10144.57. (a) Coverage of mental health and substance use disorder treatment pursuant to Section 10144.5 includes medically necessary treatment of a mental health or substance use disorder, including, but not limited to, behavioral health crisis services, provided to an insured by a 988 center or mobile crisis team, as set forth in Chapter 1 (commencing with Section 53123.1) of Part 1 of Division 2 of Title 5 of the Government Code, regardless of whether the service is provided by an in-network or out-of-network provider.
(b) An insurer shall not require prior authorization for medically necessary treatment of a mental health or substance use disorder provided by a 988 center, mobile crisis team, or other provider of behavioral health crisis services to an insured pursuant to Chapter 1 (commencing with Section 53123.1) of Part 1 of Division 2 of Title 5 of the Government Code.
(c) (1) An insurer shall reimburse a 988 center, mobile crisis team, or other provider of behavioral health crisis services for medically necessary treatment of a mental health or substance use disorder consistent with the requirements of Sections 10123.13, 10123.147, and any other applicable requirement of this part.
(2) If an insured receives medically necessary treatment for a mental health or substance use disorder from a 988 center, mobile crisis team, or other provider of behavioral health crisis services that is an out-of-network provider, the insured shall pay no more than the same cost sharing that the insured would pay for the same covered services received from an in-network provider. This amount shall be referred to as the “in-network cost-sharing amount.” An out-of-network 988 center, mobile crisis team, or other provider of behavioral health crisis services shall not bill or collect an amount from the insured for services subject to this section except for the in-network cost-sharing amount.
(d) The definition of “behavioral health crisis services” in Section 53123.1.5 of the Government Code shall apply for purposes of this section.
(e) This section does not excuse a disability insurer from complying with Section 10144.5 or any other requirement of this part.
(f) This section does not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, dental-only, or vision-only insurance policies.
(g) The commissioner may promulgate regulations 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) to implement this section, and Section 10144.4, 10144.5, 10144.51, or 10144.52 of this code. This subdivision shall not be construed to impair or restrict the commissioner’s rulemaking authority pursuant to another provision of this code or the Administrative Procedure Act.
(Added by Stats. 2022, Ch. 747, Sec. 4. (AB 988) Effective September 29, 2022.)
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