A new California law protects your right to timely mental health care

THE PROBLEM

For too long, a loophole in California law required HMOs and health insurers to provide initial mental health assessments within two weeks, but didn’t require them to also provide return therapy appointments within 10 business days.

As a result, many Californians, including members of Kaiser Permanente, have been forced to wait months to see their therapist.

THE SOLUTION

Starting July 1, 2022, a new law, SB 221, goes into effect requiring that HMOs and health insurers provide follow-up mental health and substance use disorder therapy appointments within 10 business days — unless the treating therapist determines that a longer wait would not be detrimental.

THE FACTS

  • What is SB 221?Sponsored by the National Union of Healthcare Workers and authored by State Sen. Scott Wiener, SB 221 is a landmark mental health law that guarantees Californians the right to timely mental health and substance use disorder therapy sessions.
  • When does the bill go into effect?SB 221 goes into effect on July 1, 2022. It was signed into law in 2021 after passing the legislature with nearly unanimous bi-partisan support.
  • What does the bill do?The bill requires HMOs and health insurance companies to provide mental health and substance use disorder therapy sessions within two weeks of a prior appointment, unless the treating therapist determines that a longer wait would not be detrimental.
  • What if your insurer or HMO is unable to provide an appointment within two weeks?If unable to provide an in-network therapy session, an HMO or health insurer must arrange coverage outside the plan’s contracted network.

How can I file a complaint if my health insurer or HMO is not abiding by SB 221?

To find out what agency that is, call the customer service line of your health plan. If it is the Department of Managed Health Care, you can request an independent review by calling 888-466-2219 or logging on to HealthHelp.ca.gov. If your regulator is the California Department of Insurance, call 800-927-4357.

If you are in managed-care Medi-Cal and your plan is regulated by the Department of Managed Health Care, you can ask that department for an independent review. You can also seek a “fair hearing” through the state, as can any Medi-Cal beneficiary, by going online or calling 855-795-0634.