Coordinated specialty care for early psychosis: interventions and access to care.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene) , provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts and health insurance policies that provide hospital, medical, or surgical coverage to provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses, as defined, of a person of any age. This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on and after January 1, 2023, to provide coverage for coordinated specialty care (CSC) services for the treatment of early psychosis, composed of specified treatment modalities and affiliated activities including, but not limited to, case management, pharmacotherapy and medication management, psychotherapy, and outreach and recruitment activities. The bill would require those treatment modalities and affiliated activities to be billed and reimbursed as a bundle. The bill would require the CSC services provided to be consistent with specified provisions applicable to the treatment of mental health and substance use disorders. The bill would specify the membership of the CSC team. The bill would specify that these provisions do not apply to specified Medi-Cal managed care contracts entered into between the State Department of Health Care Services and a health care service plan for enrolled Medi-Cal beneficiaries. The bill would require the California Health and Human Services Agency, in consultation with the Mental Health Services Oversight and Accountability Commission, to commission a study to improve understanding, awareness, and accountability associated with psychosis, the duration of untreated psychosis, and its impacts. Among other components, the bill would require the study to document the annual prevalence rate for the onset of psychosis in California and the availability of coordinated specialty care services to Californians who experience a first episode of psychosis, and to recommend a state or county-based system, or both, to monitor outcomes associated with access to the most effective interventions and services in response to psychosis and those associated with the lack of access to effective interventions and services, as specified. The bill also would require the agency, in consultation with the commission, to develop and implement strategies to annually improve access to effective interventions for early psychosis, and to improve the access to, and quality of, care for persons with severe and persistent psychosis, as specified. Because a violation of certain requirements of the bill by a health care service plan would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.