SACRAMENTO, Calif. (CN) — It’s been about three years since state lawmakers strengthened the California Parity Act, requiring insurers to cover necessary treatment for mental health and substance use disorders.
Implementing that law has proved spotty, with professionals and patients voicing their concerns at a Wednesday meeting of the Senate Select Committee on Mental Health & Addiction Compliance with California’s Mental Health Parity Law.
State Senator Scott Wiener — a San Francisco Democrat, author of Senate Bill 855 and committee chairman — gave the example of someone breaking their arm when describing parity. In that case, the person would visit a doctor, with insurance covering the costs.
“The same should be true if someone has mental health or addiction disorder,” Wiener said.
The committee took no action on Wednesday. State Senator Dave Cortese — a San Jose Democrat — said he wanted to gather information, potentially using it for future legislation on the issue.
The committee heard from health care providers, government officials and a patient who received mental health care.
Rebecca Farmer said she faced obstacles when getting care from Kaiser Permanente. She’d try to schedule an appointment, only to discover it would be four to six weeks out. She spent unknown hours in a back-and-forth trying to secure services.
Karen Larsen, CEO of nonprofit public policy organization The Steinberg Institute, noted the $50 million settlement announced this past week involving Kaiser. The health care giant agreed to pay the money, overhaul its behavioral health system and invest another $150 million within five years in behavioral health programs.
The state Department of Managed Health Care had cited Kaiser over years for its oversight issues. Over the past 15 years it brought enforcement actions against the health care provider over quality assurance compliance in its medical and behavioral health services.
Many speakers at the committee hearing accused the department of failing to protect consumers’ health care rights.
Meiram Bendat — founder of Psych-Appeal, which helps people challenge insurer claims denials — said the department has arbitrary regulations and has neglected a medical review system. Farmer called agency an absent regulator. Larsen said the department has failed to release the results of parity investigations.
“If other states can do it, why can’t we?” Larsen said of regulating what she called widespread noncompliance.
Michelle Cabrera, executive director of the County Behavioral Health Directors Association, said the department reached out to county behavioral health agencies after SB 855’s passage. It surveyed those departments on its views of the rulemaking process.
Cabrera said commercial insurance health plans rely on counties as a backstop. People with commercial insurance will receive county health services. Their insurance then won’t reimburse counties for their services. The burden falls onto taxpayers.
Lauren Finke, senior legislative advocate with The Kennedy Forum, said some health care plans inappropriately limit access to care and that’s why regulations for SB 855 are needed. Strong and continual oversight is necessary for people to get the care they need.
Mary Watanabe, director of the Department of Managed Health Care, spoke to the committee shortly afterward.
“I’m happy to be in the hot seat,” she said.
SB 855 significantly overhauled existing mental health parity law, Watanabe said, and her department has taken steps to implement it. Those affected by it received letters about compliance. For certain requirements, people must show the department how they become compliant.
“We have some of the strongest protections in California,” she said.
Her department is developing regulations for SB 855, a process taking significant time. The public comment period for the process ended this month. Watanabe hopes the regulations become effective in April.
Watanabe said her department has helped people avoid paying $4.2 million in balance billing — the difference between what a provider charges and what insurance pays.
When people file complaints with her department, it takes time to determine the proper path they should take.
“We always seem to need more people,” Watanabe said. “These cases are always complex.”
Subscribe to Closing Arguments
Sign up for new weekly newsletter Closing Arguments to get the latest about ongoing trials, major litigation and hot cases and rulings in courthouses around the U.S. and the world.
