Effective Jan. 1, 2021, the revised bill:

Requires health plans to determine medical necessity by following "current generally accepted standards of mental health and substance use disorder care."
Requires health plans to follow the most current treatment criteria set forth by the nonprofit professional association related to that particular clinical specialty, and explicitly prohibits them from using their own utilization criteria in most cases. Plans may set their own criteria to keep up with advances in technology that are not covered by other relevant utilization guidelines.
Authorizes the director of the Department of Managed Health Care or the Insurance Commissioner to assess penalties for violating utilization review requirements.
Requires plans to sponsor formal education for any staff or third party that makes decisions regarding utilization.

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California bill expands mental health, substance abuse disorder coverage