NUHW is teaming up with Assemblymebmer Gail Pellerin (D-Santa Cruz) on two bills that would help state regulators better enforce recent mental health parity laws and help patients advocate for their rights.
AB 3221 would help the Department of Managed Health Care better enforce state law by removing roadblocks that have made it difficult for the agency to conduct effective investigations.
AB 3260 would empower patients seeking mental health care to fight for their rights and win grievances when their health plan denies them appropriate care.
The bills, which are both sponsored by NUHW, are designed to hold health plans accountable for abiding by the groundbreaking mental health laws NUHW helped pass through its work with State Senator Scott Wiener.
“The recent $200 million Kaiser settlement documents that health plans are out of compliance with parity laws,” NUHW President Sal Rosselli said. “We’ve worked with patients and regulators to understand how health plans are getting around the law, and now we’re working with our allies in Sacramento to close those loopholes.”
To strengthen the Department of Managed Health Care’s oversight of health plans, such as Kaiser, SB 3221 would allow the agency to:
- Request health plan records in a searchable digital format, allowing for faster receipt and review of records.
- Take disciplinary action when health plans fail to respond to records fully or in a timely manner.
- Seek relief on behalf of consumers through administrative hearings rather than through the slower Superior Court hearing process that is currently required.
To ensure that patients have timely access to the care they’re legally required to receive, AB 3260:
- Prohibits health plans and disability insurers from overriding a provider’s determination that a patient (consumer) requires urgent care.
- Allows consumers to file grievances immediately if their health plans or disability insurers fail to respond to their claims within the time period and in the manner required under state law.
- Requires health plans and disability insurers to automatically resolve grievances in favor of the consumer if they don’t respond within the legally-required timeframe of 72 hours for urgent cases and 30 days for non-urgent cases.
- Increases transparency and expands due process rights for consumers who file complaints with state regulators over improper denials or lack of access to care.
