On Sept. 25, Governor Gavin Newsom signed into law more than a dozen bills aiming to expand mental health coverage in California.
California’s new bills aim to increase mental health treatments, covering far more conditions than the state’s previous mental health laws, the biggest one being addiction. The bills also clarify new guidelines for insurance denials.
These bills are some of the strictest mental health bills in the nation. Federal and state law already mandates that insurance companies cover mental health treatments. But many patient advocates claim that they still allow insurance companies to pay for care only after the mental illness has reached a late-stage crisis, or even allow companies to outright deny coverage, reported by NPR.
Assembly Bill 2112, introduced by Assemblymember James Ramos (D-Highland), establishes an Office of Suicide Prevention within the State Department of Health. This office would help providers share their best practices in helping treat youths contemplating suicide.
The office would focus and help groups most at risk such as youth, Native American youth, older adults, veterans, and LGBTQ+ people. This bill has determined that suicide is a public health crisis that has warranted a response from the state.
Over the last three years, suicide rates have gone up 34% between the ages of 15 and 19. And is the second leading cause of death among young people, reported by the CDC. The added stress related to the coronavirus pandemic has increased mental health issues as well. Hotlines have seen a dramatic increase in calls, according to the San Jose Spotlight. Yet, many people don’t have mental health coverage under their insurance plans.
The new laws signed on Sept. 25 defines the term “medical necessity”, a measure obligating private health insurance companies to pay more for substance abuse and mental health programs. Current state laws call for health plans to cover treatment for just nine serious mental illnesses.
Senate Bill 855, authored by Sen. Scott Wiener (D-San Francisco), would provide coverage for medically necessary care of mental health and substance abuse disorders based on the same standards of physical treatments. Coverage for Post-Traumatic Stress Disorder, generalized anxiety disorder, eating disorders, and opioid and alcohol use disorders are those not covered by the state’s previous mental health parity law, according to Wiener.
Mental health treatment would now be equal to physical health conditions in terms of providing the same coverage.
“Mental health care is essential to a person’s overall health, and today, we reaffirmed that people must have access to care for mental health and addiction challenges,” Weiner said about the new bill passing.
Weiner also claims that California’s mental health parity law has huge loopholes, which has allowed the insurance industry to deny important care.
Senate Bill 854, introduced by Sen. Jim Beall (D-San Jose), would help offer treatment to those who suffer from substance abuse. The bill would cover all medically necessary prescription drugs, approved by the FDA, for treating substance use disorders. It would also place all outpatient prescription drugs on the lowest copayment tier maintained by the health care service plan.
Many health insurance companies opposed the new bills, claiming that increased mental health and substance use services could lead to higher costs and premiums.
The California Association of Health Plans, one of the state’s insurance regulators, claims that the “mental health parity laws are well-established both in state and federal law.” In their press release about the new bills, they argued that the defined term “medical necessity” will restrict the “ability of the provider to determine what is clinically appropriate for the individual – ultimately putting vulnerable patients at risk.”
The new laws will take effect on Jan. 1, 2021.
