Qualified youth drop-in center health care coverage.

Senator Allen's mental health coverage legislation would require health insurers and Medi-Cal plans to cover mental health and substance use disorder treatments provided at qualified youth drop-in centers for patients 25 and younger. The bill expands existing requirements for coverage of these services at school sites.

The legislation defines qualified youth drop-in centers as facilities offering behavioral or primary health services to youth ages 12-25 that are designated by or embedded with educational institutions and can provide care outside school hours. Health plans would be prohibited from requiring prior authorization for covered services at these centers and could not impose copayments, coinsurance, deductibles or other cost-sharing.

To standardize reimbursement, the Department of Health Care Services would develop and maintain a statewide fee schedule for outpatient mental health and substance use treatment provided at both school sites and youth drop-in centers. Plans must reimburse providers at the higher of their contracted rate or the state fee schedule rate. The bill establishes a dedicated fund, supported by fees on participating health plans, to cover administrative costs of the provider network and claims processing.

The measure includes provisions for enrolling and credentialing providers, submitting claims, and sharing data between entities to facilitate timely payment and care coordination. Implementation is contingent on obtaining necessary federal approvals to maintain Medi-Cal funding. Local educational agencies retain existing obligations to provide disability-related services under state and federal law.