Healthcare (Mental Health)

Existing law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs and charges it with administrative and enforcement duties related to the provision of medical services under the act. The act makes unprofessional conduct subject to discipline by the board the regular practice of medicine in a specified hospital having 5 or more physicians and surgeons on the medical staff without rules established by the board of directors to govern the operation of the hospital. The act requires the rules to include a provision for the organization of physicians and surgeons into a formal medical staff with staff appointments on an annual or biennial basis. This bill would revise that provision to instead require staff reappointments at least every 3 years. Existing law requires that physician and surgeon staff require members of the staff to demonstrate their ability to perform surgical and other procedures competently and to the satisfaction of an appropriate committee or committees of the staff at the time of original application for appointment to the staff and at least every 2 years thereafter. This bill would instead require physician and surgeon staff to require members of the staff to demonstrate their ability at least every 3 years thereafter. Existing law provides for the licensure and inspection of health facilities, including general acute care hospitals and acute psychiatric hospitals, by the State Department of Public Health and makes a violation of those provisions a crime. This bill would require the governing body of a general acute care hospital or an acute psychiatric hospital to require that medical staff establish controls that are designed to ensure the achievement and maintenance of high standards of professional ethical practices, including a requirement that all members of the medical staff be required to demonstrate their ability to perform surgical or other procedures competently and to the satisfaction of an appropriate medical staff committee or committees at the time of original application for appointment to the medical staff and every 3 years thereafter. The bill would prohibit the department from requiring an acute care hospital or acute psychiatric hospital to undertake routine reappointments more frequently than every 3 years. Because a violation of this requirement would be a crime, this bill would impose a state-mandated local program. 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.

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, or renewed on or after January 1, 2021, to provide coverage for medically necessary treatment of mental health and substance use disorders, as defined, under the same terms and conditions applied to other medical conditions. This bill would generally require a large group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2026, to reimburse an eligible enrollee or insured for up to 12 visits with a behavioral health provider if the enrollee or insured lives in a county where a local or state emergency has been declared due to wildfires and the enrollee or insured has experienced a loss, trauma, or displacement because of the fire. The bill would prohibit these benefits from being subject to utilization review. The bill would require a health care service plan contract or health insurer to provide notice to all affected enrollees of these provisions, as specified. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. 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. This bill would declare that it is to take effect immediately as an urgency statute.