Bill > AB1429

This bill requires a specific health care service plan (referred to as "the plan" in the bill and identified through a Department of Managed Health Care enforcement matter) to fully reimburse enrollees for out-of-pocket behavioral health care expenses incurred from non-plan providers or facilities. Enrollees must submit detailed documentation, including receipts, invoices, and a statement explaining why they couldn't obtain care through their plan, and the plan must reimburse them within 60 calendar days. These reimbursement requirements apply to expenses incurred on or after May 1, 2022, and will remain in effect until the Department of Managed Health Care certifies that the plan has successfully implemented its corrective action work plan. If the plan fails to provide reimbursement, it must pay the original amount plus 10% annual interest and a $5,000 fine per incident. The bill also requires the plan to establish clear procedures for submitting and processing reimbursement requests and to submit monthly reports to the department detailing the number of requests received, amounts reimbursed, processing times, and reasons for any denied requests. The legislation is specifically designed to address ongoing issues with behavioral health care services and ensure patients receive adequate compensation for their out-of-pocket expenses.

Budget and Finance, Health and Social Services

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260AB1429