1374.724. (a) Coverage of mental health and substance use disorder treatment pursuant to Section 1374.72 includes medically necessary treatment of a mental health or substance use disorder, including, but not limited to, behavioral health crisis services, provided to an enrollee by a 988 center or mobile crisis team, as set forth in Chapter 1 (commencing with Section 53000) 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) A health care service plan 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 enrollee pursuant to Chapter 1 (commencing with Section 53000) of Part 1 of Division 2 of Title 5 of the Government Code.
(c) (1) Notwithstanding subdivision (f) of Section 1371.4, a health care service plan 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 Section 1371.4 and any other applicable requirement of this chapter.
(2) If an enrollee 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 outside the plan network, the enrollee shall pay no more than the same cost sharing that the enrollee 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 enrollee for services subject to this section except for the in-network cost-sharing amount.
(d) The definition of “behavioral health crisis services” set forth in Section 53123.1.5 of the Government Code shall apply for purposes of this section.
(e) This section does not excuse a health care service plan from complying with Section 1374.72 or any other requirement of this chapter.
(f) This section does not apply to Medi-Cal managed care contracts entered pursuant to Chapter 7 (commencing with Section 14000), Chapter 8 (commencing with Section 14200), or Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code between the State Department of Health Care Services and a health care service plan for enrolled Medi-Cal beneficiaries.
(Added by Stats. 2022, Ch. 747, Sec. 3. (AB 988) Effective September 29, 2022.)