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BHAM legislative update: Spring 2024

NUHW took positions on five behavioral healthcare bills this legislative session, including the two bills we sponsored. Only one of those bills — State Senator Scott Wiener’s Psychedelic Assisted Therapy legislation — failed to advance. Below is a summary of where the five bills stand.

NUHW sponsored AB 3221 (Pellerin) Department of Managed Health Care: This bill would allow the Department of Managed Health Care (DMHC) to take faster and more effective enforcement action to address improper denials of needed physical and behavioral health care. It would also improve compliance with the groundbreaking behavioral health parity and timely access laws California recently enacted. The bill would allow the DMHC to request that health plan records provide in electronic form, seek relief on patients’ behalf through an administrative hearing rather than through the slower and more burdensome Superior Court process, and take disciplinary action when a health plan fails to respond to a request for records fully or in a timely manner. It would also clarify timelines for enforcement actions. This bill passed the Assembly Floor by a vote of 71-0 on May 13, 2024, and has been referred to the Senate Health Committee. A hearing date has not yet been set.

NUHW sponsored AB 3260 (Pellerin) Strengthening grievance procedures: Our patient-focused bill that holds health plans accountable by strengthening grievance procedures and improving regulatory transparency. It would prohibit health plans and disability insurers from overriding a provider’s designation of a condition as urgent, tighten the timelines health plans have to approve/deny requests for care, and trigger an immediate grievance if a health plan fails to respond in a timely manner. If a health plan or disability insurer fails to resolve a grievance within mandated timeframes, it would automatically resolve in the patient’s favor. This bill passed out of the Assembly On May 21, 2024 with a vote was 57-1.The bill is now in the Senate, but has not yet been referred to Committee.

AB 236 (Holden) – Ghost networks: Every health plan in California is required to maintain an updated list of in-network health care providers for their enrollees.Too often providers on these lists are unreachable or do not actually provide care to consumers covered by that health plan. These are called “ghost networks.” This bill would establish accuracy benchmarks for plans, require plans to audit their provider networks annually, and establish penalties for health plans that fail to meet the accuracy benchmarks. The bill passed the Assembly Floor Jan 30 2024, with a vote of 59-9. It has been referred to Senate health. The hearing date has not yet been set.

SB 1012 (Wiener) Psychedelic Assisted Therapy: This bill would have established a professional licensing board for psychedelic therapy facilitators to develop training programs, ethical standards, scope of practice guidelines, and regulatory oversight. The facilitators would have provided therapeutic access to certain psychedelic substances for persons 21 and older, in a therapeutic context under the supervision of a licensed and trained facilitator. Unfortunately this bill died in the Senate Appropriations Committee on May 16.

SB 999 (Cortese) Health coverage for substance use disorder: This bill would ensure that Californians suffering from mental health and substance use disorders are able to receive the level of treatment necessary to safely recover from addiction. It would ensure that appeals of utilization review determinations are determined by a provider with appropriate training and relevant experience in the clinical specialty and diagnosis. The bill would disclose the name and credentials of the reviewer and the basis for a denial, including a citation to the clinical guidelines reviewed as well as an analysis of why the patient did not meet the clinical criteria. This bill passed the Senate Floor on May 21st, by a vote of 31-7. It is now in the Assembly awaiting referral to committee.

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