, including a Medi-Cal Managed Care Plan, to ensure that an enrollee or insured that is undergoing a course of treatment for an ongoing mental health or substance use disorder condition is able to get a followup appointment with a nonphysician mental health care or substance use disorder provider within 10 business days of the prior appointment. The bill would require that a referral to a specialist by another provider meet the timely access standards. If a health care service plan is operating in a service area that has a shortage of providers and the plan is not able to meet the geographic and timely access standards for providing mental health or substance use disorder services with an in-network provider, the bill would require the plan, including a Medi-Cal Managed Care Plan, to arrange coverage outside the plan’s contracted network. By imposing new requirements on health care service plans, the willful violation of which 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.

Status
Introduced. Read first time. To Com. on RLS. for assignment. To print. 01/13/2021
From printer. May be acted upon on or after February 13. 01/14/2021
Referred to Com. on HEALTH. 01/28/2021
Set for hearing March 17. 03/03/2021
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH. 03/09/2021
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 9. Noes 0. Page 532.) (March 17). 03/18/2021
Read second time and amended. Re-referred to Com. on APPR. 03/22/2021
Set for hearing May 3. 04/21/2021
May 3 hearing: Placed on APPR suspense file. 05/04/2021
Set for hearing May 20. 05/14/2021
From committee: Do pass as amended. (Ayes 5. Noes 2. Page 1183.) (May 20). 05/20/2021
Read second time and amended. Ordered to second reading. 05/20/2021
Read second time. Ordered to third reading. 05/24/2021
Read third time. Passed. (Ayes 32. Noes 7. Page 1318.) Ordered to the Assembly. 06/01/2021
In Assembly. Read first time. Held at Desk. 06/02/2021
Referred to Com. on HEALTH. 06/10/2021
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH. 06/28/2021
From committee: Do pass and re-refer to Com. on APPR. (Ayes 15. Noes 0.) (July 6). Re-referred to Com. on APPR. 07/07/2021
August 19 set for first hearing. Placed on suspense file. 08/19/2021
From committee: Do pass. (Ayes 16. Noes 0.) (August 26). 08/26/2021
Read second time. Ordered to third reading. 08/30/2021
Read third time and amended. 09/01/2021
Ordered to third reading. 09/01/2021
Read third time and amended. 09/03/2021
Ordered to third reading. 09/03/2021
Read third time. Passed. (Ayes 62. Noes 0.) Ordered to the Senate. 09/08/2021
In Senate. Concurrence in Assembly amendments pending. 09/08/2021
Assembly amendments concurred in. (Ayes 35. Noes 1.) Ordered to engrossing and enrolling. 09/09/2021
Enrolled and presented to the Governor at 2:30 p.m. 09/15/2021

Bill Documents
SB 221 - Enrolled
09/13/21 - SB 221 (Enrolled)


SB 221 - Senate Floor Analyses
09/08/21 - SB 221 (Senate Floor Analyses)

SB 221 - Assembly Floor Analysis
09/03/21 - SB 221 (Assembly Floor Analysis)

SB 221 - Amended Assembly
09/03/21 - SB 221 (Amended Assembly)

SB 221 - Amended Assembly
09/01/21 - SB 221 (Amended Assembly)

SB 221 - Assembly Floor Analysis
09/01/21 - SB 221 (Assembly Floor Analysis)

SB 221 - Assembly Floor Analysis
08/31/21 - SB 221 (Assembly Floor Analysis)

SB 221 - Assembly Appropriations
08/16/21 - SB 221 (Assembly Appropriations)

SB 221 - Assembly Health
07/01/21 - SB 221 (Assembly Health)

SB 221 - Amended Assembly
06/28/21 - SB 221 (Amended Assembly)

SB 221 - Senate Floor Analyses
05/25/21 - SB 221 (Senate Floor Analyses)

SB 221 - Senate Appropriations
05/20/21 - SB 221 (Senate Appropriations)

SB 221 - Amended Senate
05/20/21 - SB 221 (Amended Senate)

SB 221 - Senate Appropriations
05/03/21 - SB 221 (Senate Appropriations)

SB 221 - Senate Appropriations
04/30/21 - SB 221 (Senate Appropriations)

SB 221 - Amended Senate
03/22/21 - SB 221 (Amended Senate)

SB 221 - Senate Health
03/15/21 - SB 221 (Senate Health)

SB 221 - Amended Senate
03/09/21 - SB 221 (Amended Senate)

SB 221 - Introduced
01/13/21 - SB 221 (Introduced)