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DMHC takes action to ensure health plans comply with California’s Mental Health and Substance Use Parity Law

The California Department of Managed Health Care (DMHC) today issued guidance to ensure health plans comply with amendments made to California’s mental health parity law enacted under Senate Bill (SB) 855, authored by Senator Scott Wiener (D-San Francisco) and signed by Governor Gavin Newsom last year.

“The DMHC is committed to ensuring Californians can access quality mental health and substance use disorder services. This is especially critical right now as people are dealing with the COVID-19 pandemic that has no doubt had an impact on the mental health of many,” said DMHC Director Mary Watanabe. “This new law strengthens California’s mental health parity statute and will help improve access to quality mental health and substance use disorder services.”

SB 855 requires commercial health plans and insurers to provide full coverage for the treatment of all mental health conditions and substance use disorders. It also establishes specific standards for what constitutes medically necessary treatment and criteria for the use of clinical guidelines.

This new law applies to all state-regulated health care service plans and insurers that provide hospital, medical, or surgical coverage, and to any entity acting on the plan or insurer’s behalf. A health plan cannot limit benefits or coverage for mental health or substance use disorders treatments or services when medically necessary.

The DMHC issued an All Plan Letter to all commercial full-service health plans and specialized health plans offering behavioral health services that are regulated by the Department requiring the plans demonstrate compliance with SB 855. A fact sheet is also available to help health plan enrollees understand the changes under SB 855.

Additionally, the 2020-2021 state budget approved strategies to strengthen enforcement of behavioral health parity laws including focused investigations of commercial health plans regulated by the DMHC. These investigations will help the Department to further evaluate health plan compliance with parity and assess whether enrollees have consistent access to medically necessary behavioral health care services. The Department expects to begin the first investigations in the first quarter of 2021.

Health plan enrollees having trouble accessing behavioral health care treatment or services, should first contact their health plan at the member services phone number on their health plan member card. Their health plan will review the grievance and should ensure the enrollee is able to timely access medically necessary care. If the enrollee does not agree with their health plan’s response, they should contact the DMHC Help Center at www.HealthHelp.ca.gov or by calling 1-888-466-2219. The enrollee should contact the DMHC immediately if they are facing an urgent issue.

This article was released by the California Department of Managed Health Care.