California Insurance Commissioner Ricardo Lara has finalized new regulations requiring insurers to cover medically necessary mental health and substance use treatments.
The new regulations follow two laws enacted by California in 2020 and 2022, respectively, that aim to improve access to behavioral health services, according to a July 17 news release from Mr. Lara’s office.
Here’s what to know:
- The regulations clarify the mental health and substance use disorder services insurers must cover.
- Insurers will be required to arrange and pay for out-of-network mental health treatment when an in-network provider is not available in time.
- A denial of substance use disorder benefits requires the decision to be made by a board-certified addiction specialist physician “who is competent to evaluate the specific clinical issues involved in the benefits under review.”
- The regulations establish a complaint process for members who believe their insurer has violated mental health parity requirements.
- Health insurers in California will be required to provide gender-affirming care in line with the World Professional Association of Transgender Health’s guidelines, according to the news release.
Read more here.
