Existing law requires health care service plans that cover expenses on a group basis to offer coverage for the treatment of alcoholism, and to communicate the availability of this coverage to existing and prospective group subscribers. This bill would require health care service plans to provide coverage for substance-use disorders on the same basis as they provide coverage for any other medical care. Additionally, the bill would require health care service plans to reimburse providers of the services and would prohibit health care service plans from seeking indemnity or otherwise transferring financial responsibility for these services onto contracting providers. Because a willful violation of this bill's requirements with respect to health care service plan requirements would be a crime, this bill would impose a state-mandated local program by creating a new crime. 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. Every plan shall communicate the availability of such this coverage to all group subscribers and to all prospective group subscribers with whom they are negotiating. Health care service plans shall provide the continuum of evidence-based clinically effective and appropriate services and continuing treatment in a facility licensed or certified by the Department of Alcohol and Drug Programs, the Joint Commission on Accreditation of Hospitals, and the State Department of Health Services or by a licensed physician, an appropriately credentialed addictions counselor, or other licensed clinician. Coverage and funding shall be the same as benefits covering other physical illness, including medications, with the same cost-sharing provisions, deductibles, appropriate caps or limits on number of outpatient visits, residential or inpatient treatment days, payments, lifetime benefits, and catastrophic coverage. Every health care service plan shall communicate the availability of this coverage to all group subscribers and to all prospective group subscribers with whom they are negotiating.