SB812 - Qualified youth drop-in center health care coverage.

Amended IN Assembly July 17, 2025 Amended IN Senate May 05, 2025 Amended IN Senate April 08, 2025 CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION Senate Bill No. 812 Introduced by Senator Allen (Principal coauthor: Assembly Member Muratsuchi) (Coauthor: Senator Rubio) February 21, 2025 An act to amend Section 1374.722 of the Health and Safety Code, to amend Section 10144.53 of the Insurance Code, and to amend Section 5961.4 of the Welfare and Institutions Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST SB 812, as amended, Allen. Qualified youth drop-in center health care coverage. 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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders to cover the provision of those services to an individual 25 years of age or younger when delivered at a schoolsite. This bill would expand the definition of schoolsite to additionally require a contract or policy that provides coverage for medically necessary treatment of mental health and substance use disorders to cover the provision of those services to an individual 25 years of age or younger when delivered at a qualified youth drop-in center. Because a violation of this requirement relative to health care service plans would be a crime, the bill would create a state-mandated local program. Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires a Medi-Cal managed care plan or Medi-Cal behavioral health delivery system to reimburse providers of medically necessary outpatient mental health or substance use disorder treatment provided at a schoolsite to a student 25 years of age or younger who is an enrollee of the plan or delivery system, as specified. This Because of the expansion of the definition of schoolsite to include qualified youth drop-in centers, this bill would expand the above-described reimbursement requirement to those services when provided at a qualified youth drop-in center, as specified. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill Text The people of the State of California do enact as follows: SECTION 1. Section 1374.722 of the Health and Safety Code is amended to read: 1374.722. (a) (1) A health care service plan contract issued, amended, renewed renewed, or delivered on or after January 1, 2024, that is required to provide coverage for medically necessary treatment of mental health and substance use disorders pursuant to Sections 1374.72, 1374.721, and 1374.73 shall cover the provision of the services identified in the fee-for-service reimbursement schedule published by the State Department of Health Care Services, as described in subparagraph (B) of paragraph (5) of subdivision (c), when those services are delivered at schoolsites or qualified youth drop-in centers pursuant to this section, regardless of the network status of the local educational agency, institution of higher education, or health care provider. (2) This section does not relieve a local educational agency or institution of higher education from requirements to accommodate or provide services to students with disabilities pursuant to any applicable state and federal law, including, but not limited to, the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.), Part 30 (commencing with Section 56000) of Division 4 of Title 2 of the Education Code, Chapter 26.5 (commencing with Section 7570) of Division 7 of Title 1 of the Government Code, and Chapter 3 (commencing with Section 3000) of Division 1 of Title 5 of the California Code of Regulations. (b) The following definitions apply for purposes of this section: (1) “Health care provider” has the same meaning as defined in paragraph (4) of subdivision (a) of Section 1374.72 and paragraph (5) of subdivision (c) of Section 1374.73. (2) “Institution of higher education” means the California Community Colleges, the California State University, or the University of California. (3) “Local educational agency” means a school district, county office of education, charter school, the California Schools for the Deaf, and the California School for the Blind. (4) “Medically necessary treatment of a mental health or substance use disorder” has the same meaning as defined in paragraph (3) of subdivision (a) of Section 1374.72. (5) “Mental health and substance use disorder” has the same meaning as defined in paragraph (2) of subdivision (a) of Section 1374.72. (6) “Qualified youth drop-in center” means a center providing behavioral or primary health and wellness services to youth 12 to 25 years of age, inclusive, with the capacity to provide services before and after school hours that has been designated by or embedded with a local educational agency or institution of higher education for the purposes of this section. (6) ”Qualified youth drop-in center” means a center to which all of the following apply: (A) The center provides behavioral health and wellness services to youth up to 25 years of age, inclusive, or to a subset of youth who are between 12 and 25 years of age, inclusive. (B) The center provides at least one or more additional youth services, including, but not limited to, health services, services to support youth education and employment, and services to assist families to support youth. (C) The center has the capacity to provide services before and after school hours. (D) The center has been designated by or embedded with a local educational agency or institution of higher education for the purposes of this section. (E) The center has a physical location and offers face-to-face services. (F) The center is operated by a nonprofit entity, local government agency, or a federally recognized Indian tribe, tribal organization, urban Indian organization, or other tribal entity as designated by the department. (7) “Schoolsite” means a facility or location used for public kindergarten, elementary, secondary, or postsecondary purposes. “Schoolsite” also includes a location not owned or operated by a public school, or public school district, if the school or school district provides or arranges for the provision of medically necessary treatment of a mental health or substance use disorder to its students at that location, including off-campus clinics, mobile counseling services, qualified youth drop-in centers, and similar locations. (8) “Utilization review” has the same meaning as defined in paragraph (3) of subdivision (f) of Section 1374.721. (c) If a local educational agency, agency or institution of higher education, or qualified youth drop-in center education provides or arranges for the provision of treatment of a mental health or substance use disorder services subject to this section by a health care provider for an individual 25 years of age or younger at a schoolsite or qualified youth drop-in center, schoolsite, the student’s health care service plan shall reimburse the local educational agency, agency or institution of higher education, or qualified youth drop-in center education for those services. If an affiliated provider is designated by a local education agency or institution of higher education to directly submit claims and receive reimbursement for fee schedule services, a student’s health care service plan shall reimburse an affiliated provider directly. (1) A health care service plan shall not require prior authorization for services provided pursuant to this section. (2) A health care service plan may conduct a postclaim review to determine appropriate payment of the claim. Payment for services subject to this section may be denied only if the health care service plan reasonably determines that the services were provided to a student not enrolled in the health plan, were never performed, or were not provided by a health care provider appropriately licensed or authorized to provide the services. (3) Notwithstanding paragraph (1), a health plan may require prior authorization for services as authorized by the department pursuant to subdivision (d). (4) A local educational agency, community college district, the California State University system, or the Regents of the University of California may consolidate claims for purposes of submitting the claims to a health care service plan. (5) A health care service plan shall provide reimbursement for services provided to students pursuant to this section at the greater of either of the following amounts: (A) The health plan’s contracted rate with the local educational agency, institution of higher education, or health care provider, if any. (B) The fee-for-service reimbursement rate published by the State Department of Health Care Services for the same or similar services provided in an outpatient setting, pursuant to Section 5961.4 of the Welfare and Institutions Code. (6) A health care service plan shall provide reimbursement for services provided pursuant to this section in compliance with the requirements for timely payment of claims, as required by this chapter. (7) Services provided pursuant to this section shall not be subject to copayment, coinsurance, deductible, or any other form of cost sharing. (8) An individual or entity shall not bill the enrollee or subscriber, nor seek reimbursement from the enrollee or subscriber, for services provided pursuant to this section. (d) No later than December 31, 2023, the director shall issue guidance to health care service plans regarding compliance with this section. This guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). Any guidance issued pursuant to this subdivision shall be effective only until the director adopts regulations pursuant to the Administrative Procedure Act. (e) This section does not apply to contracts entered into pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, between the State Department of Health Care Services and a health care service plan for enrolled Medi-Cal beneficiaries. SEC. 2. Section 10144.53 of the Insurance Code is amended to read: 10144.53. (a) (1) A disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, that is required to provide coverage for medically necessary treatment of mental health and substance use disorders pursuant to Sections 10144.5, 10144.51, and 10144.52 shall cover the provision of the services identified in the fee-for-service reimbursement schedule published by the State Department of Health Care Services, as described in subparagraph (B) of paragraph (5) of subdivision (c), when those services are delivered at schoolsites or qualified youth drop-in centers pursuant to this section, regardless of the network status of the local educational agency, institution of higher education, or health care provider. (2) This section does not relieve a local educational agency or institution of higher education from requirements to accommodate or provide services to students with disabilities pursuant to any applicable state and federal law, including, but not limited to, the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.), Part 30 (commencing with Section 56000) of Division 4 of Title 2 of the Education Code, Chapter 26.5 (commencing with Section 7570) of Division 7 of Title 1 of the Government Code, and Chapter 3 (commencing with Section 3000) of Division 1 of Title 5 of the California Code of Regulations. (b) The following definitions apply for purposes of this section: (1) “Health care provider” has the same meaning as defined in paragraph (4) of subdivision (a) of Section 10144.5 and paragraph (5) of subdivision (c) of Section 10144.51. (2) “Institution of higher education” means the California Community Colleges, the California State University, or the University of California. (3) “Local educational agency” means a school district, county office of education, charter school, the California Schools for the Deaf, and the California School for the Blind. (4) “Medically necessary treatment of a mental health or substance use disorder” has the same meaning as defined in paragraph (3) of subdivision (a) of Section 10144.5. (5) “Mental health and substance use disorders” has the same meaning as defined in paragraph (2) of subdivision (a) of Section 10144.5. (6) “Qualified youth drop-in center” means a center providing behavioral or primary health and wellness services to youth 12 to 25 years of age, inclusive, with the capacity to provide services before and after school hours that has been designated by or embedded with a local educational agency or institution of higher education for the purposes of this section. (6) ”Qualified youth drop-in center” means a center to which all of the following apply: (A) The center provides behavioral health and wellness services to youth up to 25 years of age, inclusive, or to a subset of youth who are between 12 and 25 years of age, inclusive. (B) The center provides at least one or more additional youth services, including, but not limited to, health services, services to support youth education and employment, and services to assist families to support youth. (C) The center has the capacity to provide services before and after school hours. (D) The center has been designated by or embedded with a local educational agency or institution of higher education for the purposes of this section. (E) The center has a physical location and offers face-to-face services. (F) The center is operated by a nonprofit entity, local government agency, or a federally recognized Indian tribe, tribal organization, urban Indian organization, or other tribal entity as designated by the department. (7) “Schoolsite” means a facility or location used for public kindergarten, elementary, secondary, or postsecondary purposes. “Schoolsite” also [Text truncated for display. Full text available on Congress.gov.]