In a bold move to address ongoing challenges in the behavioral health space, lawmakers in California have introduced two new bills aimed at improving and expanding insurance coverage for behavioral health services. The bills—Senate Bill 854 (SB 854) and Senate Bill 855 (SB 855)—are designed to address issues related to insurance coverage for mental health and substance use disorder (SUD) treatments, which have long been a subject of debate in the U.S. These legislative efforts target private insurance companies and how they cover behavioral health conditions, marking a significant step in the ongoing fight for greater accessibility and equity in mental health and addiction care.
As a state known for setting legislative trends that often spread nationwide, California’s proposed legislation has the potential to influence policy discussions across the country. Though the bills have a long road ahead before becoming law, their introduction is being closely watched by behavioral health advocates, providers, and patients alike. This post will explore the specifics of these bills, the current state of insurance coverage for behavioral health services, and the potential impact of these legislative changes.
The Legislative Background: Addressing Behavioral Health Parity Violations
The introduction of SB 854 and SB 855 comes at a time when concerns about mental health and substance use disorder parity—ensuring that insurance coverage for behavioral health services is no more restrictive than for physical health services—remain high. While federal and state parity laws have been in place for over a decade, many insurers continue to impose significant barriers to accessing necessary behavioral health care.
Historically, insurance companies have come under fire for failing to meet parity standards, denying coverage for critical mental health treatments, and imposing hurdles such as excessive prior authorization requirements and step therapy protocols. These barriers not only delay access to care but also create significant financial and emotional stress for individuals in need of treatment. The goal of the new bills is to address these barriers head-on and provide more accessible and transparent pathways for behavioral health coverage.
SB 854 and SB 855 aim to target private insurers, excluding public programs such as Medicare and Medicaid. By focusing on private insurers, the legislation seeks to ensure that behavioral health services are treated with the same level of urgency and importance as medical and surgical services, and that patients can access the care they need without unnecessary delays or complications.
Senate Bill 854: Reforming Medication-Assisted Treatment (MAT) Coverage
One of the key provisions of SB 854 is its focus on Medication-Assisted Treatment (MAT), a highly effective and evidence-based approach to treating opioid use disorder (OUD) and other substance use disorders. MAT combines the use of medications (such as methadone or buprenorphine) with counseling and therapy to provide a comprehensive treatment plan for individuals struggling with addiction. It has been widely recognized as the gold standard in the treatment of OUD and is endorsed by organizations like the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC).
However, despite its effectiveness, MAT faces significant barriers when it comes to insurance coverage. Under current insurance practices, insurers can require patients to “fail” other forms of treatment—such as detoxification or inpatient care—before agreeing to cover MAT. This “fail first” policy often delays patients’ access to the most appropriate care and can contribute to worse outcomes.
SB 854 would prohibit insurers from requiring beneficiaries to try other treatments before covering MAT if MAT is recommended by the patient’s doctor. This measure is aimed at eliminating the “fail first” policy that has long been a roadblock to effective addiction treatment. By allowing patients to access MAT sooner, the bill aims to improve patient outcomes and reduce the time individuals spend in cycles of ineffective treatment.
Le Ondra Clark Harvey, the Director of Policy and Legislative Affairs for the California Council of Community Behavioral Health Agencies (CBHA), expressed support for this measure. “We’re very supportive of the bills’ provisions to make the prior authorization process more client-friendly,” Harvey said in a statement. The proposed changes to MAT coverage would go a long way in reducing the bureaucratic red tape that currently stands between patients and the care they need.
Senate Bill 855: Expanding Behavioral Health Coverage for All Medically Necessary Treatments
While SB 854 focuses on improving access to MAT, SB 855 goes further by addressing a broader range of behavioral health services. If passed, SB 855 would require private insurers to cover any form of behavioral health treatment that a patient’s doctor deems “medically necessary.” This provision builds on the foundation set by the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which mandates that insurers cannot impose more restrictive coverage limitations on mental health and substance use disorder benefits than on medical and surgical benefits.
Currently, under both federal and California law, parity requirements are limited. The federal MHPAEA prevents insurers from imposing stricter treatment limitations on mental health and addiction care, but it does not guarantee comprehensive access to all medically necessary treatments. Additionally, the California Mental Health Parity Act of 1999 only requires insurers to cover nine serious mental illnesses, leaving out many individuals with other mental health conditions who may still face significant barriers to care.
SB 855 seeks to go beyond these existing laws by requiring insurers to provide coverage for any treatment deemed necessary by a doctor, regardless of the specific diagnosis. This move would give physicians greater autonomy in determining the most appropriate care for their patients, without having to navigate the often complex and restrictive insurance approval process.
In a press release, California Senator Scott Wiener, who co-authored the bill, emphasized the importance of ensuring access to comprehensive behavioral health services. “No one should have to forego mental healthcare until they’ve deteriorated to the point where they’re in crisis and in the ER,” he said. “And no one should have to go into debt to pay for substance use disorder or mental health treatment.”
By expanding the definition of “medically necessary” care, SB 855 seeks to remove arbitrary barriers that prevent patients from accessing the care that could significantly improve their well-being. The bill’s proponents argue that this change would lead to better mental health outcomes and reduce the strain on emergency services by ensuring that patients receive appropriate care earlier in the treatment process.
The Reaction to SB 854 and SB 855: Support and Opposition
The introduction of SB 854 and SB 855 has generated a mixed response from different stakeholders. The California Council of Community Behavioral Health Agencies (CBHA) has been a vocal supporter of the bills, praising them for their focus on improving patient access and reducing unnecessary barriers to care.
“We support any efforts to promote behavioral health treatment, specifically anything that’s going to improve patient access or experience,” Harvey said. She also highlighted the importance of the transparency provisions included in the bills, which would make the insurance process more predictable and easier to navigate for both providers and patients.
However, not everyone is on board with the proposed legislation. A spokesperson for the California Association of Health Plans (CAHP) expressed concerns that the bills go beyond parity and create new mandates that could drive up costs for insurers. “It is hard to understand how SB 855 could be called a mental health parity bill when it sets forth a new system for medical necessity that is at a higher level than other medical services,” said Mary Ellen Grant, a CAHP spokesperson.
These concerns underscore the ongoing tension between the need for comprehensive behavioral health coverage and the financial challenges faced by insurers. Critics argue that while the bills aim to improve access to care, they could also increase premiums and administrative costs, potentially leading to higher expenses for consumers.
Conclusion: A Critical Step Forward for Behavioral Health Coverage
The introduction of Senate Bill 854 and Senate Bill 855 represents a significant step toward improving insurance coverage for behavioral health services in California. If passed, these bills could set a precedent for other states looking to address similar concerns in the mental health and substance use disorder treatment landscape. By eliminating barriers to Medication-Assisted Treatment and expanding the definition of “medically necessary” care, the legislation promises to improve access to the care that so many individuals with behavioral health issues desperately need.
While the road to passing these bills will likely be long and filled with debate, their introduction signals a strong commitment to addressing the inequities that persist in the mental health and addiction treatment sectors. For behavioral health providers, advocates, and patients, this legislation represents a beacon of hope in the ongoing effort to ensure that everyone, regardless of their background or diagnosis, has access to the mental health and substance use treatment they deserve.
