Behavioral health reimbursement.
- Requires health plans to reimburse patients for out-of-pocket behavioral health care costs from non-plan providers.
- Mandates reimbursement within 60 days of expense documentation submission.
- Imposes a $5,000 fine per incident plus 10% interest for late or denied reimbursements.
- Requires plans to submit monthly reports tracking reimbursement requests and processing times.
Assembly Member Bains, joined by Assembly Member Schiavo and Senators Cervantes and Hurtado, proposes requiring health care service plans to reimburse enrollees for out-of-pocket behavioral health care costs incurred through non-plan providers. The legislation mandates full reimbursement for expenses dating back to May 1, 2022, including copayments, deductibles, prescription medications, provider visits, telehealth consultations, and related transportation costs.
Under the bill's provisions, plans must process reimbursement requests within 60 days of receiving documented expenses from enrollees. Required documentation includes receipts, prescriber verification, and a signed statement confirming the enrollee's inability to obtain timely care through their plan. Plans that fail to meet the reimbursement deadline face penalties of 10% annual interest plus $5,000 per incident.
The legislation requires plans to establish formal procedures for submitting and processing reimbursement requests in both online and paper formats, along with an appeals process for denied claims. Plans must submit monthly reports to the Department of Managed Health Care detailing the number of requests received, total amounts reimbursed, average processing times, and information about denied claims. These requirements remain in effect until the Department certifies that the plan has completed implementation of corrective actions specified in its 2023 settlement agreement.
 Sabrina CervantesD Senator | Bill Author |  Not Contacted | |
 Joaquin ArambulaD Assemblymember | Committee Member | Not Contacted | |
 Buffy WicksD Assemblymember | Committee Member | Not Contacted | |
 Melissa HurtadoD Senator | Bill Author | Not Contacted | |
 Lisa CalderonD Assemblymember | Committee Member | Not Contacted |
Email the authors or create an email template to send to all relevant legislators.
Introduced By
Latest Voting History
| Ayes | Noes | NVR | Total | Result |
|---|---|---|---|---|
| 12 | 1 | 3 | 16 | PASS |
- Requires health plans to reimburse patients for out-of-pocket behavioral health care costs from non-plan providers.
- Mandates reimbursement within 60 days of expense documentation submission.
- Imposes a $5,000 fine per incident plus 10% interest for late or denied reimbursements.
- Requires plans to submit monthly reports tracking reimbursement requests and processing times.
Email the authors or create an email template to send to all relevant legislators.
Introduced By
Assembly Member Bains, joined by Assembly Member Schiavo and Senators Cervantes and Hurtado, proposes requiring health care service plans to reimburse enrollees for out-of-pocket behavioral health care costs incurred through non-plan providers. The legislation mandates full reimbursement for expenses dating back to May 1, 2022, including copayments, deductibles, prescription medications, provider visits, telehealth consultations, and related transportation costs.
Under the bill's provisions, plans must process reimbursement requests within 60 days of receiving documented expenses from enrollees. Required documentation includes receipts, prescriber verification, and a signed statement confirming the enrollee's inability to obtain timely care through their plan. Plans that fail to meet the reimbursement deadline face penalties of 10% annual interest plus $5,000 per incident.
The legislation requires plans to establish formal procedures for submitting and processing reimbursement requests in both online and paper formats, along with an appeals process for denied claims. Plans must submit monthly reports to the Department of Managed Health Care detailing the number of requests received, total amounts reimbursed, average processing times, and information about denied claims. These requirements remain in effect until the Department certifies that the plan has completed implementation of corrective actions specified in its 2023 settlement agreement.
Latest Voting History
| Ayes | Noes | NVR | Total | Result |
|---|---|---|---|---|
| 12 | 1 | 3 | 16 | PASS |
Sabrina CervantesD Senator | Bill Author | Not Contacted | |
Joaquin ArambulaD Assemblymember | Committee Member | Not Contacted | |
Buffy WicksD Assemblymember | Committee Member | Not Contacted | |
Melissa HurtadoD Senator | Bill Author | Not Contacted | |
Lisa CalderonD Assemblymember | Committee Member | Not Contacted |