Re: AB88 - Cal insurance must cover autism

[Guest guest]

Hal,

could you paste this and send it to the list? I don't know how to get to it.

And what all does this entail? Thanks, Lois

Hal Rounds wrote:

> As of July 1 2000 health service plans must cover

> treatment for autism and other disorders.Go to this

> link for the bill summary.

>

> http://www.assembly.ca.gov/acs/acsframeset2text.htm

>

> You might want to call your insurance company and ask

> them how they plan to implement the new law.

>

> Hal

>

> __________________________________________________

>

[Guest guest]

Also, Is this just a law in Cal? Lois

Hal Rounds wrote:

> As of July 1 2000 health service plans must cover

> treatment for autism and other disorders.Go to this

> link for the bill summary.

>

> http://www.assembly.ca.gov/acs/acsframeset2text.htm

>

> You might want to call your insurance company and ask

> them how they plan to implement the new law.

>

> Hal

>

> __________________________________________________

>

[Guest guest]

How come no where else??? How do you go about getting the same thing

elsewhere?? Lois

Hal Rounds wrote:

> Yes, this is a California law.

> --- lois noland <jlois@...> wrote:

> > Also, Is this just a law in Cal? Lois

> >

>

> BILL NUMBER: AB 88 CHAPTERED

> BILL TEXT

>

> CHAPTER 534

> FILED WITH SECRETARY OF STATE SEPTEMBER 28, 1999

> APPROVED BY GOVERNOR SEPTEMBER 27, 1999

> PASSED THE ASSEMBLY SEPTEMBER 10, 1999

> PASSED THE SENATE SEPTEMBER 9, 1999

> AMENDED IN SENATE SEPTEMBER 8, 1999

> AMENDED IN SENATE AUGUST 17, 1999

> AMENDED IN ASSEMBLY FEBRUARY 24, 1999

>

> INTRODUCED BY Assembly Member Thomson

> (Principal coauthor: Senator Perata)

> (Coauthors: Assembly Members Alquist, Aroner,

> Cardoza, Corbett,

> , Dickerson, Dutra, Frusetta, Granlund,

> Hertzberg, ,

> Knox, Kuehl, Lempert, Longville, Lowenthal, Machado,

> Mazzoni, Migden,

> Papan, Romero, , , Steinberg,

> Strom-,

> Villaraigosa, Washington, Wayne, and )

> (Coauthors: Senators Alpert, Chesbro, Escutia,

> Ortiz, Rainey,

> Solis, and Vasconcellos)

>

> DECEMBER 10, 1998

>

> An act to add Section 1374.72 to the Health and

> Safety Code, and

> to add Section 10144.5 to the Insurance Code, relating

> to health care

> coverage.

>

> LEGISLATIVE COUNSEL'S DIGEST

>

> AB 88, Thomson. Health care coverage: mental

> illness.

> Under existing law, a disability insurer or health

> care service

> plan may not discriminate based on race, color,

> religion, national

> origin, ancestry, marital status, or sexual

> orientation. A

> disability insurer or health care service plan is also

> prohibited

> from refusing to insure a person or from charging a

> different premium

> or rate because of that person's blindness.

> This bill would require a health care service plan

> contract or

> disability insurance policy issued, amended, or

> renewed on or after

> July 1, 2000, to provide coverage for the diagnosis

> and medically

> necessary treatment of severe mental illnesses, as

> defined, of a

> person of any age, and of serious emotional

> disturbances of a child,

> under the same terms and conditions applied to other

> medical

> conditions. This bill would allow a health care

> service plan or

> disability insurer to provide the required mental

> health coverage

> through a separate specialized health care service

> plan or mental

> health plan subject to certain conditions, as

> specified. The bill

> would exempt from the provision relating to a health

> care service

> plan contract, a contract between the State Department

> of Health

> Services and a health care service plan for enrolled

> Medi-Cal

> beneficiaries. The bill would exempt certain

> insurance policies from

> these provisions.

> Because a willful violation of the provisions

> relating to health

> care service plans is a crime, this 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.

>

> THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS

> FOLLOWS:

>

> SECTION 1. (a) The Legislature finds and declares

> all of the

> following:

> (1) Mental illness is real.

> (2) Mental illness can be reliably diagnosed.

> (3) Mental illness is treatable.

> (4) Treatment of mental illness is cost-effective.

> ( The Legislature further finds and declares all

> of the

> following:

> (1) There is increasing scientific evidence that

> severe mental

> illnesses, such as schizophrenia, bipolar disorders,

> and major

> depression, are as effectively treated with

> medications as other

> severe illnesses.

> (2) Most private health insurance policies provide

> coverage for

> mental illness at levels far below coverage for other

> physical

> illnesses.

> (3) Limitations in coverage for mental illness in

> private

> insurance policies have resulted in inadequate

> treatment for persons

> with these illnesses.

> (4) Inadequate treatment causes relapse and untold

> suffering for

> individuals with mental illness and their families.

> © The Legislature further finds and declares all

> of the

> following:

> (1) Lack of adequate treatment and services for

> persons with

> mental illness has contributed significantly to

> homelessness,

> involvement with the criminal justice system, and

> other significant

> social problems experienced by individuals with mental

> illness and

> their families.

> (2) The failure to provide adequate coverage for

> mental illnesses

> in private health insurance policies has resulted in

> significant

> increased expenditures for state and local

> governments.

> (d) The Legislature further finds and declares that

> other states

> that have adopted mental illness parity legislation

> have experienced

> minimal additional costs if medically necessary

> services were well

> managed.

> SEC. 2. Section 1374.72 is added to the Health and

> Safety Code, to

> read:

> 1374.72. (a) Every health care service plan

> contract issued,

> amended, or renewed on or after July 1, 2000, that

> provides hospital,

> medical, or surgical coverage shall provide coverage

> for the

> diagnosis and medically necessary treatment of severe

> mental

> illnesses of a person of any age, and of serious

> emotional

> disturbances of a child, as specified in subdivisions

> (d) and (e),

> under the same terms and conditions applied to other

> medical

> conditions, as specified in subdivision ©.

> ( These benefits shall include the following:

> (1) Outpatient services.

> (2) Inpatient hospital services.

> (3) Partial hospital services.

> (4) Prescription drugs, if the plan contract

> includes coverage for

> prescription drugs.

> © The terms and conditions applied to the

> benefits required by

> this section, that shall be applied equally to all

> benefits under the

> plan contract, shall include, but not be limited to,

> the following:

>

> (1) Maximum lifetime benefits.

> (2) Copayments.

> (3) Individual and family deductibles.

> (d) For the purposes of this section, " severe

> mental illnesses "

> shall include:

> (1) Schizophrenia.

> (2) Schizoaffective disorder.

> (3) Bipolar disorder (manic-depressive illness).

> (4) Major depressive disorders.

> (5) Panic disorder.

> (6) Obsessive-compulsive disorder.

> (7) Pervasive developmental disorder or autism.

> (8) Anorexia nervosa.

> (9) Bulimia nervosa.

> (e) For the purposes of this section, a child

> suffering from,

> " serious emotional disturbances of a child " shall be

> defined as a

> child who (1) has one or more mental disorders as

> identified in the

> most recent edition of the Diagnostic and Statistical

> Manual of

> Mental Disorders, other than a primary substance use

> disorder or

> developmental disorder, that result in behavior

> inappropriate to the

> child's age according to expected developmental norms,

> and (2) who

> meets the criteria in paragraph (2) of subdivision (a)

> of Section

> 5600.3 of the Welfare and Institutions Code.

> (f) This section shall not apply to contracts

> entered into

> pursuant to Chapter 7 (commencing with Section 14000)

> or Chapter 8

> (commencing with Section 14200) of Division 9 of Part

> 3 of the

> Welfare and Institutions Code, between the State

> Department of Health

> Services and a health care service plan for enrolled

> Medi-Cal

> beneficiaries.

> (g) (1) For the purpose of compliance with this

> section, a plan

> may provide coverage for all or part of the mental

> health services

> required by this section through a separate

> specialized health care

> service plan or mental health plan, and shall not be

> required to

> obtain an additional or specialized license for this

> purpose.

> (2) A plan shall provide the mental health coverage

> required by

> this section in its entire service area and in

> emergency situations

> as may be required by applicable laws and regulations.

> For purposes

> of this section, health care service plan contracts

> that provide

> benefits to enrollees through preferred provider

> contracting

> arrangements are not precluded from requiring

> enrollees who reside or

> work in geographic areas served by specialized health

> care service

> plans or mental health plans to secure all or part of

> their mental

> health services within those geographic areas served

> by specialized

> health care service plans or mental health plans.

> (3) Notwithstanding any other provision of law, in

> the provision

> of benefits required by this section, a health care

> service plan may

> utilize case management, network providers,

> utilization review

> techniques, prior authorization, copayments, or other

> cost sharing.

> SEC. 3. Section 10144.5 is added to the Insurance

> Code, to read:

> 10144.5. (a) Every policy of disability insurance

> that covers

> hospital, medical, or surgical expenses in this state

> that is issued,

> amended, or renewed on or after July 1, 2000, shall

> provide coverage

> for the diagnosis and medically necessary treatment of

> severe mental

> illnesses of a person of any age, and of serious

> emotional

> disturbances of a child, as specified in subdivisions

> (d) and (e),

> under the same terms and conditions applied to other

> medical

> conditions, as specified in subdivision ©.

> ( These benefits shall include the following:

> (1) Outpatient services.

> (2) Inpatient hospital services.

> (3) Partial hospital services.

> (4) Prescription drugs, if the policy or contract

> includes

> coverage for prescription drugs.

> © The terms and conditions applied to the

> benefits required by

> this section that shall be applied equally to all

> benefits under the

> disability insurance policy shall include, but not be

> limited to, the

> following:

> (1) Maximum lifetime benefits.

> (2) Copayments and coinsurance.

> (3) Individual and family deductibles.

> (d) For the purposes of this section, " severe

> mental illnesses "

> shall include:

> (1) Schizophrenia.

> (2) Schizoaffective disorder.

> (3) Bipolar disorder (manic-depressive illness).

> (4) Major depressive disorders.

> (5) Panic disorder.

> (6) Obsessive-compulsive disorder.

> (7) Pervasive developmental disorder or autism.

> (8) Anorexia nervosa.

> (9) Bulimia nervosa.

> (e) For the purposes of this section, a child

> suffering from,

> " serious emotional disturbances of a child " shall be

> defined as a

> child who (1) has one or more mental disorders as

> identified in the

> most recent edition of the Diagnostic and Statistical

> Manual of

> Mental Disorders, other than a primary substance use

> disorder or

> developmental disorder, that result in behavior

> inappropriate to the

> child's age according to expected developmental norms,

> and (2) who

> meets the criteria in paragraph (2) of subdivision (a)

> of Section

> 5600.3 of the Welfare and Institutions Code.

> (f) (1) For the purpose of compliance with this

> section, a

> disability insurer may provide coverage for all or

> part of the mental

> health services required by this section through a

> separate

> specialized health care service plan or mental health

> plan, and shall

> not be required to obtain an additional or specialized

> license for

> this purpose.

> (2) A disability insurer shall provide the mental

> health coverage

> required by this section in its entire in-state

> service area and in

> emergency situations as may be required by applicable

> laws and

> regulations. For purposes of this section, disability

> insurers are

> not precluded from requiring insureds who reside or

> work in

> geographic areas served by specialized health care

> service plans or

> mental health plans to secure all or part of their

> mental health

> services within those geographic areas served by

> specialized health

> care service plans or mental health plans.

> (3) Notwithstanding any other provision of law, in

> the provision

> of benefits required by this section, a disability

> insurer may

> utilize case management, managed care, or utilization

> review.

> (4) Any action that a disability insurer takes to

> implement this

> section, including, but not limited to, contracting

> with preferred

> provider organizations, shall not be deemed to be an

> action that

> would otherwise require licensure as a health care

> service plan under

> the Knox-Keene Health Care Service Plan Act of 1975

> (Chapter 2.2

> (commencing with Section 1340) of Division 2 of the

> Health and Safety

> Code.

> (g) This section shall not apply to accident-only,

> specified

> disease, hospital indemnity, Medicare supplement,

> dental-only, or

> vision-only insurance policies.

> SEC. 4. 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.

>

>

> __________________________________________________

>

[Guest guest]

Yes, this is a California law.

--- lois noland <jlois@...> wrote:

> Also, Is this just a law in Cal? Lois

>

BILL NUMBER: AB 88 CHAPTERED

BILL TEXT

CHAPTER 534

FILED WITH SECRETARY OF STATE SEPTEMBER 28, 1999

APPROVED BY GOVERNOR SEPTEMBER 27, 1999

PASSED THE ASSEMBLY SEPTEMBER 10, 1999

PASSED THE SENATE SEPTEMBER 9, 1999

AMENDED IN SENATE SEPTEMBER 8, 1999

AMENDED IN SENATE AUGUST 17, 1999

AMENDED IN ASSEMBLY FEBRUARY 24, 1999

INTRODUCED BY Assembly Member Thomson

(Principal coauthor: Senator Perata)

(Coauthors: Assembly Members Alquist, Aroner,

Cardoza, Corbett,

, Dickerson, Dutra, Frusetta, Granlund,

Hertzberg, ,

Knox, Kuehl, Lempert, Longville, Lowenthal, Machado,

Mazzoni, Migden,

Papan, Romero, , , Steinberg,

Strom-,

Villaraigosa, Washington, Wayne, and )

(Coauthors: Senators Alpert, Chesbro, Escutia,

Ortiz, Rainey,

Solis, and Vasconcellos)

DECEMBER 10, 1998

An act to add Section 1374.72 to the Health and

Safety Code, and

to add Section 10144.5 to the Insurance Code, relating

to health care

coverage.

LEGISLATIVE COUNSEL'S DIGEST

AB 88, Thomson. Health care coverage: mental

illness.

Under existing law, a disability insurer or health

care service

plan may not discriminate based on race, color,

religion, national

origin, ancestry, marital status, or sexual

orientation. A

disability insurer or health care service plan is also

prohibited

from refusing to insure a person or from charging a

different premium

or rate because of that person's blindness.

This bill would require a health care service plan

contract or

disability insurance policy issued, amended, or

renewed on or after

July 1, 2000, to provide coverage for the diagnosis

and medically

necessary treatment of severe mental illnesses, as

defined, of a

person of any age, and of serious emotional

disturbances of a child,

under the same terms and conditions applied to other

medical

conditions. This bill would allow a health care

service plan or

disability insurer to provide the required mental

health coverage

through a separate specialized health care service

plan or mental

health plan subject to certain conditions, as

specified. The bill

would exempt from the provision relating to a health

care service

plan contract, a contract between the State Department

of Health

Services and a health care service plan for enrolled

Medi-Cal

beneficiaries. The bill would exempt certain

insurance policies from

these provisions.

Because a willful violation of the provisions

relating to health

care service plans is a crime, this 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.

THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS

FOLLOWS:

SECTION 1. (a) The Legislature finds and declares

all of the

following:

(1) Mental illness is real.

(2) Mental illness can be reliably diagnosed.

(3) Mental illness is treatable.

(4) Treatment of mental illness is cost-effective.

( The Legislature further finds and declares all

of the

following:

(1) There is increasing scientific evidence that

severe mental

illnesses, such as schizophrenia, bipolar disorders,

and major

depression, are as effectively treated with

medications as other

severe illnesses.

(2) Most private health insurance policies provide

coverage for

mental illness at levels far below coverage for other

physical

illnesses.

(3) Limitations in coverage for mental illness in

private

insurance policies have resulted in inadequate

treatment for persons

with these illnesses.

(4) Inadequate treatment causes relapse and untold

suffering for

individuals with mental illness and their families.

© The Legislature further finds and declares all

of the

following:

(1) Lack of adequate treatment and services for

persons with

mental illness has contributed significantly to

homelessness,

involvement with the criminal justice system, and

other significant

social problems experienced by individuals with mental

illness and

their families.

(2) The failure to provide adequate coverage for

mental illnesses

in private health insurance policies has resulted in

significant

increased expenditures for state and local

governments.

(d) The Legislature further finds and declares that

other states

that have adopted mental illness parity legislation

have experienced

minimal additional costs if medically necessary

services were well

managed.

SEC. 2. Section 1374.72 is added to the Health and

Safety Code, to

read:

1374.72. (a) Every health care service plan

contract issued,

amended, or renewed on or after July 1, 2000, that

provides hospital,

medical, or surgical coverage shall provide coverage

for the

diagnosis and medically necessary treatment of severe

mental

illnesses of a person of any age, and of serious

emotional

disturbances of a child, as specified in subdivisions

(d) and (e),

under the same terms and conditions applied to other

medical

conditions, as specified in subdivision ©.

( These benefits shall include the following:

(1) Outpatient services.

(2) Inpatient hospital services.

(3) Partial hospital services.

(4) Prescription drugs, if the plan contract

includes coverage for

prescription drugs.

© The terms and conditions applied to the

benefits required by

this section, that shall be applied equally to all

benefits under the

plan contract, shall include, but not be limited to,

the following:

(1) Maximum lifetime benefits.

(2) Copayments.

(3) Individual and family deductibles.

(d) For the purposes of this section, " severe

mental illnesses "

shall include:

(1) Schizophrenia.

(2) Schizoaffective disorder.

(3) Bipolar disorder (manic-depressive illness).

(4) Major depressive disorders.

(5) Panic disorder.

(6) Obsessive-compulsive disorder.

(7) Pervasive developmental disorder or autism.

(8) Anorexia nervosa.

(9) Bulimia nervosa.

(e) For the purposes of this section, a child

suffering from,

" serious emotional disturbances of a child " shall be

defined as a

child who (1) has one or more mental disorders as

identified in the

most recent edition of the Diagnostic and Statistical

Manual of

Mental Disorders, other than a primary substance use

disorder or

developmental disorder, that result in behavior

inappropriate to the

child's age according to expected developmental norms,

and (2) who

meets the criteria in paragraph (2) of subdivision (a)

of Section

5600.3 of the Welfare and Institutions Code.

(f) This section shall not apply to contracts

entered into

pursuant to Chapter 7 (commencing with Section 14000)

or Chapter 8

(commencing with Section 14200) of Division 9 of Part

3 of the

Welfare and Institutions Code, between the State

Department of Health

Services and a health care service plan for enrolled

Medi-Cal

beneficiaries.

(g) (1) For the purpose of compliance with this

section, a plan

may provide coverage for all or part of the mental

health services

required by this section through a separate

specialized health care

service plan or mental health plan, and shall not be

required to

obtain an additional or specialized license for this

purpose.

(2) A plan shall provide the mental health coverage

required by

this section in its entire service area and in

emergency situations

as may be required by applicable laws and regulations.

For purposes

of this section, health care service plan contracts

that provide

benefits to enrollees through preferred provider

contracting

arrangements are not precluded from requiring

enrollees who reside or

work in geographic areas served by specialized health

care service

plans or mental health plans to secure all or part of

their mental

health services within those geographic areas served

by specialized

health care service plans or mental health plans.

(3) Notwithstanding any other provision of law, in

the provision

of benefits required by this section, a health care

service plan may

utilize case management, network providers,

utilization review

techniques, prior authorization, copayments, or other

cost sharing.

SEC. 3. Section 10144.5 is added to the Insurance

Code, to read:

10144.5. (a) Every policy of disability insurance

that covers

hospital, medical, or surgical expenses in this state

that is issued,

amended, or renewed on or after July 1, 2000, shall

provide coverage

for the diagnosis and medically necessary treatment of

severe mental

illnesses of a person of any age, and of serious

emotional

disturbances of a child, as specified in subdivisions

(d) and (e),

under the same terms and conditions applied to other

medical

conditions, as specified in subdivision ©.

( These benefits shall include the following:

(1) Outpatient services.

(2) Inpatient hospital services.

(3) Partial hospital services.

(4) Prescription drugs, if the policy or contract

includes

coverage for prescription drugs.

© The terms and conditions applied to the

benefits required by

this section that shall be applied equally to all

benefits under the

disability insurance policy shall include, but not be

limited to, the

following:

(1) Maximum lifetime benefits.

(2) Copayments and coinsurance.

(3) Individual and family deductibles.

(d) For the purposes of this section, " severe

mental illnesses "

shall include:

(1) Schizophrenia.

(2) Schizoaffective disorder.

(3) Bipolar disorder (manic-depressive illness).

(4) Major depressive disorders.

(5) Panic disorder.

(6) Obsessive-compulsive disorder.

(7) Pervasive developmental disorder or autism.

(8) Anorexia nervosa.

(9) Bulimia nervosa.

(e) For the purposes of this section, a child

suffering from,

" serious emotional disturbances of a child " shall be

defined as a

child who (1) has one or more mental disorders as

identified in the

most recent edition of the Diagnostic and Statistical

Manual of

Mental Disorders, other than a primary substance use

disorder or

developmental disorder, that result in behavior

inappropriate to the

child's age according to expected developmental norms,

and (2) who

meets the criteria in paragraph (2) of subdivision (a)

of Section

5600.3 of the Welfare and Institutions Code.

(f) (1) For the purpose of compliance with this

section, a

disability insurer may provide coverage for all or

part of the mental

health services required by this section through a

separate

specialized health care service plan or mental health

plan, and shall

not be required to obtain an additional or specialized

license for

this purpose.

(2) A disability insurer shall provide the mental

health coverage

required by this section in its entire in-state

service area and in

emergency situations as may be required by applicable

laws and

regulations. For purposes of this section, disability

insurers are

not precluded from requiring insureds who reside or

work in

geographic areas served by specialized health care

service plans or

mental health plans to secure all or part of their

mental health

services within those geographic areas served by

specialized health

care service plans or mental health plans.

(3) Notwithstanding any other provision of law, in

the provision

of benefits required by this section, a disability

insurer may

utilize case management, managed care, or utilization

review.

(4) Any action that a disability insurer takes to

implement this

section, including, but not limited to, contracting

with preferred

provider organizations, shall not be deemed to be an

action that

would otherwise require licensure as a health care

service plan under

the Knox-Keene Health Care Service Plan Act of 1975

(Chapter 2.2

(commencing with Section 1340) of Division 2 of the

Health and Safety

Code.

(g) This section shall not apply to accident-only,

specified

disease, hospital indemnity, Medicare supplement,

dental-only, or

vision-only insurance policies.

SEC. 4. 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.

__________________________________________________

[Guest guest]

--- lois noland <jlois@...> wrote:

> How come no where else??? How do you go about

> getting the same thing

> elsewhere?? Lois

Residents of other states without a similar law would

have to get their state legislators interested in

passing a bill. There may be a few other states that

already have similar laws but I am not sure which.

I had known for awhile that California had made this

law but didn't know the details. I got a brochure from

my state Rep. Nakano today (bless his heart) briefly

summarizing the latest California laws applying to

medical treatment.

Hal

>

> Hal Rounds wrote:

>

> > Yes, this is a California law.

> > --- lois noland <jlois@...> wrote:

> > > Also, Is this just a law in Cal? Lois

> > >

__________________________________________________

[Guest guest]

> As of July 1 2000 health service plans must cover

> treatment for autism and other disorders.Go to this

> link for the bill summary.

>

> http://www.assembly.ca.gov/acs/acsframeset2text.htm

>

> You might want to call your insurance company and ask

> them how they plan to implement the new law.

>

> Hal

>

>

> __________________________________________________

>