California law aims to strengthen access to mental health services
The law requires that patients with mental health and addiction issues be offered return appointments no more than 10 days after a previous session.
This article was published on Monday, November 1, 2021 in Kaiser Health News.
By Bernard J. Wolfson November 1, 2021
The number of people with symptoms of depression and anxiety nearly quadrupled during the COVID pandemic, making it even more difficult to get timely mental health care, even if you have good insurance. .
A California law signed Oct. 8 by Gov. Gavin Newsom could help. It requires patients with mental health and addiction issues to be offered return appointments no more than 10 days after a previous session, unless their provider allows less frequent visits.
Current insurance regulations already require offering patients a first mental health visit within 10 days of their request. But there was nothing in the books specifically on after-care so far.
The law does not come into effect until July, which lawmakers say will give health plans time to comply – mainly by hiring or contracting more therapists. Supporters say that with effective enforcement, the new law will help many people get the care they need.
The law, SB 221, “will ensure that people can actually use their insurance to get mental health treatment,” said Senator Scott Wiener (D-San Francisco), the author of the law. “For far too long, health plans have often forced people to wait long periods of time for mental health appointments, compromising their care.”
If you are not getting the care you need, there are already ways to seek redress. When the law comes into force in eight months, it will strengthen your hand. More on that in a moment.
There are two competing explanations why it is so difficult to achieve coherent mental health care. Insurers say there is a shortage of therapists. Therapists say insurers are too cheap to pay them adequately. Many therapists refuse to join insurance networks and set their own fees, which many people cannot afford.
The National Union of Healthcare Workers, which sponsored the legislation, particularly criticized Kaiser Permanente, the state’s largest commercial health insurer, for its well-publicized mental health deficiencies.
Kaiser Permanente, with more than 9 million members in California, was fined $ 4 million by state regulators in 2013 for failing to provide timely mental health care. He was cited twice subsequently for failure to resolve the issues.
Former and current KP therapists say the managed care giant handled the complaint by trying to ensure members seeking mental health treatment get a first appointment quickly. But that only made it harder for these patients to get subsequent sessions, therapists say.
“Any available appointment would be given to someone in need of initiating services,” says Susan Whitney, a marriage and family therapist who worked for Kaiser Permanente in Bakersfield for 18 years before leaving the organization in September. “Our schedules would be full for six to eight weeks – so follow-up appointments were difficult to make, to say the least.”
The American Psychological Association recommends weekly therapy for people with depression and twice a week for post-traumatic stress disorder. In a letter to the California Department of Managed Healthcare last year, the association said the long waits for follow-up care reported by KP patients and therapists “fall well short of what is appropriate care. for most patients “.
Due to the shortage of available therapists, Kaiser Permanente often refers its members to an external network of mental health care providers. But members, therapists and officials say these networks often fail to deliver.
Maya Polon, a KP member in Sacramento, started feeling emotionally frayed in March, after caring for her terminally ill grandmother. She tried to get help through Kaiser, but had to make numerous calls and continued to receive conflicting information on how to get care.
Finally, after more than a month, a Kaiser Permanente therapist told Polon, 27, that her depression, anxiety and panic attacks qualified her for a year of therapy. But if she wanted to do it through Kaiser, it would take her six months to get her first date.
KP referred her to an external mental health contractor, Beacon Health Options, who took two weeks to send her a list of therapists. She called the 20 suppliers on the list, during breaks during her work day, and left messages.
“As someone with anxiety and depression, having to actively sit down and call people who keep saying to you, ‘Oh, I’m not taking new patients,’ is a hugely defeated process,” said Polon. . “I pulled away from that thought, ‘Do I even want to go to therapy if that’s what I’m going to have to go through to get there?'”
She ended up seeing the only therapist who had room for her, but she did not have a contract with Beacon. Polon had to argue with Kaiser Permanente for months because of the paperwork.
In June, San Diego City attorney Mara Elliott sued Kaiser over what she called “ghost networks” that “falsely describe the extent of an insurer’s provider network, promising consumers access to health care which, in reality, is not available under the plan “. Elliott sued Molina Healthcare and Health Net on similar grounds.
Dr Yener Balan, vice president of behavioral health and specialty services at Kaiser Permanente in Northern California, says the organization could do better, but says it is meeting follow-up appointment recommendations from its clinicians in mental health 84% of the time – a figure strongly contested by union officials and therapists.
Balan says the SB 221 implementation date in July is helpful, “given the shortage of mental health clinicians facing all healthcare organizations.”
Critics of the medicare industry wonder if the shortage of therapists is the main problem. Wiener says health plans are not paying mental health practitioners enough to join their networks.
A 2019 report from the California Future Health Workforce Commission predicted that within a decade there would be 41% fewer psychiatrists than needed and 11% fewer psychologists, marriage and family therapists, and other health workers. Mental Health.
But a report released the same year by the state’s legislative analyst’s office indicated that the number of graduates from mental health programs had increased dramatically – although there was, according to the report, a shortage of psychiatrists.
The Department of Managed Healthcare, which regulates health plans covering a large majority of Californians, will monitor compliance with the new law and investigate consumer complaints, said Rachel Arrezola, a spokesperson for the agency.
What you can do
If you think you are missing your Medicare plan when it comes to mental health treatment, you don’t have to wait for the new law. You can contest your insurer under the regulations in force. Once the law goes into effect, however, it will provide additional ballast to any challenge and allow regulators to pursue health plans if violated.
To dispute a lack of coverage, you must first appeal directly to your health insurance plan. If you participate in a private plan, you must file the appeal within six months of the denial of care. The insurer must rule on your appeal within 30 days.
If you don’t get a satisfactory decision, take your case to the agency that regulates your insurer for independent review. And if there is an urgent health risk, you don’t need to wait 30 days. Contact your regulator immediately.
To find out which agency it is, call the customer service line for your health plan. If it is the Department of Managed Healthcare, you can request an independent review by calling 888-466-2219 or by logging into HealthHelp.ca.gov. If your regulator is the California Department of Insurance, call 800-927-4357.
If you are in Medi-Cal Managed Care and your plan is regulated by the Department of Managed Health Care, you can ask that department for an independent review. You can also request a “fair hearing” through the state, like any Medi-Cal beneficiary, by going online or calling 855-795-0634.
Of course, all of this takes time and effort. But if the delay is preventing you from getting treatment, it may be worth it.
A series of articles by Bernard J. Wolfson discussing the challenges consumers face in the California healthcare landscape.
Kaiser Health News is a national health policy news service that is part of the non-partisan Henry J. Kaiser Family Foundation.