Health

Senator Wiener Introduces Legislation To Remove Barriers To …

FOR IMMEDIATE RELEASE

January 25, 2023

Contact: Erik Mebust, erik.mebust@sen.ca.gov, (916)-995-0692

Senator Wiener Introduces Legislation To Remove Barriers To Youth Mental Health Access

SACRAMENTO – Senator Scott Wiener (D-San Francisco) introduced Senate Bill 238, the Youth Mental Health Access Act. SB 238 removes barriers to youth accessing mental health treatments by requiring that any mental health treatment denials made by private insurance companies be automatically referred to the state’s existing Independent Medical Review (IMR) process.

A large number of children are suffering from mental health challenges. Unfortunately, many are denied mental health coverage by their insurance companies. Many families have no idea they can seek review of those denials, and a large number simply don’t seek review, whether for lack of knowledge or wherewithal. Of those who seek review, a very high percentage win, with the insurance company denial overturned. Nearly all families that do seek review are English speakers, meaning that almost no non-English speakers are seeking review.

Thus, by triggering automatic independent review of children’s mental health treatment denials, California will significantly expand that treatment.

“We’re experiencing a massive surge in youth mental health problems, and we need to do everything in our power to expand access,” said Senator Wiener. “This legislation removes burdensome barriers that prevent families from accessing care for their children. When insurance companies deny mental health treatments to minors, too many families are locked out because they simply don’t know how to navigate our complex healthcare system — or they don’t know about the system at all. By automatically placing these cases into the existing independent review process, we’ll make sure no child is denied care because of an insurance company’s decision to maximize its profits at their expense.”

Young people in California, and across the nation, are faced with increasingly serious mental health challenges. The U.S. Department of Health and Human Services reports that in “recent years, we have seen significant increases in certain mental health disorders in youth, including depression, anxiety, and suicidal ideation.” These challenges are the leading cause of disability and poor outcomes among young people, and they are particularly pronounced in communities of color.

Each year, thousands of families receive no treatment because of a denial of service from their insurance company. Under current California law, families denied service are required to participate in a 30-day grievance process with their insurer. If the issue is not resolved, the consumer may file an Independent Medical Review (IMR) complaint with the Department of Managed Health Care (DMHC). A board of providers not affiliated with the health plan will review the decision, and the health plan is bound by their decision.

Mental health denials make up the majority of cases that make it to IMR – and the number is growing. In 2021, more than 50% of all youth IMR cases were for a “mental disorder” diagnosis. And critically, most of these denials were reversed by the board of independent providers: according to the DMHC Annual Report, approximately 67.5% of all enrollees that submitted IMR requests in 2021 received the service(s) or treatment(s) they requested. The percentage of IMR decisions overturning mental health denials has more than doubled since 2017.

These data show that the IMR process is an effective tool to secure youth access to mental health treatments. But critically, the process doesn’t serve everyone who needs it. By placing the burden on consumers to initiate the appeals process, the status quo pushes out children whose parents never initiate the process due to language barriers, health literacy, demanding jobs, or other extenuating circumstances.

Modeled on an existing Medicare process, SB 238 removes these barriers to access by automatically placing mental health treatment denials to patients age 20 or younger under review. It builds on ​​existing mental health laws, like SB 855 (2020), which now require health plans to provide medically necessary mental health treatment. It removes an unnecessary step in the process of obtaining these critical treatments.

The bill will help provide more equal access to mental health treatment. According to reports from the DMHC call center, approximately 94% of IMRs between 2020-2022 were filed in English and 3.87% were filed in Spanish. These statistics are not reflective of the state’s population, suggesting that those who do not speak English are having trouble accessing the process to review health plan denials. 

SB 238 is sponsored by Children Now.
“The last few years have highlighted the importance of our children’s mental health,” said Lishaun Francis, Senior Director for Behavioral Health at Children Now. “We’re at a critical juncture- we can continue to ignore their needs or put into place the safeguards that ensure they can get the care they deserve. SB 238 will provide those safeguards, resulting in more kids getting crucial services.”

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