Santa Clara County cosponsors state legislation to help youth access mental health services

Prioritizing the fight for mental health parity, Santa Clara County has cosponsored state legislation to help children and young adults get better treatment for behavioral health disorders.

Senate Bill 294, authored by state Sen. Scott Wiener, D-San Francisco, strengthens existing laws for insurers to cover an expanded set of mental health conditions. The bill adds a new requirement that would trigger an automatic review of providers if they deny mental health treatment to patients aged 26 years and younger.

The bill also is cosponsored by Children Now, a research, policy and advocacy organization.

“Young people across California are struggling with mental health, and it’s our responsibility to ensure they can access the health care they urgently need,” Wiener said in a press release. “This legislation removes unnecessary administrative hurdles standing between families and life-saving mental health treatment for their children,” he added.

It is not uncommon for private insurers to reject mental health claims, according to Santa Clara County officials. This then puts the onus on patients and their families to contest these denials, with more than two-thirds of the cases eventually overturned. “This demonstrates that commercial health plans are improperly denying medically necessary mental health treatment at alarmingly high rates,” the county said in a press release.

SB 294 aims to change that by instituting an automatic review process that would compel private insurers to treat mental health disorders seriously and offer young patients the help they need more quickly.

“Mental health issues need to be treated with the same urgency that we provide someone who has a debilitating disease, or a broken bone, or any physical condition that would result in medical attention — with no questions asked,” said Santa Clara County Supervisor Joe Simitian in the press release.

Denying medical treatment for mental health disorders is not only a health parity issue; it also is a health equity issue. Navigating the current process can be daunting for patients and their families, the county said.

First a grievance must be filed with the provider to contest the rejection. If no resolution is reached, then after 30 days a complaint can be submitted to the Department of Managed Health Care. A board of providers not affiliated with the health plan then reviews the case with the outcome bound by their decision, according to Wiener’s office.

The drawn-out process is just one obstacle to treatment. Patients also may not dispute the medical denial because of language and time constraints, or they may not even realize the option is available to them, the county said.

An automatic review of denied claims would help put mental health treatment on a more level playing field for all patients. And for urgent and life-threatening cases, it would speed up access to care by automatically referring the denied claims to the state’s Independent Medical Review (IMR) process, the county said.

“Removing barriers to mental health services for youth and families is a priority, and this bill will help ensure families have access to life-saving treatment,” said Sherri Terao, director of the county’s behavioral health services department.

SB 294 also is fiscally responsible, as health plans will bear the cost of the grievances and the IMR process, according to Wiener’s office.

If passed by the state legislature, the bill would go into effect July 1, 2025.