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Summary
“Everyone has been denied some form of care,” said a mental health defender in California. Legislators are now progressing new accounts for behavioral health coverage.
Disappointed Californians have long complained that they cannot get their health plans to cover the desperate treatment for mental health.
Nowadays, it seems that state legislators hear them – and are trying to act.
A bill introduced this session will require health plans to cough more Covered Covenant Details– And those who mistakenly deny the claims most often.
Another will require plans Wait at least 28 days After approving the patient, enter the treatment center for the use of substances before re -evaluating whether the patient may stay there.
A third would ban health plans from demanding Previous authorization For the treatment of mental health and use of substances before and during the patient’s stay in hospital.
The list goes on.
Four years after the passage of state leaders remarkable legislation In order to improve mental health and the use of substances, polls depict the public, still deeply dissatisfied with what they receive. One such poll by Californians last year found that more than 80% of the surveyed demand the governor and the legislature To increase access to treatment of mental healthS
“Everyone has been denied some form of care,” says John Zbinger, a senior defender at the Steinberg Institute, an advocacy organization. “Nobody likes this. If you haven’t been, you know someone who has.”
At February a supervisory hearing of the Budget Committee and Senate Fiscal Review, WienerThe Democratic State Senator in San Francisco, who is the author of the 2020 coverage law called the process by which consumers can Refusal of the State Department of Management Health Care “burdensome, opaque and time -consuming”.
In light of federal efforts to dismiss workers and remove data from government websites, he said: “It is more important than ever to lead.”
It is still early enough in the process that any of the proposed legislation can be stimulated by various factors, including federal fiscal uncertainty, health opposition and disagreement between defenders about the best approach.
Last year, a handful of bills designed to hold health plans eventually died late in the legislative process. Proponents blame Navigated Costs of Cost about their death.
But some of these same legislators and defenders say that the tenor of the conversation changed in the months after 26-year-old Luigi Mangione shot and killed Brian Thompson, CEO of UNITEDHEATHALTHARE, last December. This murder caused a pouring of public frustration and became a cultural flash.
During the hearing of Supervision in February, Mary Vatanabe, Director of the Ministry of Management Health Care, seemed open to requiring plans to provide more information on the refusal of the coverage.
“We really strive to understand the barriers that consumers are experiencing by navigating the behavioral health system,” she said.
Mary Ellen Grant, a spokeswoman for the California Association of Health Plans, said in an email that it is premature to offer a comment, given that the Industrial Association has not yet taken an official position on the individual bills. It provided a factual sheet of the importance of the preliminary permission for “making health care more fascinated, higher quality and more accessible”.
Here are some of the best accounts trying to deal with this problem:
Wiener would like to see much more transparency from commercial health plans. His Senate 363 bill will require plans to report detailed state data on how often they deny treatment. This bill applies to the waiver of all types of medical care, not just mental health.
The state also has its own appealing process for consumers known as Independent medical examinationS Wiener’s bill will also penalize plans if the state cancels their refusals of more than half the time.
Wiener admits that health plans have proven “worthy opponents” of some of his other bills. But he calls the impetus for greater accountability “long overdue”. Ever since he introduced the legislation, he said, he has been struck by how many people have stopped him on the streets of San Francisco to share his personal nightmares that he has been refused reflection.
“It touches a nerve,” he said.
Assembly Bill 669 They will keep plans to review the patient’s eligibility for continuing treatment with the use of substances up to at least 28 days after their approval.
Matt Hani, Democratic State Assembly from San Francisco, who is the author of the bill, says his interest in the bill was inspired by Ryan Matlook HistoryS A Matlok, a young man whose story was presented at Calmatters last fall, died of an overdose of fentanyl shortly after his health plan decided to stop covering his housing treatment. Initially, the plan decided that Matlock did not need to stay in the hospital after spending only three days there. Matlok’s mother, Christine Doggree, testifies on behalf of the legislation.
Hani says 12 other states already have similar laws.
“It is also angry that the insurer may refuse to care that they say they need, and their doctor says they need, but this is denied the hired” hired of the insurer “who has never even spoken to the patient,” he said.
Among the organizations sponsoring the bill are the California Consortium on Addiction Programs and Professionals, the California Association for Behavioral Health, the Coalition for Advocate for the Treatment of Addiction and a new path (parents for the treatment and healing of addiction).
The Mental Health Affairs Act, AB 384, will prevent health plans Requirement of prior permission For stationary care for mental health and treating the use of substances. It will also prevent plans from requiring prior permission for any medical assistance, which are considered necessary during the stationary stay.
Damon KonoliDemocratic State Council from San Rafael says he has modeled the bill from such, successful legislation in Illinois.
“Too frequently preliminary permission creates a delay in a situation where every second counts,” he said.
The California State Association of Psychiatrists and the California Association for Behavioral Health jointly sponsor the bill.
Health plans are needed to cover medical care for health and mental health. But what is a medical need? A bill of the Democratic State Assembly member of Freen Joaquin ArambulaAB 980, would Determine “medically needed” To mean legally prescribed medical care that is reasonable and fits in with the standards set by the medical community. The bill also describes in detail the damage that plans can be responsible if such care is not provided.
As wild fires erase entire neighborhoods in the state, it is clear that some people in devastated communities will need behavioral health treatment. Democratic State Assembly Bill John Harabedian from Pasadena and Robert Rivas By Salinas, AB 1032 will require health insurers to reinstate to participants from a disaster zone for up to up 12 visits with a licensed behavioral health provider During the year after an event with a wild fire.