Santa Clara County has prioritized the fight for mental health equity and co-sponsored state legislation to help children and youth receive better treatment for behavioral health disorders.
Senate Bill 294, authored by state Sen. Scott Wiener (D-San Francisco), would strengthen current law for insurance companies to cover a wide range of mental health conditions. The bill adds new requirements that would trigger an automatic review of health care providers if they deny mental health treatment to a patient under the age of 26.
The bill is also co-sponsored by Children Now, a research, policy, and advocacy organization.
“Young people across California are struggling with mental health, and it is our responsibility to ensure they have access to the medical care they urgently need,” Wiener said in a press release. “This legislation removes unnecessary administrative hurdles that stand between families and children with lifesaving mental health treatment,” he added.
Santa Clara County officials say it’s not uncommon for private insurance companies to deny mental health insurance claims. This placed the onus on patients and their families to challenge these denials, and ultimately more than two-thirds of his cases were overturned. “This shows that commercial health plans are unfairly denying medically necessary mental health treatment at alarmingly high rates,” the county said in a press release.
SB 294 aims to change this by introducing an automated review process that would force private insurance companies to treat mental health disorders seriously and provide young patients with the help they need more quickly. .
“Mental health issues need to be treated with the same urgency that we would treat someone with a debilitating illness, broken bone, or any physical illness requiring medical attention, no questions asked.” said Santa Clara County Supervisor Joe. Simitian’s press release.
Denial of medical care for mental health disorders is not just a health equity issue. It’s also a health equity issue. The county says navigating through the current process can be daunting for patients and their families.
First, you must file a complaint with your provider to dispute the denial. If you do not receive a resolution, you may file a complaint with the Department of Managed Care after 30 days. A panel of health care providers not affiliated with the health plan will then review the matter, and the outcome will be binding on their decision, Wiener’s office said.
Prolonged processes are just one obstacle to treatment. Patients also may not be able to challenge medical denials due to language or time constraints, or may not even be aware that option is available to them, the county said. .
Automated review of denied claims will help put mental health treatment on a more level playing field for all patients. The county also said that for emergency and life-threatening cases, access to care will be expedited by automatically referring denied claims to the state’s Independent Medical Review (IMR) process.
“Removing barriers to mental health services for youth and families is a priority, and this bill will help families access life-saving treatment,” said Sherry Terrao, county director of behavioral health services. said.
Wiener’s office said SB 294 is also fiscally responsible, as health plans pay for the grievance process and IMR process.
If passed by the state Legislature, the bill would go into effect on July 1, 2025.
