Advocacy Alert: Insurance Commissioner Issues Memorandum for Plan Reviews to Assess Parity Compliance to Meet SB 855 Requirements

December 24, 2020


December 11, 2020

In preparation for the implementation of CCAPP-supported Senate Bill 855 (Wiener), California’s Insurance Commissioner Ricardo Lara yesterday issued a memorandum to all plans regulated by the Department of Insurance regarding requirements of the new law which substantially expands the California Mental Health Parity Act of 1999 which will take effect on January 1, 2021.

“CCAPP is extremely pleased by the Commissioner’s quick attention to implementing this important legislation,” said CCAPP President and CEO, Pete Nielsen. “This bill has given his department the tools necessary to actually enforce the parity laws we have had on the books for decades.”

There are significant requirements that all providers and their clients should be made aware of. Here are just a few:

  • Providing that if medically necessary mental health or substance use disorder services are not available in-network within the geographic and timely access standards set by network adequacy law or regulation, an insurer must arrange for the provision of out of-network services that, to the maximum extent possible, meet the network adequacy standards, and cover the out-of-network services subject to in-network cost sharing.
  • Prohibiting coverage limitations and exclusions for medically necessary services because the services should be or could be covered by a public entitlement program, including, but not limited to, special education or an individualized education program, Medicaid, Medicare, Supplemental Security Income, or Social Security Disability Insurance.
  • For a primary diagnosis of a substance use disorder in adolescents and adults, The ASAM Criteria developed by the American Society of Addiction Medicine must be used for placement decisions.

CCAPP urges all providers and practitioners to review the guidance letter and to report any suspected violations to the Department of Insurance and to notify CCAPP concerning the nature of any suspected violation. The memorandum can be viewed here.

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