California Psychiatric Association Documents

Key Provisions of AB 88 (Thomson), Non-Discriminatory Health Care Coverage for Mental Disorders and related legislation

AB 88 (Thomson and Perata), was enacted as Chapter 534 of the 1999 statutes, took effect on July 1, 2000, and was phased in as HMOs and insurers renewed their coverage contracts. In most cases, contracts are renewed annually, so this law should have covered nearly all insureds by July 1, 2001.

As of July 1, 2000, AB 88 requires HMOs to provide the same coverage as they provide for all other illnesses for treatment of the severe mental disorders of 

• schizophrenia
• schizoaffective disorder
• bipolar disorder
• major depressive disorders
• panic disorder
• obsessive-compulsive disorder
• pervasive developmental disorder or autism
• anorexia nervosa and bulimia nervosa, and
• serious emotional disturbances in children.

Health insurers will also have to cover them, but will be allowed to use an HMO model for this coverage. CPA has engaged in 2 implementation projects. Dr. Shadoan headed a task force to work with the plans to assure appropriate implementation. CPA co-sponsored, with the California Medical Foundation and NAMI California, a conference on implementation.

Since many have experienced an HMO engaging in tactics to avoid coverage, such as questioning medical necessity, some other bills enacted in 1999 may be important to AB 88's being fully effective. They include the following.

• SB 59 (Perata), Chapter 539, establishes time frames and procedures for HMOs to review a treatment request by a physician.
• AB 55 (Migden), Chapter 533, requires an external independent review when a patient contests a plan's denial, delay or modifications of a treatment recommended by the patient's doctor. It is effective January 1, 2001.
• SB 189 (Schiff), Chapter 542, requires the HMO to give written responses to grievances, and expedites the review process.
• AB 78 (Gallegos), Chapter 525, created a new state agency, the Department of Managed Health Care (DMHC), and an Office of the Patient Advocate to assist patients with complaints and engage in other consumer protections. DMHC has a website, www.dmhc.ca.gov. Additionally, the consumer help line is 888-HMO-2219, the complaint line for physicians is 877-525-1295, and the e-mail for physicians to contact DMHC is plans-providers@dmhc.ca.gov.
• AB 215 (Soto), Chapter 530, sets deadlines for HMOs to respond to physician requests for referral of a patient to a specialist.

NOTE: A copy of AB 88, can be obtained through the legislature's informational web site, www.leginfo.ca.gov, Choose "legislation" and insert the bill number you are seeking (choose Assembly Bills, 1999-2000 session).

Prepared by staff of California Psychiatric Association, 2000, updated April 2003.