Newly Introduced Bills Aim to Improve, Expand Behavioral Health Insurance Coverage

Lawmakers in one state have introduced two new bills designed to improve and expand insurance coverage for behavioral health services.

The legislation was proposed Tuesday in California, a state that frequently sets legislative trends known to catch on nationwide.

The bills in question — Senate Bill 854 and Senate Bill 855 — target private insurance companies and how they cover certain behavioral health conditions. The bills do not apply to public insurance programs such as Medicare and Medicaid. 

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Historically, insurers have come under fire for behavioral health parity concerns and violations. The goal is to expand coverage and reduce the number of hurdles patients and providers must jump through before insurers will pay for treatment. 

While the bills have a long way to go before becoming law, the California Council of Community Behavioral Health Agencies (CBHA) applauded their introduction. CBHA represents non-profit behavioral health providers across the state.

“We support any efforts to promote behavioral health treatment, specifically anything that’s going to improve patient access or experience,” Le Ondra Clark Harvey, CBHA’s director of policy and legislative affairs, told Behavioral Health Business. 

Harvey is also the executive director of the California Access Coalition, which educates policymakers on behalf of behavioral health stakeholders. 

“The bills propose lowering costs and sharing tiers for health plans and drug formularies and making the prior authorization process more client friendly, which we’re very supportive of,” she said. “The transparency language that’s being shared is also promising. They’re all steps in the right direction.”

Legislative specifics 

State Senators Scott Wiener and Jim Beall coauthored the bills.

SB 854 takes aim at prior authorization and step requirements for medication-assisted treatment (MAT). If passed, it would prohibit insurers from making beneficiaries try other forms of SUD treatment before covering MAT, if MAT is recommended by the patient’s doctor.

While MAT is often considered the most effective intervention for conditions such as opioid use disorder (OUD), some are still against the treatment, which combines medication and counseling. As such, insurers can deny MAT coverage and point patients to other forms of treatment to try first. 

Meanwhile, SB 855 goes a step beyond current federal and state parity laws to mandate that insurers cover any form of behavioral health treatment that a patient’s doctor deems “medically necessary.” 

Currently, the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) only prevents insurers from imposing more stringent coverage limitations on mental health and substance use disorder benefits than on medical and surgical benefits. Additionally, the California Mental Health Parity Act of 1999 only requires insurers to cover nine serious mental illnesses.

“No one should have to forego mental healthcare until they’ve deteriorated to the point where they’re in crisis and in the ER,” Wiener said in a press release announcing the bills’ introduction. “And no one should have to go into debt to pay for substance use disorder or mental health treatment. It’s time for every Californian to have access to comprehensive and preventative mental and physical health care.”

Meanwhile, a spokesperson from the California Association of Health Plans told the San Francisco Chronicle the bills “are less about mental health parity and more about creating new mandates.” 

“It is hard to understand how SB 855 could be called a mental health parity bill when it sets forth a new system for medical necessity that is at a higher level than other medical services,” spokesperson Mary Ellen Grant told the publication. 

The introduction of SB 854 and SB 855 comes just a few months after California passed two new laws aimed to regulate the substance abuse treatment industry. 

In October, Gov. Gavin Newsom signed AB 919 and AB 290 into law. They’re meant to target fraudulent and unscrupulous substance abuse treatment providers by restricting behavioral health providers’ ability to offer housing and transportation as part of their services, as well as their ability to pay for clients’ insurance coverage.

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