March 26, 2024
Mental Health America of California (MHAC) is writing to express our support of AB 3260 (Pellerin), which will improve transparency and provide due process for consumers filing grievances and regulatory complaints concerning access to care, denied health care services, and coverage disputes.
Far too often, when commercially insured patients seek treatment for behavioral health or substance use disorders, health plans exceed required timeframes for approving care requests, fail to provide access to care within legally mandated timelines, or deny requests that should be covered—even when the patient’s condition is urgent. People with mental health challenges can seek recourse, but grievance procedures are slow and opaque and frequently result in patients neither receiving timely treatment nor receiving due process when they register complaints. California’s groundbreaking behavioral health parity (SB 855) and timely access laws (SB 221) could address this crisis if consumers were able to more fully enforce them. AB 3260 empowers consumers to do just that.
As stated in my testimony before the Senate Select Committee on Mental Health and Addition in August 2022, I have firsthand experience as a family member and employer with care that is frequently delayed seven or more months and often only after incorporating the assistance of DMHC.
Unfortunately, health plans do not consistently decide or provide proper notice of decisions concerning claims such as prior authorization based on medical necessity, urgency, and/or access to care, nor do they address grievances within the timeframes and manner specified by law. This leads consumers either to pay out of pocket while waiting for health plans to respond or to go without treatment altogether.
AB 3260 would address these issues by prohibiting health plans and disability insurers from overriding a provider’s designation of a condition as urgent, which can result in improper and dangerous delays in care It would 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 adjudicate a grievance within mandated timeframes, it would automatically resolve in the patient’s favor. The bill will also expand due process rights to patients and prohibit ex parte communication between departments and parties to regulatory complaints, as well as further harmonize state law with federal law.
AB 3260 improves transparency and due process for consumers to ensure they have recourse when they are denied timely access to the appropriate care they are entitled to receive under the law, by health insurance for which they have already paid.
For all of these reasons, MHAC supports AB 3260 (Pellerin), and we respectfully request an “AYE” vote.
Sincerely,
Heidi L. Strunk
Chief Executive Officer