Bill Text: CA AB815 | 2023-2024 | Regular Session | Introduced

California Assembly Bill 815

NOTE: There are more recent revisions of this legislation. Read Latest Draft

Bill Title: Health care coverage: physician and provider credentials.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed) 2024-08-15 - In committee: Held under submission. [AB815 Detail]

Download: California-2023-AB815-Introduced.html

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill

No. 815

Introduced by Assembly Member Wood

February 13, 2023

An act to amend Section 1374.197 of the Health and Safety Code and to amend Section 10144.56 of the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL'S DIGEST

AB 815, as introduced, Wood. Health care coverage: mental health and substance use disorders: provider credentials.

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.

Existing law requires 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 plan’s or disability insurer’s networks, to assess and verify the qualifications of a health care provider within 60 days after receiving a completed provider credentialing application.

This bill would extend the period within which a health care service plan or disability insurer is required to assess and verify the qualifications of a health care provider from 60 days to 90 days after receiving a completed provider credentialing application.

Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO

The people of the State of California do enact as follows:

SECTION 1.

Section 1374.197 of the Health and Safety Code is amended to read:

1374.197.

(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 90 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~~ 90-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 of the Insurance Code is amended 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 90 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~~ 90-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.