Sacramento, Calif. (AP)-Sacramento, Calif. (AP)-
For the first time in California, Gov. Gavin Newsom signed a law defining "medical necessity," compelling private health insurers to pay for additional mental health and addiction treatment.
Mental health therapies are already covered under state and federal regulations. According to the California Health Benefits Review Program, 99.8% of private health insurance plans cover mental health and substance misuse issues as well as other medical diseases.
But those statutes don't define "medically essential" to determine coverage. As a result, activists say private insurers often deny coverage for some mental health and substance misuse therapies.
Medically essential mental health and drug addiction treatments are covered by law. The law requires insurance companies to use the most recent criteria and recommendations published by non-profit professional organisations, such as the American Society of Addiction Medicine.
The bill's author, San Francisco Democrat Scott Wiener, said many insurance companies deny mental health or drug addiction treatment because it's "not serious enough." A stage one cancer patient cannot be treated till a stage four cancer patient.
"We'd never tolerate it with our health. But we are addicted to it "explained he
The California Association of Health Plans called it a "misconception" that private insurance only cover mental health and addiction therapy when people are in crisis. It "recklessly defines medical necessity in a way that will impair clinicians' ability to assess what is clinically appropriate for their patients," they said.
"Not everyone is thrilled with us," Newsom admitted during a virtual bill signing event on Friday.
"A lot of people wanted to cancel today's Zoom call," Newsom added, "but we're doing it because we're zooming into the future."
Californians are currently battling with a coronavirus pandemic, racial inequality, and major wildfires that have devastated homes and businesses while polluting the air.
The APA's annual "Stress in America" study shows the greatest levels of stress since the survey began in 2007.
"All of it really highlights the need for not only adequate but outstanding treatment right now," he said.
National Council on Behavioral Health Medical Director Joe Parks said the law is the first comprehensive overhaul. He believed it would "push other states to fill in the holes that this act leaves."
On Friday, Newsom signed over a dozen health-related bills. One of the bills, proposed by San Jose Democrat Sen. Jim Beall, sets guidelines for peer support specialists – those who have struggled with mental health or drug addiction and want to help others. The bill also allows the state Medicaid program to seek federal reimbursement for peer support experts.
Previous governors vetoed similar proposals twice. It's one of Beall's last bills to pass because he's leaving office due to term restrictions.
"The pandemic has definitely shifted popular opinion. According to Beall, the bill "adds proven mental health resources at a time when we most need them.""
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