Coalition Letter to the DMHC

CSAP just signed on to a coalition letter expressing concerns about several recent instances in which the Department of Managed Health Care (DMHC) has permitted health care service plans to terminate medically necessary mental health and substance use disorder (MH/SUD) treatment in a manner inconsistent with Senate Bill 855’s requirements. These cases are troubling given previous discussions with DMHC in advance of proposed rulemaking on SB 855, specifically with respect to health plans’ obligations to ensure timely access to ongoing mental health services in a manner consistent with generally accepted standards of care. These discussions had the coalition to believe that our understanding of what the statute requires aligns with DMHC’s. The first area of concern is that DMHC is permitting plans to terminate coverage for out-of-network care arranged due to the unavailability of timely or geographically accessible mental health services when plans belatedly identify network providers. This coercive practice subverts the therapeutic alliance, a critical agent of cure, and disregards generally accepted standards of MH/SUD care, a key requirement of Senate Bill 855. The second area of concern is that DMHC is permitting plans, notwithstanding generally accepted standards of care, to terminate coverage for ongoing, out-of-network services when plans lack and fail to arrange in-network services available within timely access standards, in violation of the statute. Read more here.

DMHC Posts Formal Proposed SB 855 Regulations

As fate would have it, the next day, the DMHC posted of the rulemaking for “Mental Health and Substance Use Disorder Coverage Requirements” that can be viewed here: Open Pending Regulations. CSAP plans to comment on these proposed regulations, if you want to forward any thoughts re same, please do so

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