CA SB1397

Health care service plans and health insurers must reimburse county behavioral health agencies for medically necessary mental health and substance use disorder services provided to referred or authorized enrollees/insureds starting July 1, 2025.

Reimbursement rates must be the greater of either the plan's/insurer's contracted rate with the county behavioral health agency or the Medi-Cal specialty behavioral health program rate for the same or similar services.

County behavioral health agencies must contact plans or insurers before initiating services unless the enrollee/insured is already referred or authorized, and plans/insurers must offer appointments within 48 hours for urgent care or 10 business days for non-urgent care or authorize county agency services.

In-network cost sharing capped at in-network deductibles and out-of-pocket maximums applies to these services, and plans/insurers must comply with timely payment requirements.

The Department of Managed Health Care and Department of Insurance must issue guidance by April 1, 2025, regarding compliance with these provisions.