CA SB999

Requires health care service plans and disability insurers to base medical necessity determinations for mental health and substance use disorder treatment on current generally accepted standards of care from nonprofit clinical specialty associations.

Prohibits plans and insurers from applying different, additional, conflicting, or more restrictive utilization review criteria than those established by professional clinical specialty guidelines for level of care placement and patient care decisions.

Mandates health care providers and insurers maintain telephone access during California business hours for providers to request authorization and conduct peer-to-peer discussions regarding mental health and substance use disorder treatment.

Requires utilization review determinations to be made by health care providers in the same clinical specialty with equivalent education, training, experience, and certification as the requesting provider.

Establishes requirements for staff education programs, interrater reliability testing with a minimum 90 percent pass rate, and detailed disclosure of denial reasons citing specific clinical guidelines.