New California Mental Health Law

Each year in the United States, millions of Americans struggle to obtain access to the mental health care they need. Those seeking treatment for mental illnesses are forced to navigate through disjointed and expensive obstacle-riddled systems that cause stress and loss to follow-ups. From the opioid epidemic to the COVID-19 pandemic, Americans have faced diseases of the mind for decades. In addition to the complicated and unfair path to mental health treatment, the stigma surrounding mental illness has infected the country for years. The state of California recently enacted a new law with the goal of significantly improving access to care for mental health and substance use disorders (SUD). Let’s see what this mental health law means for the state, and reveal how Overland IOP is able to benefit its community.

What is the New Mental Health Law?

The new law in California states that commercial health insurance companies must adopt standardized criteria for care and cover all necessary medical care including the treatment of any mental health issues or addiction disorders. This standard of care for mental illnesses will align with the most recent edition of the DSM-5 or the Diagnostic and Statistical Manual of Mental Disorders. The new state law will compel commercial health plans and insurers to provide full coverage for treatment of all mental health conditions and substance use disorders, including but not limited to the treatment of post-traumatic stress disorder (PTSD), generalized anxiety disorder, and opioid or substance use disorders. Most importantly, the new law clearly establishes specific standards for medically necessary treatment and criteria for the use of clinical guidelines.

Senate Bill 855 serves to fill the void created by the way mental illness and its treatment has been handled by the state of California, and the entire United States. The bill serves to redefine the meaning of the term “medical necessity” that is used by most health plans across the nation. Until recently, the term did not meet the nationally recognized standard of care and was developed by insurance companies using their own criteria.

What This New Law Means for California

In the past, most American’s that have sought out treatment for mental health and addiction have been forced to exhaust their savings, max out their credit cards, or take out second mortgages on their homes. This happens as a result of their health insurers finding ambiguities in federal laws placed to protect people in these exact situations. Laws and decisions to implement change in these situations come from the state level and California’s governance on such a perilous issue will be responsible for saving lives, as well as preventing insurance companies from shifting costs associated with mental health and substance use disorders to Medicaid and public programs. The ultimate goal of the new law is to make treatment of these stigmatized disorders more accessible to the residence of California.

Under the new law, health insurance policies or health care service plans are not able to deny a claim based on a differing definition of the term “medical necessity”. They no longer have the right to limit benefits or coverage for mental health and substance use disorders to short-term or acute treatment. Additionally, in the event that medically necessary services are not available in the patients’ network or within state geographic and most importantly, timely access standards, the insurance company or service plan is obligated to arrange for out-of-network coverage that corresponds to the geographic and timely access standards. This includes medically necessary follow-up services. Limited access to follow-up care is one of the ways the mental health treatment system in the united states fails every day, so this point is extremely important. The law mandates that the individual will be required to pay no more than what would have been paid for the same services received within their network.