Legislative update: December 2023
Eliminating Ghost Networks is a 2024 legislative priority
One of the biggest challenges Californians face in accessing behavioral healthcare is trying to find anyone on their health plan’s list of in-network providers who’s actually reachable or available to schedule a therapy session.
These “Ghost Networks” are especially common in behavioral health and are a big problem for Kaiser Permanente patients, especially now as more patients are sent outside the Kaiser system.
In 2021, San Diego City Attorney Mara Elliott filed a lawsuit accusing Kaiser of intentionally and illegally overstating the number of mental health providers available to its 9 million members in California. According to the complaint, 38 percent of the psychologists, therapists and licensed clinical social workers listed in Kaiser’s provider directories were not actually available to care for Kaiser patients.
While the lawsuit has not remedied this problem of Ghost Networks, Assemblymember Chris Holden has introduced AB 236 to finally hold health plans accountable for maintaining accurate lists of in-network providers.
The bill, as currently written, requires health plans to audit their own provider directories per standards set by the Department of Managed Health Care. Health plans would be required to achieve 80 percent accuracy by 2026 and 95 percent accuracy by 2028. Plans that fail to meet accuracy benchmarks would be fined.
NUHW views passing AB 236 as a priority for the coming legislative session that begins in January to continue building on our string of legislative successes over the past few years:
- 2020 — SB 855, which expanded the right of Californians to access medically necessary behavioral health care.
- 2021 — SB 221, a bill sponsored by NUHW that requires health plans to provide follow-up therapy sessions within 10 business days unless the treating clinician determines that a longer wait period would not be detrimental to the patient.
- 2022 — SB 858, which increased maximum penalties for violating timely access to care laws tenfold.
- 2023 — SB 770, which takes an important step toward a universal healthcare system in California that would guarantee the right to mental health care.
There will be future updates on how we can advocate for AB 236, and other bills that could improve access to behavioral healthcare in California.