County of Santa Clara Co-sponsors Bill Aimed at Expediting Review Process for Mental Health Claims
AB 3260 would improve the due process for complaints regarding denied behavioral health care services by mandating a timely response
SANTA CLARA COUNTY, Calif. – A bill recently co-sponsored by the County of Santa Clara aims to speed up the grievance and resolution process for denied mental health claims, streamlining the process to force fast action for claims considered urgent or life-threatening.
County leaders have prioritized putting behavioral health disorders on equal footing with physical ailments, and co-sponsoring AB 3260, co-authored by Assemblymember Gail Pellerin (whose 28th District includes part of Santa Clara County), is an effort toward what’s known as “mental health parity.”
“There is a clear need in the community for timely access to behavioral health services. This legislation shortens the amount of time it takes an individual who is experiencing mental distress to get the mental health help they need,” said Santa Clara County Supervisor Joe Simitian, a longtime advocate for mental health parity. “When folks are in crisis – and they know they’re in crisis, and they want to get the help they need – they deserve to get that help and to get it on a timely basis.”
Currently, if a person’s treatment provider determines that mental health care is needed, the health plan or disability insurer can have another health professional review the request and approve, deny, delay or modify it. The timeline for this determination is based on urgency – it needs to be done within 30 days for standard requests but is shortened to 72 hours for cases in which the client faces an imminent and serious threat to their health – such as severe anxiety, schizophrenia, chronic and crippling depression, or thoughts of suicide.
As it stands, the health plan or insurer can override a treatment provider’s determination of urgency, meaning the legal response time increases tenfold, from 3 to 30 days. AB 3260 would make the treatment provider’s determination binding, holding it to 3 days.
Per the proposed law, if that timeline is not met the patient would be able to immediately file a grievance and if that grievance in turn is not responded to by the legal deadline it would be automatically resolved in favor of the patient – meaning the original assessment for needed care stands.
The bill would also increase transparency and expand due process rights for individuals who file complaints with state regulators over improper denials or lack of access to care.
According to the California Department of Managed Health Care, denied claims that were challenged were overturned in about 68% of cases in 2022 – that means the client ultimately received the help they were initially refused. These numbers demonstrate that commercial health plans are improperly denying medically necessary mental health treatment at alarmingly high rates.
“Health plans do not consistently decide or provide proper notice of their decisions regarding coverage of claims, said bill co-author Assemblymember Pellerin. “This leads to patients bearing the mental, physical, and financial burden of prescribed care while waiting for their health plans to respond.”
Pellerin said that may mean a patient will ultimately forgo getting the care they need.
“AB 3260 clarifies consumers’ rights to file grievances concerning a lack of access to care and allows them to file immediately if their insurers fail to respond to their claims within the time period and in the manner required by existing law,” she said.
The bill is slated to be heard by the State Assembly Health Committee at its meeting on April 16.
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The County of Santa Clara government serves a diverse, multicultural population of 1.9 million residents in Santa Clara County, Calif., making it more populous than 14 states in the United States. The County provides essential services to its residents, including public health protection, environmental stewardship, medical services through the County of Santa Clara Health System, child and adult protection services, homelessness prevention and solutions, roads, park services, libraries, emergency response to disasters, protection of minority communities and those under threat, access to a fair criminal justice system, and many other public benefits.
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