CA SB999

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

Mandates plans and insurers maintain telephone and direct communication 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 with appropriate training and relevant experience in the clinical specialty, with preference for training from nonprofit clinical specialty associations.

Establishes requirements for plans and insurers to sponsor education programs, provide clinical review criteria at no cost, track how criteria are used, conduct interrater reliability testing with 90 percent pass rate thresholds, and remediate poor performance.

Prohibits plans and insurers from applying different, additional, or more restrictive utilization review criteria than those in the most recent versions of nonprofit clinical specialty association treatment guidelines for level of care and patient care decisions.