Substance use disorder coverage.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Appropriations
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Overview
This bill aims to improve access to healthcare for individuals with substance use disorders in California. It proposes changes to health insurance coverage, specifically delaying or prohibiting certain types of reviews – like concurrent or retrospective medical necessity reviews – for the first 28 days of inpatient or residential substance use disorder treatment and for initial outpatient services. The bill also restricts the use of prior authorization requirements for outpatient prescription drugs used to treat substance use disorders. It clarifies that certain provisions do not apply to Medi-Cal behavioral health programs.
Key provisions
- Prohibits concurrent or retrospective review of medical necessity for the first 28 days of inpatient or residential substance use disorder stays.
- Prohibits concurrent or retrospective review of medical necessity for the first 28 days of intensive outpatient or partial hospitalization services for substance use disorder.
- Prohibits prior authorization requirements for outpatient prescription drugs used to treat substance use disorder when determined medically necessary.
- Exempts Medi-Cal behavioral health delivery systems and Medi-Cal managed care plans from certain provisions.
- Specifies that the ASAM Criteria should be used for medical necessity review.
- Requires a 24-hour review period for internal appeals.
- Establishes a timeframe for expedited external appeals.
- Defines specific terms related to substance use disorder coverage.
Who is affected
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Sponsors
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1 on record
Primary sponsor
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