WE'LL CALL TO ORDER THE SENATE'S
LIKE COMMITTEE ON MENTAL HEALTH
AND ADDICTION. I'M GOING TO
THANK SENATOR CORTESI FOR
JOINING US. WE'LL HAVE A FEW
OTHER SENATORS, I THINK SHORTLY.
UM. WE WILL HAVE A REMOTE PUBLIC
COMMENT IN ADDITION TO IN
PERSON, PUBLIC COMMENT AT THE
END OF THE HEARING FOR PEOPLE
WHO WANT TO PARTICIPATE REMOTELY
PARTICIPANT NUMBER IS 8772268.
AND THE ACCESS CODE IS 736 TO 83
TO, UM. I WANT TO JUST KNOW
THAT, AS ALWAYS WILL BE
MAINTAINING THE QUORUM DURING
THE HEARING TODAY, ANY
INDIVIDUAL WHO IS DISRUPTIVE MAY
BE REMOVED FROM THE REMOTE
MEETING SERVICE OR HAVE THEIR
CONNECTION MUTED. WE HAVE ONE
PANELIST PARTICIPATING REMOTELY.
TODAY EVERYONE ELSE WILL BE IN
PERSON. AND I WANT TO THANK ALL
OF OUR PANELISTS FOR JOINING US.
UM AND WITH THAT WE WILL
PROCEED. SO THE TODAY'S HEARING
IS ABOUT MENTAL HEALTH PARODY
AND FOR MEMBERS OF THE PUBLIC
WHO MAY NOT BE FAMILIAR WITH THE
PHRASE MENTAL HEALTH. PARODY
IT'S ACTUALLY QUITE
STRAIGHTFORWARD. IT MEANS THAT
MENTAL HEALTH INCLUDING
ADDICTION. WILL BE TREATED
EXACTLY THE SAME AS PHYSICAL
HEALTH. THE BASIC CONCEPT THAT
IF YOU BREAK YOUR ARM OR YOU
HAVE CANCER, YOU GO TO YOUR
DOCTOR AND YOUR HEALTH INSURANCE
COVERS, IT PAYS FOR IT. AND THE
SAME SHOULD BE TRUE IF SOMEONE
HAS MENTAL HEALTH OR ADDICTION
DISORDER. UNFORTUNATELY
HISTORICALLY, HEALTH INSURANCE
HAS NOT ADEQUATELY COVERED
MENTAL HEALTH AND ADDICTION
TREATMENT AND HAS NOT TREATED IN
THE SAME WAY THAT PHYSICAL
HEALTH HAS BEEN COVERED. WE HAVE
HAD A LONG HISTORY OF PEOPLE
SIMPLY BEING UNABLE TO GET
INSURANCE COVERAGE FOR MENTAL
HEALTH. TREATMENT UM, AND
INSURANCE PLANS, EFFECTIVELY
TAKING THE POSITION THAT YOU CAN
ONLY GET TREATMENT IF YOU HAVE
BASICALLY IN CRISIS, AND OF
COURSE, WE WANT TO GET TO PEOPLE
AND GET PEOPLE TO HELP THEY NEED
BEFORE THEY ARE IN CRISIS. IT
WOULD BE SIMILAR TO TELLING
SOMEONE WHO WAS DIAGNOSED WITH
STAGE ONE CANCER. WE KNOW YOU
HAVE STAGE ONE CANCER, BUT IT'S
NOT SERIOUS ENOUGH YET, SO WE'RE
NOT GOING TO COVER YOUR
TREATMENT AND COME BACK AND SEE
US WHEN YOU'RE AT STAGE FOUR
CANCER, AND THEN WE'LL COVER IT.
WE WOULD NEVER TOLERATE THAT FOR
PHYSICAL HEALTH. AND YET FOR
MANY YEARS WE HAVE TOLERATED IT
FOR MENTAL HEALTH. AND AS A
RESULT, WE HAVE SO MANY PEOPLE
WHO HAVE EVEN GOOD INSURANCE.
WHO ARE UNABLE TO GET THE HELP
THAT THEY NEED, AND WE NEED THAT
TO CHANGE. SO IN 2020 I AUTHORED
SENATE BILL 855, AND WE JUST
LEGISLATURE WITH STRONG
BIPARTISAN SUPPORT PAST IT, AND
THE GOVERNOR SIGNED IT, AND THAT
PUTS CALIFORNIA IN THE LEAD ON
MENTAL HEALTH PARITY. IT IS THE
STRONGEST MENTAL HEALTH PARITY
LAW. IN THE COUNTRY AND OTHER
STATES ARE SEEKING TO REPLICATE
IT. THERE EVEN BEEN EVERYTHING
CONGRESS TO TAKE A NATIONAL. IT
IS A STRONG LAW MAKING VERY,
VERY CLEAR THAT THAT IF. WELCOME
SENATOR ASHBY MAKING VERY CLEAR
THAT WE'RE GOING TO TREAT MENTAL
HEALTH AND ADDICTION TREATMENT,
THE SAME AS PHYSICAL HEALTH. IT
HAS NOW BEEN NEARLY THREE YEARS
SINCE SB 855 WENT INTO EFFECT ON
JANUARY 1ST 2021, BUT BUT IN
THOSE NEARLY THREE YEARS WE
STILL DO NOT HAVE FINALIZED
REGULATIONS. THE DEPARTMENT OF
MANAGED HEALTH CARE OR THE
DEPARTMENT OF INSURANCE. WE KNOW
THAT THE ONLY WAY THAT THIS IS
STRONG LAW WILL HAVE TRUE
MEANING IS FOR IT TO BE FULLY
IMPLEMENTED AND FULLY ENFORCED
WITH FULL COMPLIANCE BY THE
HEALTH PLANS. IT IS SO IMPORTANT
THAT THESE STRONG STRONG
REGULATIONS BE FINALIZED AS
QUICKLY AS POSSIBLE. IT'S TAKEN
TOO LONG. I AM GRATEFUL THAT THE
DEPARTMENT OF MANAGED HEALTH
CARE HAS BEEN WORKING TO
SIGNIFICANTLY IMPROVE ITS
PROPOSED REGULATIONS. BUT I
THINK THEY CAN BE STRENGTHENED
EVEN FURTHER TO PROTECT
CONSUMERS AND MAKE SURE PEOPLE
CAN ACCESS TO HEALTH CARE THAT
THEY NEED. IT'S ALSO CRITICALLY
IMPORTANT THAT GMHC S BEHAVIORAL
HEALTH INVESTIGATIONS TO
THOROUGHLY REVIEW COMPLIANCE
WITH FEDERAL AND STATE PARITY
LAWS HAPPEN AS QUICKLY AS
POSSIBLE AND AS THOROUGHLY AS
POSSIBLE. UM DAMAGE. SHE HAS THE
TOOLS AND THE AUTHORITY THAT IT
NEEDS TO EFFECTIVELY REGULATE
PLANS. MENTAL HEALTH PARITY
COMPLIANCE. AND SO WE NEED TO
MAKE SURE THAT THAT COMPLIANCE
HAPPENS AND THAT ACCOUNTABILITY
HAPPENS WHEN THE HEALTH PLANS
FALL SHORT. UM WE ALSO KNOW
THERE CONTINUE TO BE LENGTHY
DELAYS FOR EXPEDITED.
INDEPENDENT MEDICAL REVIEWS WANT
TO HEALTH PLAN DOES DENY MENTAL
HEALTH COVERAGE. THESE DELAYS
OFTEN EXCEED ALLOWABLE TIME
PERIODS. WE CONTINUE TO HEAR
FROM RESIDENTS WHO ARE NOT ABLE
TO GET THE CARE THAT THEY NEED
ON THE TIMELINE THAT IS REQUIRED
AND THAT TIMELINE, OF COURSE
UNDER SENATE BILL 2 TO 1 FOR
FOLLOW UP MENTAL HEALTH
APPOINTMENT IS 10 BUSINESS DAYS
TO WEEKS. UM, I ALSO JUST WANT
TO KNOW THAT RECENTLY, THE
DEPARTMENT OF MANAGED HEALTHCARE
ENTERED INTO A RESOLUTION WITH
KAISER WITH A VERY LARGE FINE OF
I BELIEVE $50 MILLION AND A
NUMBER OF COMMITMENTS BY KAISER
TO IMPROVE THE AVAILABILITY OF
BEHAVIORAL HEALTH TREATMENT
WITHIN THE KAISER SYSTEM, AND I
WANT TO THANK THE MHC FOR THAT
WORK. THAT IS A SIGNIFICANT STEP
FORWARD. SO IN TODAY'S HEARING
WILL BE HEARING FROM A NUMBER OF
DIFFERENT PERSPECTIVES FROM OUR
DEPARTMENTS FROM ADVOCATES FROM
HEALTHCARE PROFESSIONALS FROM
PATIENTS TO REALLY SEE WHERE WE
ARE IN TERMS OF IMPLEMENTATION
OF SB, 855 ENFORCEMENT AND
COMPLIANCE, AND WE'LL HEAR FROM
THE HEALTH PLANS AS WELL. AND I
HOPE THAT AFTER TODAY WE WILL
HAVE A ROAD MAP TO ENSURING FULL
IMPLEMENTATION AND COMPLIANCE.
WITH THAT I WANT TO INVITE IF
ANY OF MY COLLEAGUES WOULD LIKE
TO MAKE ANY OPENING REMARKS NOW,
IT WOULD BE A GOOD TIME, SENATOR
RUBIO. GOOD MORNING, EVERYONE.
CAN YOU HEAR ME? WELL, FIRST OF
ALL, MR CHAIR. THANK YOU FOR
ARRANGING THIS. I KNOW THIS IS A
TOPIC THAT'S IMPORTANT TO YOU AS
WELL AS ALL OF US. BUT MORE
IMPORTANTLY, ALL OF THOSE THAT
ARE GOING TO BE PRESENTING HERE
TODAY. IT'S SO IMPORTANT THAT WE
HEAR OF PROSPECTIVE AND A LOT OF
THE TIMES WE PASSED BILLS, AND
WE DON'T COME BACK TOGETHER TO
ENSURE THAT IMPLEMENTATION IS
HAPPENING AND THAT YOU KNOW IT
WAS. IT'S DOING WHAT IT'S
INTENDING TO DO. I KNOW THIS
ISSUE IS VERY IMPORTANT JUST
ACROSS CALIFORNIA AND AS WE
CONTINUE TO TRY TO ENSURE THAT
EVERYONE HAS THE BEST QUALITY OF
CARE, YOU KNOW, I'M REALLY EAGER
TO HEAR SOME OF THE TESTIMONIALS
AND STORIES OF THOSE HAVE BEEN
IMPACTED TO SEE WHAT WE CAN DO
AS A LEGISLATURE TO CONTINUE TO
PUSH. TO MAKE SURE THAT AGAIN
THAT WE MEET THE MARK AND THE
GOALS THAT WERE INTENDED BY THIS
BILL. SB 855, WHICH I WAS PROUD
TO SUPPORT AND PUSH FORWARD AS A
MEMBER OF THE HEALTH COMMITTEE,
BUT I KNOW FOR ME, YOU KNOW. OF
COURSE, MENTAL HEALTH AND
SUBSTANCE USE DISORDERS CONTINUE
TO BE A BIG ISSUE, BUT WHAT? I'M
SEEING A LOT PERSONALLY AND
AROUND MY DISTRICT IS YOU KNOW
WHAT'S HAPPENING TO OUR YOUTH
MENTAL HEALTH THAT DISTRESS
AFTER THE PANDEMIC AND SO MANY
THINGS THAT WE STILL HAVE TO
DIVE DEEP INTO TO SEE WHAT WE
CAN DO TO HELP OUR YOUTH AND
MAKE SURE THAT THEY DON'T
CONTINUE TO GET WORSE AT THE
END, YOU KNOW AS THEY GET OLDER
AND BECOME ADULTS. YOU KNOW, I
DO A LOT OF DOMESTIC VIOLENCE
AND THAT CONTINUES TO BE
SOMETHING THAT WORRIES ME. MOST
VICTIMS OR SURVIVORS THAT END UP
IN THE STREET DON'T HAVE TO CARE
THAT THEY DESERVE AND SHOULD GET
IN. SO THIS HEARING HERE TODAY
WILL HELP ME UNDERSTAND BETTER
WHAT WE CAN DO TO CONTINUE TO
HELP THOSE THAT ARE IN DISTRESS
ON THE STREET. THROUGH NO FAULT
OF THEIR OWN, SO JUST LEAVE IT
AT THAT. I WANT TO SAY ONCE
AGAIN THANK YOU, MR CHAIR AND
ALL OF MY COLLEAGUES. I KNOW WE
ALL HAVE TO FLY IN OR COME FROM
A LONG DISTANCE TO BE HERE AND I
LOOK FORWARD TO LEARNING AND
WORKING WITH YOU ON THIS. THANK
YOU. THANK YOU, SENATOR.
COURTESY WELL, FIRST FOLLOW AND
SHARE WIENER. THANK YOU SO MUCH
FOR CONVENING AND PULLING THIS
TOGETHER AND YEAH, ENSURING THAT
WE HAVE A SENTENCE SO THAT
COMMITTEE OF MENTAL HEALTH AND
ADDICTION SO I'M REALLY HAPPY TO
PARTICIPATE AND HAPPY TO MAKE
THE COMMUTE TODAY TO BE HERE. I
DO WANT TO SAY, UM I HOPE THIS
IS CONSISTENT WITH THE IDEA THAT
WE'RE REALLY HERE TO TALK ABOUT
SB 55. I HAVE DONE SOME WORK AS
CHAIR, NOSE AND SURE IT WAS VERY
SUPPORTIVE OF ON UTILIZATION
REVIEW ON A BILL PREVIOUSLY
NUMBERED SP 999, WHICH PASSED
THE LEGISLATURE BUT WAS VETOED.
I ONLY BRING THAT UP BECAUSE
FOUNDATIONAL E. I WANT TO MAKE
SURE THAT WE DO GET TO THE
BOTTOM IF WE CAN TODAY OR SOON,
UM TO, YOU KNOW WHAT IS THERE?
IF ANYTHING BEYOND PURITY AND
AGAIN, THIS IS A LANDMARK
LEGISLATION 8 55, AND I KNOW MY
PREDECESSOR IN THE CENTER FROM
SAN JOSE WORKED IN THIS AREA. AS
EFFECTIVELY AS HE COULD. UM. AT
SOME POINT WE NEED TO, OF
COURSE, ADDRESS THE ISSUE THAT
BROKEN LEG MAY VERY WELL MEAN
DISCHARGED WITHIN 24 HOURS OR 48
HOURS OR SOMETHING. A LITTLE. UM
MORE TRAUMATIC IN TERMS OF
PHYSICAL INJURY MAY MEAN
DISCHARGE IN TWO WEEKS. UM, WE
NEED TO MAKE SURE THAT WHOEVER
IS REVIEWING THESE CASES
UNDERSTANDS CLEARLY, UM, THAT
THAT SERIOUS ADDICTION THAT'S
BEEN TREATED ISN'T GONNA. HAVE
PURITY IN TERMS OF LENGTH OF
TREATMENT, EVEN THOUGH WE WANT
PARITY IN TERMS OF COVERAGE IN
TERMS OF MAKING PEOPLE WHOLE,
FINANCIALLY FISCALLY AND SO
FORTH. SO IT'S CHALLENGING TO
GET INTO THOSE ISSUES. WE TOOK A
STAB AT IT. PREVIOUSLY WITH SP 9
99. BUT IF IT'S NOT, I THINK I
THINK WE MAY HEAR TODAY FROM
PROVIDERS. IF IT'S NOT 9 99.
WHAT IS IT BECAUSE WE NEED TO
GET TO THE BOTTOM OF THIS ISSUE
OF HOW DO WE PURSE THINGS ENOUGH
AND TRUST OUR PROVIDERS ENOUGH
TO KNOW THAT WE JUST CAN'T BE,
YOU KNOW, SENDING PEOPLE OUT ON
THE STREET. UM YOU KNOW, TWO
WEEKS AFTER WE SENT HIM IN FOR
STABILIZATION, EVEN CARE COURT
RECOGNIZES THAT RIGHT THAT THERE
IS THERE IS A NEED TO HAVE
LONGER TERM PLANS FOR PEOPLE AND
WE'RE JUST NOT SEEING THAT YET
IN THE RESULTS AND FRANKLY, IF
INSURERS WANT TO TALK ABOUT WHY
THAT IS, IT WOULD BE GREAT TO
HEAR FROM THEM AS WELL. WELL.
WONDERFUL WE CAN GET TO AN MANY
OUTCOMES TODAY. BUT IF ONE OF
THE OUTCOMES IS MAYBE AN IDEA AS
TO HOW WE GO FURTHER ON THE
UTILIZATION REVIEWS CITED TO
MAKE SURE THAT PARODY REALLY
MEANS PARODY. THANK YOU. THANK
YOU, SENATOR ASHBY. YEAH. THANK
YOU SO MUCH, AND I'M PROBABLY
THE ONLY ONE HERE. THAT WASN'T
HERE FOR THE PASSAGE OF THIS,
BUT IN HERE NOW AND INTERESTED
TO LEARN MORE ABOUT HOW SB 855
IS BEING IMPLEMENTED, AND FOR ME
SOME OF THE THINGS I'LL BE
LISTENING TO CLOSELY TODAY. I
FEEL MAYBE COMING FROM THE LOCAL
THAT MENTAL HEALTH OFTEN DOESN'T
HAVE A FRONT DOOR, AND SOMETIMES
THAT FRONT DOOR IS THE EMERGENCY
ROOM. SO I'LL BE INTERESTED IN
HOW ALL OF THIS INTER PLACE HOW
THE HEALTH PLANS AND THE
REQUIREMENTS OF 855
NECESSITATING MENTAL HEALTH
SERVICES, HOW THAT IS BEING
INITIATED. AND IF THAT IS BEING
INITIATED IN WAYS THAT ARE
CONGRUENT WITH HOW PEOPLE ARE
ACTUALLY SEEKING SERVICES. AND
THIS IS A PRETTY ACTUALLY
SYSTEMIC PROBLEM IN SOME OF OUR
EMERGENCY ROOMS, EMERGENCY
DEPARTMENTS ACROSS THE STATE
THAT FOLKS ARE IN THERE ON
MENTAL HEALTH HOLDS, AND IT'S
OFTEN IT'S IT HAS BECOME OUR
HARD DEFACTO FRONT DOOR, SO I'LL
BE INTERESTED IN UNDERSTANDING
HOW HOW THIS INTER PLAYS WITH
THE BOOTS ON THE GROUND ISSUE,
AND WHERE PEOPLE WHO REALLY SEEK
AND NEED MENTAL HEALTH SERVICES
ARE POPPING UP IN OUR SYSTEM. AH
BECAUSE IT ISN'T ALWAYS A NEAT
AND TIDY VISIT TO THE DOCTOR.
WITH A FAMILY MEMBER WHO CAN
EXPLAIN EVERYTHING AND WALK YOU
THROUGH A PROCESS. SO HOW ARE WE
GETTING TO THE FOLKS THAT NEED
THIS THE MOST? AND HOW IS THE
PROGRAM BEING IMPLEMENTED IN
WAYS THAT ARE MEANINGFUL AND
IMPACTFUL, TOO? GETTING TO THE
CHANGES WE NEED IN MENTAL HEALTH
CARE. THANKS GREAT. THANK YOU.
OKAY. WE WILL NOW GO TO OUR
FIRST PANEL, WHICH IS WITH
HEALTH CARE PROVIDERS AND
PATIENTS WOULD LIKE TO CONVENE
THAT FIRST PANEL WITH. I DON'T
WANT TO MISPRONOUNCE YOUR NAME.
MERAM. BEN DOT PLAY DID NOT
MISPRONOUNCE THAT WHO IS? UH PH.
D AND FOUNDER OF PSYCH APPEAL?
REBECCA FARMER WHO IS A KAISER
PATIENT AND WILL BE JOINING US
REMOTELY. JOAN BORSTEN, THE
EXECUTIVE DIRECTOR OF SOME
ESTATE RECOVERY CENTER, AND
MICHELLE CABRERA, THE EXECUTIVE
DIRECTOR OF THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION.
AND WE'LL START WITH MISS VEN
DOT. WHAT. OKAY, MR. I'M SORRY,
OKAY? OKAY MR BROWN NOT TO PRESS
THIS BUTTON OR I'M FINE, OKAY?
OKAY? GOOD MORNING CHAIR WIENER
AND MEMBERS OF THE COMMITTEE. MY
NAME IS MARILYN VINE DOT AND
I'M, A SANTA BARBARA BASED
ATTORNEY PSYCHOTHERAPIST AND
FOUNDER OF PSYCH APPEAL, A LAW
FIRM HELPING PATIENTS, FAMILIES,
PROVIDERS AND INSTITUTIONAL
STAKEHOLDERS SUCH AS NUH W
OVERCOME SYSTEMIC BARRIERS TO
MEDICALLY NECESSARY MENTAL
HEALTH CARE. I HAVE SUCCESSFULLY
SPEARHEADED MULTIPLE CONSUMER
CLASS ACTIONS, INCLUDING WHIT
VERSUS UNITED BEHAVIORAL HEALTH.
IN 2016. I SUED THE MHC FOR
FAILING TO TIMELY ADMINISTER
CALIFORNIA'S INDEPENDENT MEDICAL
REVIEW SYSTEM. I HAVE TESTIFIED
IN CONGRESS AND IN MULTIPLE
STATE LEGISLATURES, AND I ALSO
CONSULTED FEDERAL HEALTH PLAN
REGULATORS IN 2020. I HELPED
DRAFT SB 855 ABOUT WHICH I AM
HERE TODAY. LAST WEEK IN
ANNOUNCING GMHC SETTLEMENT WITH
KAISER GOVERNOR NEWSOM HELD A
TECTONIC SHIFT IN TERMS OF OUR
ACCOUNTABILITY AND THE DELIVERY
OF BEHAVIORAL HEALTH SERVICES.
HE EMPHASIZED THAT
ACCOUNTABILITY OF THE PRIVATE
SECTOR IS FOUNDATIONAL TO
ENSURING OUR ENTIRE SYSTEM OF
BEHAVIORAL HEALTHCARE WORKS FOR
ALL CALIFORNIANS. I'M HERE TO
REMIND THE COMMITTEE THAT
ACCOUNTABILITY OF THE PUBLIC
AGENCIES CHARGED WITH REGULATING
THE PRIVATE MANAGED CARE SECTOR.
IS ALSO FOUNDATIONAL AND THAT
BOTH GMHC AND CD I HAVE FALLEN
FAR SHORT OF THEIR MANDATES TO
ENFORCE SB 855 IN THE MIDST OF
CONCURRENCE, SUICIDE AND
OVERDOSE EPIDEMICS. FOR STARTERS
, CALIFORNIA'S REGULATORS ARE
SIMPLY NOT ADDRESSING CONSUMER
COMPLAINTS, INCLUDING NETWORK
INADEQUACY COMPLAINTS WITHIN THE
TIMELY ACCESS MANDATES OF SB 855
AND SP 2 TO 1. WHEREAS CD LACKS
LEGAL AUTHORITY TO COMPEL
INSURERS TO RESPOND TO CONSUMER
COMPLAINTS IN LESS THAN 21 DAYS,
CMHC, WHICH CAN LEGALLY REQUIRE
HEALTH PLANS TO RESPOND TO
URGENT COMPLAINTS WITHIN FIVE
DAYS OR LESS TAKES MONTHS TO
PROCESS THEM VIOLATES ITS
INTERNAL OPERATING PROCEDURES
FREQUENTLY DISREGARDS OR
SUPPRESSES GLARING DEFICIENCIES.
SCAPEGOATS PATIENTS AND
PROVIDERS AND NEARLY ALWAYS
DEPRIVES CONSUMERS WHO DO
PROCESS NAMELY, AND ADVANCED
OPPORTUNITY TO REVIEW AND
RESPOND TO INACCURATE OR
MISLEADING INFORMATION PREFERRED
BY HEALTH PLANS, WHICH THE MHC
TREATS LIKE CLIENTS. MOREOVER
UNLIKE CD, WHICH PROMULGATED
LONGSTANDING GEOGRAPHIC ACCESS
STANDARDS CMHC HAS NOT.
THEREFORE DESPITE SP 855 PROMISE
OF GEOGRAPHICALLY ACCESSIBLE
CARE CALIFORNIANS WITH GMHC
REGULATED PLANS LACK PROTECTION
THROUGH CONCRETE GEOGRAPHIC
ACCESS STANDARDS AND ARE SUBJECT
TO ARBITRARY PROVIDER DISTANCE
MEASURES THAT ARE POORLY IF EVER
ENFORCED. CMHC HAS ALSO SEVERELY
NEGLECTED CALIFORNIA'S
INDEPENDENT MEDICAL REVIEW
SYSTEM ESTABLISHED TO RESOLVE
MEDICAL NECESSITY DISPUTES.
ALTHOUGH EXPEDITED I MARS
CONCERNING THREATS TO LIFE OR
HEALTH MUST BE ADJUDICATED
WITHIN 72 HOURS FOR THE PAST
SEVEN YEARS, ON AVERAGE, GMHC
HAS PERMITTED ITS CONTRACTOR,
MAXIMUS TO DECIDE EXPEDITED,
EXPEDITED MENTAL HEALTH. I AM
OURS IN NEARLY DOUBLE THE TIME
SET BY LAW. EVIDENCE OF THIS IS
ALREADY WITHIN THE COMMITTEE'S
POSSESSION. THESE FAILINGS,
ARBIT SNIPPETS OF THE PERVASIVE
REGULATORY DYSFUNCTION THAT THIS
COMMITTEE MUST TACKLE AS THE
RECENT KAISER SETTLEMENT READS
THE PLANS. RESPONSIBILITY IS
MORE THAN PASSIVE MONITORING.
THIS COMMITTEE SHOULD HOLD OUR
STATE'S REGULATORS TO NO LESS A
STANDARD. THANK YOU. THANK YOU,
REBECCA FARMER. WHO'S REMOTE? MM
HMM. GOOD MORNING. MY NAME IS
REBECCA FARMER AND I RECEIVED
MENTAL HEALTH CARE TREATMENT
FROM KAISER IN SAN FRANCISCO AND
OAKLAND FOR MANY YEARS, STARTING
IN 2008, AND UP UNTIL THIS YEAR,
I'M LIVING WITH MAJOR DEPRESSION
, ANXIETY AND A PHD AND I ALSO
WANT TO POINT OUT I'M A SISTER,
A DAUGHTER AND AUNT, A PARTNER
OR A FRIEND AND A COLLEAGUE AND
DESPITE HAVING WONDERFUL SUPPORT
NETWORKS, THESE MENTAL HEALTH
CHALLENGES ARE INCREDIBLY
DIFFICULT AND OFTEN VERY
ISOLATING. ONE OF THE PLACES
THAT I'M SUPPOSED TO BE ABLE TO
TURN FOR CONSISTENT SUPPORT IS
FROM HEALTH PROVIDERS. BUT FOR
MORE YEARS THAN I CAN REMEMBER,
I MET WITH OBSTACLE AFTER
OBSTACLE AND TRYING TO GET
TIMELY AND ADEQUATE MENTAL
HEALTH CARE FROM KAISER. AFTER
THE PANDEMIC HIT MY MENTAL
HEALTH PLUMMETED. LIKE MANY OF
US, AND I HAD NEW LOWS THAT WERE
FRANKLY, VERY FRIGHTENING WHEN I
TRIED TO SCHEDULE APPOINTMENTS
WITH MY KAISER PSYCHIATRIST, I
HAD TO WAIT ANYWHERE FROM 4 TO
6. WEEKS SOMETIMES MORE, AND
THIS INCLUDED URGENT AND FOLLOW
UP APPOINTMENTS. WHEN I WAS ABLE
TO GET AN APPOINTMENT, THEY
LASTED 30 MINUTES. IF THAT I WAS
USUALLY TOLD JUST TO EMAIL MY
PSYCHIATRIST. WHICH IS NOT A
REPLACEMENT FOR SEEING A
PROVIDER, ESPECIALLY DURING
AMIDST HELP CRISIS. YEAH WHEN I
ASKED FOR AN APPOINTMENT WITH
ANOTHER KAISER PSYCHIATRIST WHO
MIGHT HAVE EARLIER AVAILABILITY.
I WAS TOLD THAT I COULD ONLY SEE
MY PSYCHIATRIST WHICH SHOCKED ME
BECAUSE WHEN MY PRIMARY CARE
POSITION IS UNAVAILABLE, I'M
ABLE TO SEE ANOTHER DOCTOR, AND
IT MADE NO SENSE WHY IT WOULD BE
DIFFERENT HERE. I CONTACTED GMHC
MULTIPLE TIMES CALLING AND
FILING COMPLAINTS. I WAS TOLD
THAT I NEEDED TO FILE AGREEMENTS
DIRECTLY WITH KAISER. FIRST I
DID THAT. BUT GIVEN THE WEEKS OF
REVIEW, THIS PROCESS CAN TAKE
THIS. JUST DEFEATED THE PURPOSE.
WHAT I NEEDED WAS TIMELY MENTAL
HEALTH CARE AND IN THE MIDST OF
A MAJOR DEPRESSIVE EPISODE AND
FRANKLY STRUGGLING, SOMETIMES
WITH WANTING TO LIVE BECAUSE
THERE'S THERAPY ALSO IS SO
INADEQUATE AND INACCESSIBLE HAS
BEEN FOR ME THAT I HAD TO PAY
ROUGHLY $4000 PER YEAR OUT OF
POCKETS FOR AN OUTSIDE THERAPIST
. AND AS A QUEER WOMAN. I NEED
TO BE ABLE TO MAKE SURE THAT MY
MENTAL HEALTH PROVIDERS
UNDERSTAND HOW TO SUPPORT LGBTQ
PEOPLE, WHICH IS AMONG THE
REASONS I HAD TO SEEK OUT MENTAL
CARE THERAPIST ON MY OWN. I'M
VERY FORTUNATE TO HAVE HAD THE
RESOURCES TO PAY FOR THIS. BUT
EVEN THEN THE COST IS A STRETCH
AND I HAD TO REDUCE VISITS WITH
MY THERAPIST. I SPENT COUNTLESS
HOURS BACK AND FORTH WITH KAISER
IN RECENT YEARS, JUST TRYING TO
GET ACCESS TO MENTAL HEALTH
SERVICES THAT SHOULD BE COVERED
AND TIMELY AND DOING ALL THIS
WHILE IN THE MIDST OF IT
INCREDIBLY DARK DEPRESSION,
WHICH LEFT ME EXHAUSTED AND WITH
VERY LITTLE BANDWIDTH FOR
ANYTHING ELSE. I ALSO WANT TO
NOTE THAT I SPENT MY CAREER
WORKING IN SOCIAL CHANGE
ORGANIZATIONS LIKE THE W AND
BREAST CANCER ACTION, SO I
UNDERSTAND HOW TO ADVOCATE FOR
MYSELF AND HEALTHCARE SYSTEM,
BUT NO ONE SHOULD HAVE TO HAVE
SPECIALIZED KNOWLEDGE TO GET
BASIC ACCESS TO HEALTH CARE THAT
WE DESERVE, LET ALONE THAT WE
ALSO PAY FOR ALL OF US SHOULD
HAVE TIMELY ACCESS TO QUALITY,
MENTAL HEALTH CARE, AND FOR THE
CHALLENGES THAT I HAVE FACED AS
A WHITE WOMAN WITH A STEADY
INCOME. I KNOW THAT THE
OBSTACLES ARE EVEN MORE
DIFFICULT FOR ANYONE STRUGGLING
TO MAKE ENDS MEET FOR LGBTQ
YOUTH AND FOR BLACK, INDIGENOUS
AND PEOPLE OF COLOR. FROM MY
PERSPECTIVE, KAISER'S MENTAL
HEALTH CARE SYSTEM IN CALIFORNIA
HAS DONE A COMPLETE DISSERVICE
TO PATIENTS LIKE ME, AND IT'S
CAUSING SIGNIFICANT HARM BY
CONTINUING TO ROUTINELY REFUSED
TIMELY AND QUALITY CARE.
MEANWHILE THE RECENT SETTLEMENT
ASIDE, THE DEPARTMENT OF MANAGED
HEALTH CARE HAS BEEN AN ABSENT
REGULATOR, ALLOWING KAISER AND
LIKELY OTHER HEALTH INSURANCE
COMPANIES TO EFFECTIVELY WITH
HOLDS ADEQUATE AND TIMELY MENTAL
HEALTH CARE WHEN WE NEED IT, THE
MOST SO UNLESS GMHC AGGRESSIVELY
UPHOLDS ITS ROLE AS A REGULATOR,
KAISER WILL NO DOUBT CONTINUE
FAILING PATIENTS LIKE ME WHO
NEED TIMELY MENTAL HEALTH CARE,
AS THEY HAVE DONE FOR TOO MANY
YEARS AND WITHOUT GMHC S CLOSE
MONITORING. I HAVE NO CONFIDENCE
THAT KAISER WILL REIMBURSE
PATIENTS OR MEET ANY OTHER TERMS
OF THE SETTLEMENTS. THANK YOU
FOR YOUR TIME. THANK YOU VERY
MUCH WILL NOW HEAR FROM JOAN
BORSTEN, THE EXECUTIVE DIRECTOR
OF SUMMIT ESTATE RECOVERY CENTER
. GOOD MORNING. I'M ALSO THE CO
FOUNDER AND FORMER CEO OF MALIBU
BEACH RECOVERY CENTER AND A CO
FOUNDER AND FORMER VP OF THE
ADDICTION TREATMENT ADVOCACY
COALITION. I'M HERE TO TESTIFY
ABOUT A DECADE LONG PROBLEM IN
CALIFORNIA AND THE NATION.
INSURANCE COMPANIES THAT
INCENTIVIZE DOCTORS WHO DO NOT
CURRENTLY PRACTICE ADDICTION
MEDICINE TO DENY NEEDED
TREATMENT. CALIFORNIA'S
ADDICTION TREATMENT PROVIDERS
ALL BREATHED A SIGH OF RELIEF.
WHEN FIVE DAYS AFTER SB 855
BECAME LAW, THE D M D M H C AND
C D NOTIFIED INSURANCE COMPANIES
AND PROVIDERS THAT THE ONLY
CRITERIA THEY COULD USE GOING
FORWARD TO DETERMINE LENGTH OF
STATE AND LEVEL OF CARE. WERE
THOSE OF ACE, UM, THE AMERICAN
SOCIETY OF ADDICTION MEDICINE.
BUT THE SITE THESE REFORMS, MOST
INSURANCE COMPANIES CONTINUE TO
HIRE THE VERY SAME DOCTORS
THEY'VE HIRED FOR YEARS WILL USE
THE SAME INAPPROPRIATE REASONS
TO DENY COVERAGE ACROSS
CALIFORNIA. INSURANCE COMPANIES
PREMATURELY SEND SUBSTANCE USE
DISORDER PATIENTS HOME EARLY,
DISREGARDING THE SAME CRITERIA,
PUTTING COUNTLESS PATIENTS AT
RISK OF RELAPSE, HOMELESSNESS.
AND IN SOME TRAGIC CASES, EVEN
DEATH IN NOVEMBER OF 2021. SOME
HAVE JOINED FORCES WITH SEVERAL
BILLION COMPANIES TO TRACK THESE
DENIALS ACROSS 38 FACILITIES
OVER THE TWO YEARS. OUR RESULTS
FOUND THAT NONE OF THE
APPROXIMATELY 80 EXTERNAL AND
INTERNAL DOCTORS HIRED BY
INSURANCE COMPANIES, PRIMARILY
ANTHEM TO PERFORM A PEER REVIEWS
FOR ADDICTION. PATIENTS WERE
ASEM ACCREDITED, NOR DID THEY
BASE THEIR DECISIONS ON A SOME
CRITERIA. SHOCKINGLY THE DOCTORS
MOST FREQUENTLY ASSIGNED TO
REVIEW ADDICTION CASES IN
CALIFORNIA HAVE DENIAL RATES OF
100% 90% 80% 70% AND SO ON. MANY
OF THE WORST DENIERS ARE THE SO
CALLED EXTERNAL DOCTORS FROM
WISCONSIN BASED PRESTON
ASSOCIATES, FOLLOWED BY ANTHEMS
INTERNAL DOCTORS WHO UPHOLD THE
PRESS DENIALS. FOLLOWED BY
DOCTORS FROM MSN. IN 2020 TO OUR
LOCAL STATE SENATOR DAVID CORTEZ
, E AUTHORED SB 999 TO SAVE
LIVES AND OUTLAW THE PRACTICE OF
INSURANCE COMPANIES USING
UNQUALIFIED DOCTORS TO DENY
TREATMENT DETERMINED NECESSARY
BY ACM. YES WE 999 ALSO CALLED
FOR IMPROVED WORKING CONDITIONS
FOR PEER TO PEER REVIEWS ENDING
LAST MINUTE SCHEDULING APPEAR TO
BE REVIEWS, ELIMINATING THE CUT
AND PASTE DENIALS DEVOID OF
PATIENT SPECIFIC INFORMATION.
THE BILL WAS ULTIMATELY VETOED
BY THE GOVERNOR. IN HIS VETO
MESSAGE, THE GOVERNOR STATED THE
BILL WAS PREMATURE, GIVEN THE
RECENT PASSAGE OF SB 855 THE
REGULATIONS OF WHICH THE DEAL
AND GMHC WE'RE STILL FINALIZING.
WHILE WAITING FOR THESE TWO
AGENCIES TO ACT, OUR PATIENTS
BEGIN SUBMITTING INDEPENDENT
MEDICAL REVIEWS. I AM OURS TO
THE D¯ÚI AND, UM HC TO CHALLENGE
THE ILLEGAL DENIALS. REMARKABLY
THEY WANT EVERY CASE, THEY
FOUGHT AND BLOOMBERG NEWS
REPORTED. THAT 66% OF ALL I AM
ARE IS RELATED TO ADDICTION AND
MENTAL HEALTH. FILED AFTER SB
855 BECAME LAW ALSO OVERTURNED
DENIALS. SO I'D LIKE TO SHARE
ONE OF MANY EXAMPLES OF SUMMIT
PATIENTS WHO SURVIVED DESPITE
THE DENIALS. PATIENT NUMBER FIVE
IS A 40 YEAR OLD MARRIED
BUSINESS ANALYTICS MANAGER WITH
TWO SMALL CHILDREN HAD BEEN A
PROBLEM DRINKER PRETENDING
YEARS. HE CAME TO TREATMENT
AFTER BEING KICKED OUT OF HIS
HOME BY HIS WIFE. AFTER 15 DAYS,
HE WAS TOLD TO GO HOME AND
ATTEND OUTPATIENT BY AN EXTERNAL
PRESSED. PSYCHIATRIST WITH 100%
DENIAL RATE UPHELD BY AN ANTHEM
GERIATRIC PSYCHIATRIST WITH AN
88% DENIAL RATE. THE PATIENT
SAID. IF I HAD LEFT RESIDENTIAL
TREATMENT EARLY, I PROBABLY
WOULD HAVE RELAPSED LOST MY JOB
AND MY FAMILY. I KNOW FROM
EXPERIENCE WHILE I'M DRINKING MY
MIND STOPS RESPONDING TO REASON,
EVEN IF IT MEANS GETTING
ARRESTED, STEALING SOMETHING,
DRIVING RECKLESSLY ENDURING
MYSELF AND OTHERS AND MAKING
STUPID DECISIONS. IN CALIFORNIA.
THE FUTURE OF MENTAL HEALTH AND
ADDICTION. TREATMENT CENTERS IS
HANGING IN THE BALANCE THAT WE
HAVE THE POWER TO PROTECT THEM.
WE PREDICTED OF THE FINAL SB 855
REGULATIONS DO NOT REQUIRE USE
OF QUALIFIED DOCTORS CURRENTLY
PRACTICING ADDICTION MEDICINE
WHO USED A SAME CRITERIA. HUGH
DETERMINE LENGTH OF STAY AND
LEVEL OF CARE. CALIFORNIA'S
LANDMARK PARITY BILL WILL HAVE
NO TEETH AND SUBSTANCE USING
MENTAL HEALTH PATIENTS WILL
AGAIN HAVE NO VOICE. AND I JUST
WANT TO ADD THAT IF YOU GO IF
YOU WANT TO SEE MORE OF WHAT I
CAN TELL YOU, PLEASE GO TO WWW
DOT FRIENDS OF SB 999 .COM AND
THERE'S A BUTTON ON THE UPPER
RIGHT SCROLL DOWN TO JOAN
TESTIMONIAL. THANK YOU WILL NOW
HEAR FROM MICHELLE CABRERA FROM
THE COUNTY BEHAVIORAL HEALTH
DIRECTORS ASSOCIATION. THANK
YOU, MR CHAIR AND MEMBERS. I AM
THE EXECUTIVE DIRECTOR OF THE
COUNTY BEHAVIORAL HEALTH
DIRECTORS ASSOCIATION OF
CALIFORNIA AND OUR MEMBERS ARE
THE LEADERS OF THE COUNTY
BEHAVIORAL HEALTH SAFETY NET
THROUGHOUT CALIFORNIA'S 58
COUNTIES ARE RESPONSIBLE FOR
PROVIDING PRIMARILY MEDICAL
SPECIALTY CARE. TO BENEFICIARIES
WITH SIGNIFICANT MENTAL HEALTH
AND SUBSTANCE USE CONDITIONS
THROUGHOUT THE LIFESPAN. HOWEVER
FOR DECADES, COUNTIES HAVE
PROVIDED A BROADER SAFETY NET IN
THE FORM OF COMMUNITY BASED
SPECIALTY BEHAVIORAL HEALTH
SERVICES TO MILLIONS OF
CALIFORNIANS WITH PRIVATE
COMMERCIAL INSURANCE COVERAGE
WHO ARE EITHER UNDERSERVED OR
INAPPROPRIATELY SERVED BY THEIR
COMMERCIAL PLANS. EXCEPT TO THE
EXTENT THAT LOCAL RESOURCES ARE
AVAILABLE. COUNTIES HAVE A STAKE
IN OFFERING THESE BROADER SAFETY
NET SERVICES BECAUSE MENTAL
HEALTH AND SUD CONDITIONS ARE
THE WORLD'S LEADING CAUSE OF
DISABILITY, AND OVER HALF OF ALL
, CALIFORNIANS HAVE SOME FORM OF
PRIVATE INSURANCE. COUNTIES WILL
SERVE THESE MEMBERS OF THE
COMMUNITY WHEN RESOURCES ALLOW
BOTH TO SAVE LIVES IN THE
IMMEDIATE BUT ALSO TO PREVENT
THEIR CHRONIC CONDITIONS FROM
PROGRESSING TO THE POINT OF
SIGNIFICANT DISABILITY, WHICH
CAN LEAD TO JUSTICE, INVOLVEMENT
, HOMELESSNESS AND PREMATURE
MORTALITY, AS OTHERS HAVE
COMMENTED EARLY IN 2022
FOLLOWING THE PASSAGE OF ÁP SB
855 LANDMARK LEGISLATION, WHICH
YOU CHAIR AUTHORED. UM THE IMAGE
HE DID REACH OUT TO COUNTIES TO
BETTER UNDERSTAND OUR AGENCIES
EXPERIENCES WITH SERVING
COMMERCIAL PLAN BENEFICIARIES AS
PROVIDERS BUT ALSO AS
COORDINATORS OF SPECIALTY
BEHAVIORAL HEALTH SERVICES. SEE
BHD'S SURVEYED OUR MEMBERS AND
CONDUCTED FOCUS GROUPS AND
SHARED OUR MEMBERS EXPERIENCES
WITH STATE REGULATORS TO INFORM
THEIR RULE MAKING PROCESSES.
HERE'S A SAMPLE OF WHAT WE
LEARNED. COUNTIES ARE SERVING A
BROAD RANGE OF INDIVIDUALS WITH
COMMERCIAL INSURANCE, PRIMARILY
IN THE AREAS OF CRISIS CARE,
SCHOOL BASED SERVICES AND
SPECIALTY SERVICES. BOTH IN
MENTAL HEALTH AND SUBSTANCE IS
TO SORT OF PROGRAMS. WE END UP
TOUCHING THESE BENEFICIARIES,
AND THIS GOES TO SENATOR ASHBY'S
QUESTION FOR A VARIETY OF
REASONS. FIRST THE PUBLIC HAS AN
EXPECTATION THAT CERTAIN
BEHAVIORAL HEALTH SERVICES LIKE
CRISIS CARE WILL BE THERE FOR
THEM, REGARDLESS OF INSURANCE
STATUS AND FUNCTION WITH SIMILAR
MECHANISMS FOR REIMBURSEMENT TO
HOW PHYSICAL HEALTH EMERGENCY
AND CRISIS SERVICES FUNCTION.
SECOND PLANS HAVE COME TO RELY
ON COUNTY SAYS A BACKSTOP SOME
OF OUR STATE'S LARGEST, MOST
WELL FUNDED, SOPHISTICATED
HEALTH PLANS DIRECTLY REFER
THEIR BENEFICIARIES TO OUR
SPECIALTY PROGRAMS, SUCH AS FULL
SERVICE PARTNERSHIPS, FUNDED
UNDER THE MENTAL SERVICES ACT OR
FIRST EPISODE PSYCHOSIS PROGRAMS
WITHOUT THE INTENTION OF PAYING
FOR THOSE SERVICES BASED ON AN
EXPECTATION THAT COUNTIES WILL
COVER THESE TREATMENTS WITH
MHSC, ANOTHER FUNDING SOURCES.
WHEN COUNTIES COULD THEY DID,
HOWEVER, THEY WERE OVERWHELMED
WITH REFERRALS FROM COMMERCIAL
PLAN BENEFICIARIES IN SOME CASES
AND HAD TO CLOSE OFF THAT ACCESS
IN ORDER TO ENSURE THAT MEDICAL
BENEFICIARIES REMAINED THE
PRIORITY. AND MOVING FORWARD.
MHSC REFORMS WILL FUNDAMENTALLY
CHANGE THE NATURE OF HOW OUR
MHSC FUNDS WORK AND THE
AVAILABILITY OF THESE SERVICES
TO INDIVIDUAL SOURCE COMMERCIAL
INSURANCE. HOWEVER THE
REIMBURSEMENT AND REGULATORY
STRUCTURES TO ENSURE PAYMENT ARE
ALSO SIMPLY NOT THERE TODAY.
WHEN WE SURVEYED OUR MEMBERS, WE
FOUND THAT COUNTIES BILLING
COMMERCIAL INSURANCE PLANS OFTEN
HAVE THEIR FIRST CLAIMS
ROUTINELY DENIED, REGARDLESS OF
THE COVERAGE THOSE PLANS HAVE OR
THE CODES THAT WE USED WITH ONE
COMMERCIAL PLAN, ALWAYS DENYING
CLAIMS SUBMITTED BY THE COUNTY,
MEANING 100% OF THE TIME. FOR
PLANS THAT DID PAY. SOMETIMES
THEIR PRACTICE WAS TO PAY THE
MINIMUM RATES WITH COUNTIES
NEEDING TO APPEAL TO RECOUP
SUFFICIENT REIMBURSEMENT, WHICH
ULTIMATELY REQUIRED DOUBLE THE
ADMINISTRATIVE WORKLOAD. MOST
COUNTIES SIMPLY DO NOT HAVE THE
WORKFORCE DURING THIS WORKFORCE
CRISIS OR THE BUILDING
INFRASTRUCTURE NECESSARY TO
CHASE DOWN MULTIPLE APPEALS. AND
SO THEY END UP COVERING THOSE
UNREIMBURSED CLAIMS THROUGH MHSC
OR REALIGNMENT. BY THE
LEGISLATURE IN THE
ADMINISTRATION HAVE ATTEMPTED TO
CLEAN UP REIMBURSEMENT
REQUIREMENTS INCLUDED IN A B 9
88 TO REMOVE THE REQUIREMENT
THAT INDIVIDUALS MEET MEDICAL
NECESSITY CRITERIA FOR CRISIS
SERVICES. COUNTIES ARE STILL
TODAY ROUTINELY DENIED
REIMBURSEMENT FOR CRISIS
SERVICES TO COMMERCIAL
BENEFICIARIES. COUNTY CRISIS
SERVICES ARE TODAY IN HIGH
DEMAND AMONG THESE COMMERCIALLY
INSURED BENEFICIARIES. ONE LOCAL
COUNTY REPORTED THAT ONLY ABOUT
20 TO 25% OF THEIR MOBILE CRISIS
THESE CALLS ARE FOR MEDICAL. THE
REMAINING 75 TO 80% ARE FOR OUR
PRIVATELY INSURED COMMUNITY
MEMBERS WHO LACK ACCESS TO
OUTPATIENT CARE THAT CAN PREVENT
CRISIS AND THEN LATER TO THE
CRISIS SERVICES THAT THEY MAY
NEED WHEN THEY DECOMPENSATE.
COUNTY CRISIS SERVICES ALSO GO
BEYOND MOBILE CRISIS. I WANT TO
KNOW AND INCLUDE CRISIS
STABILIZATION, PSYCHIATRIC
HEALTH FACILITIES AND INPATIENT
SERVICES, WHICH ARE ALSO
ROUTINELY DENIED. COUNTIES HAVE
ALSO CITED THAT BLOCK GRANTS ARE
USED TO FUND SUBSTANCE USE
DISORDER, RESIDENTIAL TREATMENT,
AND WHILE ONE COUNTY HAS BEEN
SUCCESSFUL IN GETTING IN NETWORK
WITH A COMMERCIAL PLAN FOR THESE
SUD SERVICES, COMMENTED THAT
COMMERCIAL PLANS NEVER
REIMBURSED FOR BUPRENORPHINE. IN
ADDITION, WE HAVE HEARD
REPEATEDLY FROM OUR
BENEFICIARIES WITH SIGNIFICANT
MENTAL HEALTH CONDITIONS SUCH AS
SCHIZOPHRENIA AND OTHERS THAT
THEIR COMMERCIAL INSURANCE PLANS
SUGGEST TO THEM DIRECTLY THAT
THEY DROPPED THEIR COMMERCIAL
INSURANCE AND BECOME MEDICAL
ELIGIBLE SO THAT THEY CAN ACCESS
THE MORE ROBUST SET OF BENEFITS
THAT ARE AVAILABLE THROUGH OUR
COUNTIES. THIS REALLY SHOWS THAT
WE HAVE SO MUCH MORE WORK TO DO
BEYOND PARODY, AND THIS GOES TO
SENATOR COURT TENDENCIES,
COMMENTS TO IMPROVE COVERAGE OF
LIFE SAVING TREATMENTS THAT CAN
ASSIST INDIVIDUALS IN PREVENTING
THE WORST OUTCOMES. THESE
INCLUDE SERVICES SUCH AS FIRST
EPISODE PSYCHOSIS, PSYCHIATRIC
HEALTH FACILITIES AND FSP
SERVICES, BUT ESPECIALLY THOSE
THAT ARE DESIGNED TO ADDRESS THE
BIO CIRCLE PSYCHOSOCIAL NATURE
OF BEHAVIORAL HEALTH, IN OTHER
WORDS, FIELD BASED IN HOME BASED
SERVICES ARE OFTEN DENIED ON
THOSE BASES AS OUR SERVICES
DELIVERED THROUGH NON CLINICIANS
, SUCH AS PEER SUPPORT
SPECIALIST WHICH CAN BE FAR MORE
EFFECTIVE. AND INSURANCE
COMPANIES HAVE A PREFERENCE FOR
PHYSICIAN AND OR LICENSED
CLINICIAN DELIVERED CARE.
CALIFORNIA HAS MADE SIGNIFICANT
PROGRESS IN ADDRESSING THE NEED
FOR COMMERCIAL PLANS TO COVER
TREATMENTS SUCH AS ABBA FOR
AUTISM, WHICH HAS ENSURED THAT
THOSE WITH EMPLOYERS COVERAGE
ARE NOT RELEGATED TO THE PUBLIC
SAFETY NET TO LIVE THEIR BEST
LIVES AND THE MAJORITY OF COUNTY
BEHAVIOR HALLS. AGENCIES WE
SURVEYED IN SUMMARY HAVE
ATTEMPTED TO BUILD COMMERCIAL
INSURANCE PLANS ARE RARELY
SUCCESSFUL IN RECOUPING AND
REALLY, AT THE END OF THE DAY,
DENIAL APPEARS TO BE THE
DEFAULT. OUR SAFETY NET WILL BE
GIVEN A NEW SET OF OBLIGATIONS
IF PROPOSITION ONE IS PASSED BY
THE VOTERS AND ASSUMING THAT THE
RESPONSIBILITY FOR CONTRACTING
WELCOME TO COUNTY BEHAVIORAL
HEALTH PLANS, WE WILL THEN NEED
TO BUILD OUT NEW ADMINISTRATIVE
CAPACITY TO CHASE DOWN BOTH
CONTRACTS AS WELL AS
REIMBURSEMENTS FOR THIS OUT OF
NETWORK CARE. COVERAGE MATTERS
AS MUCH AS PARODY IN CERTAIN
SPECIALTY SERVICES THAT ARE
SIMPLY NON EXISTENT FOR
COMMERCIAL PLAN BENEFICIARIES
AND GIVEN THE SEVERE OUTCOMES,
INCLUDING DISABILITY AND
PREMATURE MORTALITY, AS WELL AS
THE COST SHIFTING TO THE PUBLIC
SECTOR. WE BELIEVE IT'S
IMPORTANT TO CONTINUE TO PURSUE
BROADER COVERAGE REQUIREMENTS TO
ENSURE THAT WE LIVE INTO THE
SPIRIT OF PARODY, MEANING THAT
THE COVERAGE IS AS GOOD FOR
INDIVIDUALS WITH COMMERCIAL
COVERAGE AS IT IS FOR THOSE WITH
MEDICAL THANK YOU FOR THE
OPPORTUNITY TO REPRESENT THE
PERSPECTIVE OF COUNTY BEHAVIORAL
HEALTH, AND I'M HAPPY TO TAKE
ANY QUESTIONS. THANK YOU VERY
MUCH COLLEAGUES. ANY QUESTIONS
FOR ANY OF THE MEMBERS OF THIS
PANEL, SENATOR RUBIO. WELL IT'S
NOT A QUESTION, BUT AS WE MOVE
FORWARD, AND I KNOW THAT WE'RE
TRYING TO FIGURE OUT WHAT THE
DEFICIENCIES ARE IN TERMS OF YOU
KNOW WHAT'S HAPPENING OUT IN THE
FIELD, BUT YOU KNOW, AS PEOPLE
COME UP AND PRESENT, I ALSO WANT
TO JUST LOOK AT OURSELVES AS A
LEGISLATURE. YOU KNOW, WHAT CAN
WE DO TO STRENGTHEN SOME OF THE
DEFICIENCIES BY WAY, OF EXAMPLE?
I THINK I WANT TO VIEW STATED
THAT THE M H C COULD TAKE CARE
OF SOME COMPLAINTS WITHIN FIVE
DAYS, BUT YET THEY TAKE MONTHS
AND THEN YOU KNOW, AND I KNOW I
HAVE THIS EXPERIENCE WITH
ANOTHER DEPARTMENT LAST YEAR
THAT I WORKED WITH FOR ABOUT SIX
MONTHS AND THE RADAR APPROVAL
AND THINGS LIKE THAT WERE
HAPPENING AT A VERY SLOW PLAY
PIECE. BUT AFTER SILLY DIVING
DEEP. YOU KNOW, WE REALLY DID
COME TO THE CONCLUSION THAT THEY
WERE LACKING STAFF AND SUPPORT
AND WE WERE ABLE TO SUPPLEMENT
SOME OF THE WORK FORCE. AND SO
YOU KNOW, WE'RE HOPEFUL THAT
THAT WILL MOVE THINGS FORWARD.
BUT YOU KNOW, POLICE AS WE MOVE
FORWARD WITH THE CONVERSATION I
WANT TO HEAR WHAT IS IT THAT WE
CAN DO ON OUR SIDE? BECAUSE IT
COULD BE VERY LEGITIMATELY THAT
THE CAPACITY IS NOT THERE AND
WE'RE GOING TO SOLVE THIS
PROBLEM THEN. THEN WE WANT TO BE
HELPFUL ON THIS SITE TO MAKE
SURE THAT WE PROVIDE THE
RESOURCES OF FUNDING. WHATEVER
IT IS THAT WE NEED TO PROVIDE,
BUT THANK YOU FOR SHARING THAT.
SENATOR I SPEAK. I JUST WANT TO
THANK YOU FOR WALKING THROUGH
THE BEHAVIORAL HEALTH SERVICES
SIDE OF THE EQUATION AND REALLY
MORE OF A COMMENT, BUT I NOTICE
YOU TALKED ABOUT PROP ONE IN
THERE. AND I THINK WE HAVE TO BE
REALLY CAUTIOUS THAT PROP. ONE
HAS A VERY FINITE FOCUS, AND IT
IS TO MAKE SURE THAT PEOPLE HAVE
ACCESS TO THE BEHAVIORAL, HEALTH
AND ADDICTION CARE THAT THEY
NEED. AND IF WE DON'T WANT TO,
UM, THROW EVERYTHING ON THE
PROP. ONE AND THEN IT DOESN'T
MEET ITS GOAL. SO IT WAS
INTERESTING TO HEAR YOU BRING
THAT UP AND MENTIONED IT IN IN
THAT CAPACITY AND ALSO
INTERESTING TO HEAR THE
PERSPECTIVE OF SORT OF THE
COUNTY ON TRYING TO BILL.
OBVIOUSLY, THERE ARE MANY TIMES
I WANTED TO SAY TELL ME THE NAME
RIGHT? BUT YOU CAN. YOU CAN
SHARE THAT WITH US LATER AND IN
A DIFFERENT VENUE IF THERE ARE
PARTICULAR COUNTIES OR ENTITIES
THAT MAYBE WE THINK ARE OUTLIERS
IN GOOD WAYS OR BAD WAYS,
BECAUSE MAYBE THERE ARE THINGS
WE COULD LEARN FROM THE ONE
COUNTY THAT'S BEING ABLE TO FOR
EXAMPLE, MAYBE THEY HAVE A
REALLY GOOD RELATIONSHIP WITH
THEIR PROVIDER OR SOMETHING. BUT
THERE MUST BE. THERE MUST BE
SOME TRADE SECRETS IN THERE
SOMEWHERE THAT WE CAN STILL WORK
ON TO GREEN GATOR. GREATER
SUCCESS FOR MORE INDIVIDUALS
ACROSS OUR STATE, BUT I REALLY
APPRECIATED HEARING THAT
PERSPECTIVE FROM YOU. THANK YOU,
SENATOR. IF I MAY, UM THE REASON
I REFERENCED PROPOSITION ONE IS
BECAUSE THERE IS A REQUIREMENT
INCLUDED IN THAT LEGISLATION
THAT COUNTY BEHAVIORAL HEALTH
AGENCIES SEEK TO CONTRACT WITH
ALL THE COMMERCIAL PLANS IN
THEIR COUNTY AND SO THAT WILL
IMPOSE A NEW REQUIREMENT ON
COUNTIES TO ATTEMPT TO BE IN
NETWORK PROVIDERS WITH THOSE
HEALTH PLANS AND SO TO YOUR
POINT, YES. UNDERSTANDING THE
SORT OF TRICKS OF HOW THAT ONE
COUNTY WAS ABLE TO GET IN
NETWORK WILL BE IMPORTANT AND
THERE IS A LOT OF VARIATION
ACROSS PLANTS EVEN PLANS WITH
THE SAME BRAND NAME WILL HAVE
DIFFERENCES, DEPENDING ON WHERE
THEY'RE LOCATED IN THE STATE IN
TERMS OF DENIAL RATES AND THE
LIKE, I THINK IN ORDER TO BE
SUCCESSFUL IF WE HAVE TO LOOK
BEYOND JUST COUNTIES Tð
INDIVIDUAL. CAN WE JUST STOP
TREATING COUNTIES LIKE SILOS?
BECAUSE WHEN YOU ARE EVEN WITH
MEDICAL IF YOU'RE CERTIFIED
THROUGH SACRAMENTO AND YOU WALK
FIVE MILES THAT WAY IN YOUR IN
YOLO COUNTY. IT'S VERY DIFFICULT
TO GET THE APPROVALS NECESSARY
FROM A SEPARATE COUNTY THAN THE
ONE THAT YOU'RE BEING SEEN IN
AND SO YOU KNOW, THERE ARE A LOT
OF THINGS THAT WE NEED TO WORK
ON HERE THAT ARE REALLY JUST
EXCHANGE OF INFORMATION BUT
REALLY ARE NO FAULT. OF THE
PATIENT THEMSELVES, AND SO WE'VE
GOT TO FIND WAYS TO STREAMLINE
ACCESS TO THESE RESOURCES, WHICH
IS I BELIEVE CHAIR WIENERS POINT
IN THE IN THE FIRST PLACE IN
PROPER ONE. MAYBE THE SOLUTION
FOR SOME OF THOSE THINGS
CERTAINLY. TO HAVE A COUPLE
QUESTIONS. FIRST ONE IS FROM HIS
BORSTEN. THE. MAYBE YOU CAN YOU
CAN CLARIFY OR EXPLAIN THE IDEA
THAT IS GOOD IN AS POWERFUL AS 8
85 IS THAT THE GUIDELINES THAT
THE CRITERIA MAY BE SAID A
LITTLE TOO NARROW IN TERMS OF UM
THREE. IN TERMS OF PROVIDING FOR
ACCESS. TO FOLKS WHO NEEDED
COULD YOU TALK ABOUT THAT? JUST
A LITTLE MORE. I KNOW YOU COULD
PROBABLY WRITE A VOLUME OF I'M
GOING TO GIVE YOU AN EXTREME I
JUST WANTED I JUST WANT TO HEAR
AS WE MOVE BEFORE WE MOVE AWAY
FROM THE PANEL. YOU KNOW WHAT?
WHAT WHAT WOULD BE A SOLUTION?
IF WE'RE GOING TO BE PART OF A
SOLUTION, INCLUDING YOU ON THE
PANEL? UM WHAT WOULD WE ADD ON?
OR HOW WOULD WE MODIFY IN ANY
WAY THE 85 APPROACH TO MAKE SURE
SOME OF THESE PROBLEMS A COUPLE
OF YOU HAVE TESTIFIED TO DON'T
HAPPEN? I MEAN, I THINK THAT,
UM, PERIOD APPEAR DOCTORS WHO
ARE ASKED TO DETERMINE HOW MANY
ADDITIONAL DAYS OF TREATMENT
PATIENT CAN HAVE. SHOULD BE
CURRENTLY PRACTICING ADDICTION
MEDICINE. OTHERWISE, HOW DO THEY
KNOW? AND, UM THE FACT THAT THEY
SO BLATANTLY IGNORED THE
REGULATIONS PUT OUT FIVE DAYS
AFTER SB 855 BECAME LAW IS
SHOCKING TO ME, AND IT CONTINUES
NOW 33 YEARS AND SOME OF THEM
NONE OF THEM. USE A SOUND LIKE
THEY MIGHT MENTION IT, BUT THEY
DON'T USE THE SAME CRITERIA. I
KNOW THAT BECAUSE WE HAVE A SOME
DOCTORS WHO SPEND A LOT OF TIME
GOING THROUGH ALL THESE
CRITERIA. AND THEN THEY JUST SAY
THAT PERSON OUGHT TO BE IN
TREATMENT, BUT IT'S ABOUT MONEY
ISN'T IT IS DENIED. SO YOU NEED
TO HAVE STRONGER YOU NEED TO SAY
IT. YOU CAN'T SEND UP A DIA
TRIST TO DETERMINE WHETHER A
STAGE FOR LIVER CANCER PATIENT
NEEDS MORE CHEMOTHERAPY, AND
THAT'S IN MY OPINION. I'M
EXAGGERATING, BUT IT'S
ESSENTIALLY WHAT THEY'RE DOING,
AND THEY'RE BEING ALLOWED TO IF
I CAN. IT'S PROBABLY NOT AN
EXHAUSTIVE EXAGGERATION IN
SPECIALIST WORLD OF MEDICINE. IN
THIS OR HEALTHCARE TO SAVE MORE
BROADLY, AND THIS IS HEALTH CARE
THAT WE'RE TALKING ABOUT? UM
MISS CABRERA. YOU TALKED ABOUT
SPORTS. I WAS TALKING ABOUT PEER
TO PEER. REVIEW OF CLAIMS LIKE
UTILIZATION REVIEW. I THINK YOU
WERE TALKING ABOUT PURE TO PURE.
THERAPY AT ONE POINT CORRECT ME
IF I'M WRONG, IT'S STUNNING TO
ME THAT IF I HEARD YOU CORRECTLY
THAT. ALMOST 100 YEARS AFTER THE
FOUNDING OF A, WHICH IS, YOU
KNOW, AT A MINIMUM, A PEER TO
PEER HAND OFF, YOU KNOW, POST
MAYBE. CLINICAL WORK OR
PSYCHIATRIC WORK, AS IS EVERY
OTHER 12 STEP PROGRAM. I HAVE
SEEN THAT THAT'S NOT RECOGNIZED,
AND IT'S NOT RECOGNIZE THAT
PRIOR TO 1935, OR WHENEVER THAT
KIND OF THERAPY WAS FOUNDED.
THAT THERE WAS A REALIZATION THE
SAME REALIZATION WE'RE TALKING
ABOUT TODAY THAT YOU CAN'T JUST
SEND FOLKS TO A DOCTOR OR
SANITARIUM, SO TO SPEAK, WHICH
WERE THEY WERE CALLED THEN AND
WERE TO JUST JUST CLINICAL HELP
UNLESS IT UNLESS IT WORKS IN
SOME ASPECT OF AN ADDICT.
COMMUNICATING WITH ANOTHER
ADDICT. CAN YOU SPEAK TO THAT?
AND I ONLY HAVE ONE OTHER
QUESTION FOR HER AFTER THIS MR
CHAIR, WHICH HAS TO DO WITH THE
JUSTICE SYSTEM, BUT CAN YOU JUST
TALK ABOUT THAT A LITTLE MORE?
BECAUSE YOU WERE I KNOW YOU WERE
TIME LIMITED AND YOU WERE SURE
QUICKLY WITH YOUR COMMENTS.
THANK YOU. YES, I WAS REFERRING
TO PEER SUPPORT SPECIALISTS AND
WE HAVE CERTIFICATION UNDER
MEDICAID AND NOW HAVE A BENEFIT
IN CALIFORNIA, WHICH COUNTIES
ARE ABLE TO PROVIDE. UM THE
COMMENT WAS BASED ON WHEN WE
ASKED ABOUT OUR ATTEMPTS TO
BUILD INSURANCE PLANS. THEY WILL
DENY CLAIMS BECAUSE CERTAIN
CLAIMS ARE NOT DELIVERED BY
PHYSICIANS OR ER BECAUSE THEY'RE
DELIVERED BY WAVERED CLINICIAN
TO ARE WORKING TOWARDS LICENSOR,
FOR EXAMPLE. AND SO, ESSENTIALLY
, THESE ARE FOLKS WHO EITHER ARE
CLINICIANS WHO ARE GOOD ENOUGH
FOR MEDICARE BENEFICIARIES AND
TO WORK IN THE COUNTY SYSTEM WAS
SUPERVISION BUT DETERMINED NOT
TO MEET ADEQUATE STANDARDS FOR
COMMERCIAL INSURANCE PLANS,
WHICH HAVE A BIAS TOWARDS
PHYSICIAN DIRECTED CARE, AND
THAT IS FUNDAMENTALLY
PROBLEMATIC IN BEHAVIORAL
HEALTH. BECAUSE OFTENTIMES WHAT
IS MOST EFFECTIVE AND WHAT IS
MOST HELPFUL TO PEOPLE IS CARE
THAT'S DELIVERED THROUGH
PARAPROFESSIONALS OR THROUGH
PEER SUPPORT SPECIALIST FOR
EXAMPLE, AND IN OUR CASE,
THEY'VE GOT QUITE A BIT OF
TRAINING AND STANDARDS BEHIND
THAT. THERE'S A SCOPE OF
PRACTICE, ETCETERA. AND SO
THAT'S ANOTHER KIND OF LAYER TO
SOME OF THE INSURANCE DENIALS
THAT WE THINK IS MERITS LOOKING
AT, AND IT'S PARTICULARLY
IMPORTANT WITH CERTAIN SERVICES
LIKE OUR MOBILE CRISIS SERVICES
WHERE PEERS MIGHT BE DELIVERING
THOSE SERVICES AND THEREFORE
BEING DENIED BY THE COMMERCIAL
PLANS WERE IT NOT FOR SOME OF
THE PROTECTIONS THAT WERE
INCLUDED IN A B 988 THAT ALLOW
FOR US TO GET REIMBURSEMENT IF
THEY MEET THE MEDICAID STANDARD,
SO WE NEED TO LOOK AT MORE OF
THOSE COVERAGE KIND OF ISSUES.
IT SORT OF GOES TO A COMMENT BY
SENATOR RUBIO, TOO, WHICH IS
THAT THERE IS JUST SORT OF A
FUNDAMENTAL LACK OF EXPERTISE. I
THINK BOTH AT COMMERCIAL PLANS,
BUT ALSO AMONG OUR STATE
REGULATORS. AND I DON'T SAY THIS
TO DISPARAGE THEM. GMHC WAS
GREAT AND THAT THEY BROUGHT IN
SPECIAL CONSULTANTS TO ASSIST
THEM WITH WORKING ON THE
REGULATIONS TO PROVIDE THAT
BEHAVIORAL HEALTH EXPERTISE, BUT
I THINK IT'S REALLY IMPORTANT
FOR US TO BE GROUNDED AND
UNDERSTANDING OUR STARTING POINT
. WHICH IS THAT EVEN AMONG OUR
STATE REGULATORY AGENCIES AND
ENTITIES, THERE IS A NEED TO
BUILD OUT A WORKFORCE THAT UNDER
THAT TRULY UNDERSTANDS
BEHAVIORAL HEALTH, AND WHEN WE
TRY TO SUBMIT CLAIMS FOR
REIMBURSEMENT. WE'RE SEEING TWO
OTHER POINTS OF OUR COLLEAGUES
HERE THAT THE PEOPLE REVIEWING
THOSE CLAIMS HAVE NO IDEA WHAT
THEY'RE LOOKING AT. AND I THINK
THAT SUGGESTS TO US THAT THEY'RE
NOT GETTING A TON OF REQUESTS
FOR REIMBURSEMENT. OUTSIDE OF
SOME OF THESE DISCRETE POCKETS
OF PROVIDERS WHO ARE ATTEMPTING
TO BUILD THEM SO THEIR OWN
NETWORKS, MAYBE OR NOT TRYING TO
BUILD FOR CERTAIN THINGS, AND
THE CLAIMS ARE EITHER JUST
TOTALLY UNFAMILIAR TO THE PEOPLE
WHO ARE RECEIVING THEM. OR THE
PEOPLE WHO ARE RECEIVING THEM
DON'T HAVE THE TRAINING,
EDUCATION AND BACKGROUND TO
UNDERSTAND WHAT THEY'RE LOOKING
AT. I THINK IT'S A LITTLE BIT OF
BOTH. AND UM, BUT WE HAVE TO TRY
TO PEEL BACK THOSE LAYERS AND
BUILD IN SOME BETTER
COMPETENCIES ACROSS THE BOARD. I
APPRECIATE THAT. THANK YOU. AND
THE OTHER QUESTION, UM,
REGARDING THE JUSTICE SYSTEM,
AND I ASKED HAVING BEEN IN
COUNTY SUPERVISOR, SANTA CORE
COUNTY AND RECOGNIZING THAT YOU
HAVE SOME SOME UNDERSTANDING OF.
I ASSUME CROSS SYSTEMS THINGS
THAT ARE GOING ON IN COUNTIES.
BUT IF IT'S AN UNFAIR QUESTION
IS JUSTICE QUESTION. YOU DON'T
FEEL YOU HAVE TO ANSWER IT. IT.
WE'RE BOTH IN THE CORPORAL
SYSTEM, JAILS, PRISONS AND IN A
REENTRY SYSTEMS. UM, WE'RE USING
PROGRAMS THAT. UM ARE BASICALLY
WHAT YOU JUST DESCRIBED. BUT
THOSE THOSE SYSTEMS ARE REENTRY
CENTERS, FOR EXAMPLE, RANCHER
CENTER IN SANTA CORK COUNTY HAS
IN EFFECT ITS OWN EXPLORATION
RIGHT. THE IDEA IS TO MOVE
PEOPLE ALONG SO THAT THEY CAN
BECOME PRODUCTIVE MEMBERS OF
SOCIETY THERE THERE. TWO DAYS
AFTER THE RELEASE FROM PRISON
UNDER THE OLD ABBEY 109. THEY'RE
ENTERING INTO PEER SUPPORT
PROGRAMS IN IN THERAPY. BUT THEN
THEY'RE OUT. IT IS HOW MUCH OF A
PROBLEM IS IT IN TERMS OF
RECIDIVISM, OR DO WE KNOW FOR
THOSE FOLKS ONCE THEY'RE OUT TO
BE HAVING THEIR CLAIMS DENIED? I
GOT MY JOB. I GOT MY SUPPORT OF
AFFORDABLE HOUSING. MY JOB IS
PROVIDING ME INSURANCE. BUT NOW
NOBODY'S NOBODY'S THERE TO PAY
FOR MY CLAIMS. DO WE KNOW IS
THAT SOMETHING WORTH EXPLORING
FURTHER? SO IN TERMS OF THE
IMPACT ON INDIVIDUALS WHO ARE
EXPERIENCING REENTRY FROM CAR,
SEVERAL SETTINGS. UM YOU KNOW, I
CAN'T SPEAK TO THAT AS MUCH
BECAUSE WHEN I'VE ASKED OUR
COUNTIES ABOUT THE INTERSECTION
WITH COMMERCIALLY INSURED
INDIVIDUALS AND INCARCERATION
FOR PEOPLE WITH BEHAVIORAL
HEALTH CONDITIONS IT'S OFTEN THE
CASE THAT BY THE TIME SOMEONE IS
BUMPING UP AGAINST THE JUSTICE
SYSTEM THERE ARE ALREADY PRETTY
FAR DOWN THE LINE IN TERMS OF
THE DISEASE PROGRESSION, RIGHT
WHETHER IT'S MENTAL HEALTH OR
SUD, AND SO OFTEN TIMES THOSE
INDIVIDUALS IF THEY DIDN'T
QUALIFY FOR MEDICAL THEY DO NOW,
UM, I THINK THERE IS AN ELEMENT
TO THIS THAT I WANT TO KIND OF
UNPACK. THAT'S A BIT UPSTREAM,
THOUGH, WHICH IS SOMETHING I
DIDN'T MENTION IN MY TESTIMONY.
WE LEARNED, FOR EXAMPLE, THAT IN
THE CENTRAL VALLEY WHERE WE
PROVIDE SCHOOL BASED ACCESS TO
SCHOOL BASED FOR RISK IS TO ALL
KIDS, REGARDLESS OF INSURANCE.
IN ONE OF OUR COUNTIES, WE HAVE
QUITE A NUMBER OF KIDS WHO ARE
WHO HAVE JOB BASED COVERAGE
THROUGH THEIR PARENTS, BUT THE
DEDUCTIBLES AND COPAYS ARE SO
HIGH THAT THOSE FARMWORKER KIDS
FAMILIES CANNOT AFFORD TO PAY
FOR THERAPY OUT OF POCKET OR DO
WHAT THEY NEED TO DO TO PREVENT
THEM FROM GETTING INTO CRISIS IN
THE FIRST PLACE, RIGHT? OR
ENDING UP INVOLVED WITH THE
JUSTICE SYSTEM OR WHATEVER. AND
SO EVEN THOUGH THEY'RE
COMMERCIALLY INSURED, WE END UP
PARK LIKE MAKING UP THE
DIFFERENCE TO TRY TO GET THAT
KID ACCESS TO HELP, AND I THINK
THAT GOES BACK TO THIS OTHER
POINT WHICH YOU'VE LIFTED UP,
WHICH IS THAT PARODY. ENSURES
THAT YOUR BEHAVIORAL HEALTH
COVERAGE IS AS BAD AS YOUR
PHYSICAL HEALTH COVERAGE AND
YOUR PHYSICAL HEALTH COVERAGE.
HAVING HIGH COST SHARING MIGHT
NOT BE A BIG DEAL. IF YOUR KID
BREAKS THEIR ARM ONCE EVERY
COUPLE OF YEARS OR I DON'T KNOW,
HOPEFULLY EVERY DECADE OR NOT,
BUT IF YOU NEED THERAPY ONCE A
WEEK OR ONCE A MONTH, EVEN THAT
DEDUCTIBLE THAT COPAY MATTERS A
LOT MORE, AND SO WE DON'T OFTEN
TALK ABOUT THE INTENSITY AND THE
DURATION THAT'S REQUIRED FOR
BEHAVIORAL HEALTH SERVICES. AND
I THINK THAT GOES TO SOME OF
POINTS THAT OTHER FOLKS HAVE
MADE AS WELL RIGHT? AND THAT IS
WHY THE BUSINESS BEHIND THIS IS
REALLY TOUGH, AND IT'S GOING TO
BE HARD TO TURN AROUND BECAUSE
OF INTENSITY AND DURATION. AND
JUST THE WIDE RANGE OF NEEDS
THAT WE HAVE THEIR UNMET
CURRENTLY. THANK YOU TURN IT
BACK OVER TO THE CHAIR, BUT I
DON'T KNOW WHY IT OCCURRED TO
ME. ESPECIALLY AS MUCH WORK I'VE
DONE ON THE YOUTH JUSTICE SIDE
THAT YOUTH WOULD BE
PARTICULARLY, UM VULNERABLE TO
THIS REVIEW SYSTEM THAT WE HAVE.
THANK YOU. THANK YOU, MR CHAIR.
THANK YOU. AND JUST JUST A
BOTTOM BOTTOM LINE AND CLEAN
ENGLISH. BASICALLY THERE ARE
MEMBERS OF THE COMMUNITY WHO ARE
COMMERCIALLY INSURED AND THE
COMMENTS RECEIVED COUNTY MENTAL
HEALTH SERVICES AND THEN THE
HEALTH PLANS ARE NOT REIMBURSING
THE COLONIES. FOR PROVIDING
THOSE SERVICES SO EFFECTIVELY,
WE'RE SEEING HEALTH PLANS DUMP
AH, THEIR OBLIGATIONS TO ENSURE
THAT FOR IT TO ENSURE THAT THESE
PATIENTS ONTO TAXPAYERS.
CURRENTLY YES, AND EVEN WITH
DIRECT REFERRALS INTO OUR
PROGRAMS WITH NO EXPECTATION
THAT THEY WILL PAY, CORRECT.
THANK YOU. AND WE WE'VE SEEN
THAT. I MEAN, JUST IN GENERAL
ISSUE, NOT JUST IN MENTAL
HEALTH, BUT WITH TAXPAYERS
ABSORBING WHAT HEALTH PLANS
SHOULD BE PAYING FOR PEOPLE WHO
HAVE COMMERCIAL INSURANCE, SO
AND THEN IT SEEMS LIKE WHAT
YOU'RE SAYING IS THAT, UM AH,
THAT AS A AS A WORKAROUND TO
AVOID MENTAL HEALTH PARODY JUST
HAVE PROVIDERS WHO ARE GOING TO
BASICALLY, UM. SAY THAT WHAT IS
CLEARLY APPROPRIATE CARE IS
ACTUALLY NOT APPROPRIATE.
PROVIDERS OR THE INSURANCE
COMPANIES. BUT IT SOUNDS LIKE
WHAT YOU'RE SAYING IS THAT THE
IN THE HEALTH PLANS HAVE AN
INCENTIVE. TO HAVE IN NETWORK
PROVIDERS WHO ARE NOT GOING TO
SAY THAT WHAT IS APPROPRIATE
CARE IS ACTUALLY APPROPRIATE IN
ORDER. SENATOR I BELIEVE THAT IN
THE SCOREBOARD THAT WE CREATED
OVER THE TWO YEARS, A LOT OF
THEM ARE IN NETWORK AND ALSO
DENIED. BUT I'M JUST TRYING TO
MAKE SURE I UNDERSTAND WHAT YOU
WERE SAYING. YOU'RE SAYING THEIR
PROVIDERS YOU TERM DOES NOT.
THEY'RE NOT QUALIFIED TO PROVIDE
. FOR EXAMPLE, SUBSTANCE. THE
PROVIDERS ARE BUT THE DOCTORS
THAT ARE THE DOCTORS THAT ARE
SENT TO DETERMINE HOW MANY DAYS
OF TREATMENT SOMEONE NEEDS.
THERE'S NOTHING TO DO WITH
ASSAM. IT HAS TO DO WITH. I
DON'T KNOW WHAT AND THEY DENY.
ARE YOU SAYING THAT THE PEOPLE
WHO ARE EMPLOYED BY THE HEALTH
PLANS TO REVIEW OKAY, SO NOT THE
ACTUAL PROVIDERS IN NETWORK
PROVIDER? OKAY AND THEY ARE
PEOPLE WHO IN THEIR PROVIDERS,
HEALTH PLANS ARE EMPLOYING
REVIEWERS WHO ARE NOT ACTUALLY.
SPECIALIZED IN THE AREA OF
SUBSTANCE USE DISORDER TREATMENT
, SOME OF MOVEMENT IN EYEING FOR
A DECADE. OKAY? THANK YOU. OKAY
UM, REALLY APPRECIATE OUR FIRST
PANEL. WE'LL NOW GO TO OUR
SECOND PANEL OF POLICY EXPERTS
WOULD LIKE TO INVITE DR EMILY
WOULD WHO WAS PAST CHAIR OF THE
CALIFORNIA STATE ASSOCIATION OF
PSYCHIATRISTS GOVERNMENT AFFAIRS
COMMITTEE. SHARON BèC, SENIOR
LEGAL COUNSEL FOR THE CALIFORNIA
MEDICAL ASSOCIATION. KAREN
LARSON, THE CEO OF STEINBERG AND
TWO AND LAUREN FINKE, WHO IS THE
SENIOR LEGISLATIVE ADVOCATE FOR
THE KENNEDY FORUM.
I'M SORRY. OKAY I'M SORRY, AND
DOCTOR WOULD WILL BE APPEARING
REMOTELY, SO WE'LL START WITH
DOCTOR WOULD. THANKS SO MUCH FOR
HAVING ME I'M A CHILD,
ADOLESCENT AND ADULT
PSYCHIATRIST AND I LIVE AND WORK
IN LOS ANGELES COUNTY, WHERE I
AM A SUPERVISING PSYCHIATRIST AT
THE LOS ANGELES COUNTY JAIL AND
HAVE A VERY SMALL PRIVATE
PRACTICE SPECIALIZING IN RURAL
DEVELOPMENT DISORDERS, AND I
PREVIOUSLY WORKED AT THE LOS
ANGELES COUNTY JUVENILE HALLS.
I'M HERE REPRESENTING THE
CALIFORNIA STATE ASSOCIATION OF
PSYCHIATRISTS AND REALLY WANT TO
SAY THANK YOU TO SENATOR WEINER
AND THE COMMITTEE FOR INVITING
ME TO SPEAK ABOUT THIS IMPORTANT
ISSUE. DESPITE YOUR EFFORTS TO
LEGISLATE PARITY BETWEEN MENTAL
AND PHYSICAL HEALTH TREATMENT
COVERAGE, THERE REMAIN MAJOR
GAPS. THAT'S WHY WE'RE HERE
TODAY. WE CONTINUE TO EXPERIENCE
EXTREMELY HIGH RATES OF PRIOR
AUTHORIZATION REQUIREMENTS AND
OTHER HURDLES IN PROVIDING OUR
PATIENTS WITH MEDICATIONS THAT
HAVE NUMEROUS STUDIES
DEMONSTRATING BETTER OUTCOMES,
FOR EXAMPLE, LONG ACTING
INJECTABLE FORMULATIONS OF ANTI
PSYCHOTIC MEDICATIONS ARE
ABSOLUTELY THE MOST EFFECTIVE
TREATMENT FOR PSYCHOTIC SPECTRUM
DISORDERS. THESE MEDICATIONS ARE
ADMINISTERED EVERY 1 TO 6 MONTHS
AND ARE ASSOCIATED WITH LOWER
OVERALL SIDE EFFECTS WHEN
COMPARED TO THEIR RURAL
COUNTERPARTS. SADLY IT IS MUCH
EASIER FOR ME TO GET LONG ACTING
INJECTABLE MEDS FOR MY PATIENTS
IN THE JAIL THAN FOR MY PATIENTS
IN PRIVATE PRACTICE MY
COLLEAGUES AT U. C S IN PRIVATE
HOSPITALS AND CLINICS. REPORT
BARRIER AFTER BARRIER TO
ACCESSING THESE METS FOR THEIR
PATIENTS. YOU CAN IMAGINE THE
FRUSTRATION EXPERIENCED BY AN IN
PATIENT DOCTOR, ARGUING WITH THE
COMPANY THAT IS BOTH REFUSING TO
PAY FOR THE MEDICATION WITH THE
BEST CHANCE OF ASSURING
STABILIZATION AND IS DENYING
COVERAGE FOR FURTHER INPATIENT
STABILIZATION. WE ARE STRUGGLING
TO GET COVERAGE FOR OUR NOVEL
AND VERY EFFECTIVE TREATMENTS,
TRANSCRANIAL MAGNETIC
STIMULATION AND KETAMINE CAN BE
REVOLUTIONARY TREATMENTS FOR
THOSE SUFFERING FROM MEDICATION
RESISTANT DEPRESSION OR FOR
INDIVIDUALS WHO DO NOT WANT TO
TAKE DAILY LONG TERM MEDS. THESE
TREATMENTS REQUIRED SOME
ADDITIONAL SHORT TERM COSTS, BUT
MAY DRAMATICALLY IMPROVED THE
LIFE AND TREATMENT COURSES FOR
OUR PATIENTS. I AM ABLE TO
PROVIDE US KETAMINE TREATMENT
WHEN I OFFERED THIS OPTION TO A
PATIENT WITH AUTISM AND CHRONIC
DEPRESSION WHO I HAVE BEEN
WORKING WITH FOR MANY YEARS, SHE
WAS DIRECTED BY HER INSURANCE TO
ONE OF THEIR APPROVED PROGRAMS.
OF COURSE, IT TOOK MANY WEEKS TO
GET INTO THE NEW PROGRAM. IT WAS
A LONG DISTANCE FROM THE
PATIENT'S HOME, AND THEY HAD TO
GO THROUGH MULTIPLE NEW PATIENT
ASSESSMENTS TO ESTABLISH CARE.
ONCE TREATMENT STARTED, MY
PATIENT REPORTED ABNORMAL SIDE
EFFECTS OF THE TREATMENT. AS I
SPECIALIZE IN WORKING WITH
CHILDREN AND ADULTS WITH AUTISM
AND CO MORBID DISORDERS, I HAVE
THE EXPERTISE TO PARSE THEIR
DIVERGENT EXPERIENCES AND
CHANGED COURSE TO FIT THEIR
SPECIFIC NEEDS. BUT THE PROGRAM
MY PATIENT WAS SENT TO WAS NOT
SO EQUIPPED AFTER ALL OF THAT.
THEY STOP THE THERAPY AFTER TWO
OR THREE SESSIONS, AND MY
PATIENT FELT MORE HOPELESS ABOUT
HER SITUATION THAN BEFORE. THE
MENTAL HEALTH CARVE OUT SYSTEM
CONTINUES TO ENCOURAGE INSURANCE
COMPANIES TO SHIRK PAYMENT BY
POINTING FINGERS WITHIN
DIFFERENT BRANCHES OF THEIR OWN
INSTITUTIONS. WHEN IT WAS
INTRODUCED. THE CAR ABOUT SYSTEM
CREATED A REQUIREMENT FOR
INSURANCE COMPANIES TO COVER
MENTAL HEALTH CARE AT ALL.
THEREFORE, IT WAS AN EARLY STEP
TOWARDS PARITY. WE NOW FACE A
SITUATION WHERE THIS SYSTEM IS
SEVERELY LIMITING. FOR INSTANCE,
WHILE MEDICARE HAS CREATED A
COMPREHENSIVE COMPENSATION MODEL
FOR THE COLLABORATIVE CARE MODEL
THAT INVOLVES BUILDING THROUGH
THE PRIMARY CARE SITE, PRIVATE
INSURANCE COMPANIES ARE BEHIND
THE TIMES BECAUSE THEY SEPARATE
THE COVERAGE FOR MEDICAL AND
MENTAL HEALTH. THEREFORE WHEN IT
COST IS NOT CLEARLY ONE OR THE
OTHER. THE COMPANY FACTIONS WILL
DENY PAYMENT ON THE GROUNDS THAT
THE OTHER ONE IS RESPONSIBLE. I
AM VERY EXCITED ABOUT PROP. ONE
AND THE PASSING OF SB 43. AND
WITH THESE MAJOR STEPS FORWARD,
I FORESEE THAT PUBLICLY PROVIDED
MENTAL HEALTH SERVICES ARE
LIKELY TO SURPASS THOSE PROVIDED
BY PRIVATE INSURANCE IN THE
COMING YEARS. AND I HOPE THAT
THIS COMMITTEE CAN WORK ON THAT.
THANK YOU VERY MUCH WILL NOT
HEAR FROM SHRINK BèC. I'M SORRY
IF I MISPRONOUNCE YOUR NAME.
THIS IS A GOOD MORNING, MR CHAIR
AND MEMBERS OF THE COMMITTEE.
THANK YOU FOR THE OPPORTUNITY TO
TESTIFY ON THIS IMPORTANT ISSUE.
MY NAME IS SCHURINGA DUCEY. I AM
SENIOR LEGAL COUNSEL FOR THE
CALIFORNIA MEDICAL ASSOCIATION.
PRIOR TO JOINING CMA. I SPENT
NEARLY 11 YEARS REGULATING
HEALTH INSURANCE AT THE
DEPARTMENT OF INSURANCE AND ONE
OF MY PRIMARY AREAS OF EXPERTISE
AT THE DEPARTMENT. INCLUDED
IMPLEMENTING AND ENFORCING
MENTAL HEALTH PARITY LAWS.
BEFORE THE ENACTMENT OF THE
FEDERAL MENTAL HEALTH PARITY
LAW. HEALTH PLANS ROUTINELY
LIMITED ACCESS TO TREATMENT FOR
MENTAL HEALTH AND SUBSTANCE USE
DISORDERS THROUGH THE USE OF
DRACONIAN AND ARBITRARY VISIT
LIMITS, BENEFIT CAPS, EXCLUSIONS
AND HIGH COST SHARING. AFTER THE
FEDERAL PARTY LAW TOOK EFFECT,
STATE REGULATORS GAIN POWERFUL
TOOLS TO IMPLEMENT PARODY IN
MANY OF THESE AREAS, LEADING TO
THE ELIMINATION OF SOME OF THESE
INAPPROPRIATE COVERAGE
LIMITATIONS. THE TOOLS IN THE
FEDERAL PARITY LAW WERE LESS
EFFECTIVE, HOWEVER, WHEN IT CAME
TO UTILIZATION MANAGEMENT,
INCLUDING MEDICAL NECESSITY
CRITERIA, WHERE PLANS TO FIND
WHEN CARE IS MEDICALLY NECESSARY
AND THEREFORE COVERED BY THE
PLAN. SO AS REGULATORS BEGAN TO
ENFORCE PARODY IN THE MORE
OBVIOUS AREAS AFFECTING PATIENT
ACCESS, COST SHARING EXCLUSIONS
VISIT LIMITS PLANS BEGAN
INCREASINGLY APPLYING THOSE SAME
DRACONIAN AND ARBITRARY
LIMITATIONS. THROUGH THEIR
UTILIZATION MANAGEMENT PRACTICES
, AN AREA WHERE FEDERAL PARTY
STANDARDS WERE LESS CLEAR AND
HARDER TO ENFORCE. FEDERAL
LAWSUIT IN 2019 HIGHLIGHTED THE
PRACTICE OF PLANS IMPOSING THEIR
OWN BESPOKE MEDICAL NECESSITY
CRITERIA TO DENY PLANS
CRITICALLY NEEDED MENTAL HEALTH
TREATMENT. THESE CRITERIA WERE
DESIGNED PRIMARILY WITH CLAIMS
COSTS, NOT PATIENT CARE IN MIND,
UM AND WERE OFTEN SUBSTANTIALLY
NARROWER THAN OR AT ODDS WITH
THE GENERALLY ACCEPTED STANDARDS
OF CARE. THAT CASE WITH THE
UNITED BEHAVIORAL HEALTH
HIGHLIGHTED A GAP IN CALIFORNIA
LAW, WHICH AT THE TIME LACKED
PROPER STANDARDS FOR PLANS
MEDICAL NECESSITY CRITERIA WHILE
THE AFFORDABLE CARE ACT AND
STATE LAW REQUIRED PLANS TO
COVER MEDICALLY NECESSARY CARE
FOR MENTAL HEALTH AND SUBSTANCE
USE DISORDERS, PLANS WERE
ESSENTIALLY FREE TO DICTATE WHAT
WHEN THAT CARE WAS MEDICALLY
NECESSARY. A JUDGMENT THAT
SHOULD BE LEFT TO EXPERIENCE.
PHYSICIANS AND CLINICIANS
PRACTICING IN THAT AREA OF
MEDICINE, NOT HEALTH PLANS AND
INSURANCE COMPANIES. THAT CASE
INSPIRED ONE OF THE REFORMS
ENACTED BY SP 855 IN 2020
EXPRESS REQUIREMENT THAT HEALTH
PLANS USE GENERALLY ACCEPTED
STANDARDS OF CARE TO DETERMINE
MEDICAL NECESSITY FOR MENTAL
HEALTH AND SUBSTANCE USED TO
SORT OF TREATMENT. IMPORTANTLY
SP 855 ALSO STRENGTHENED PLANS
OBLIGATIONS TO PROVIDE TIMELY
ACCESS AND PARTICULARLY
IMPORTANT TO OUR PHYSICIAN
MEMBERS, ADEQUATE NETWORKS. AND
IT GAVE STATE REGULATORS
POWERFUL TOOLS TO ENFORCE
COMPLIANCE. THE PROTECTIONS OF
ESCALATE 55 ARE VITAL FOR
PATIENTS AT A VULNERABLE TIME.
THAT'S WHY IT'S CRUCIAL THAT
STATE REGULATORS IMPLEMENT THE
LAW IN A WAY THAT MEANINGFULLY
ENSURES PATIENTS ACTUALLY
RECEIVE THE BENEFITS OF SB 855
PROTECTIONS. AS OUR STATE
REGULATORS WORK THROUGH THE
RULEMAKING PROCESS, THEY MUST
ENSURE THE STANDARDS THEY ADOPT
RESULT IN REAL COMPLIANCE. THIS
MEANS ADOPTING LEGAL
REQUIREMENTS THAT ENSURE PLANS
ADHERE TO THE APPROPRIATE
STANDARDS OF CARE. SO THAT
COMPLIANCE OCCURS ON THE FRONT
END AND DOESN'T PUT THE BURDEN
ON PATIENTS AND PROVIDERS TO
NAVIGATE AN OWNER'S COMPLAINTS
AND APPEALS PROCESS. CONSUMER
COMPLAINTS AND INDEPENDENT
MEDICAL REVIEWS SHOULD NOT BE
THE FIRST LINE MECHANISM FOR
REGULATORY OVERSIGHT. THERE
SHOULD BE A MEASURE OF LAST
RESORT ALSO MEANS ADOPTING CLEAR
STEPS FOR HELP PATIENTS MAY
ACCESS OUT OF NETWORK CARE AND
CLARIFYING PLANS OBLIGATIONS IN
THE PROCESS SO THAT PATIENTS AND
PROVIDERS AREN'T LEFT HOLDING
THE BAG. THIS INCLUDES REQUIRING
PLANTS TO INFORM PATIENTS ABOUT
THE RIGHT TO OBTAIN OUT OF
NETWORK CARE. IN THE PLACES
ENROLLEES ARE MOST LIKELY TO SEE
THEM PROVIDER DIRECTORIES AND TO
REIMBURSE NON CONTRACTED
PROVIDERS APPROPRIATELY AND WHEN
PATIENTS GET OUT OF NETWORK CARE
. UNDER THIS LAW, THE
REGULATIONS SHOULD SAFEGUARD
PATIENTS FROM PREMATURE
TRANSITIONS OF CARE BY THEIR
HEALTH PLAN BEFORE THEIR COURSE
OF TREATMENT IS COMPLETED.
DISRUPTIONS TO MEDICAL TREATMENT
CAN HAVE SERIOUS CONSEQUENCES
FOR PATIENT RECOVERY. THIS IS
ESPECIALLY TRUE FOR MENTAL
HEALTH AND SUBSTANCE USE
DISORDERS. FINALLY CALIFORNIANS
WON'T HAVE TO ACCESS TO CARE
UNTIL PLANTS PROVIDE ROBUST
NETWORKS WITH PROVIDERS AND
FACILITIES THAT ARE QUALIFIED
AND ACTUALLY AVAILABLE TO TREAT
PATIENTS WHEN THEY NEED IT OUT
OF NETWORK ACCESS IS AN
IMPORTANT STOPGAP MEASURE. BUT A
LACK OF NETWORK PROVIDERS OFTEN
DETERS PATIENTS FROM SEEKING
CARE IN THE FIRST PLACE AND HAS
BROADER REACHING EFFECTS ON THE
HEALTH CARE DELIVERY SYSTEM.
LONG TERM SP 855 MADE
SIGNIFICANT PROGRESS IN MENTAL
HEALTH COVERAGE STANDARDS. IT IS
IMPERATIVE THAT STATE REGULATORS
IMPLEMENT THE LAW IN A WAY THAT
ENSURES PATIENTS ACTUALLY
BENEFIT FROM THESE CRITICAL
PROTECTIONS. THANK YOU. THANK
YOU VERY MUCH. WE'LL NOW HEAR
FROM KAREN LARSON FROM THIS TIME
BRING INSTITUTE. THANK YOU.
THANK YOU SO MUCH FOR HOLDING
THIS IMPORTANT HEARING AND FOR
INVITING ME TO JOIN YOU TODAY.
MY NAME IS KAREN LARSEN AND THE
CEO FOR THE STEINBERG INSTITUTE,
A NONPROFIT PUBLIC POLICY
INSTITUTE DEDICATED TO
TRANSFORMING CALIFORNIAN'S
MENTAL HEALTH AND SUBSTANCE USE
CARE SYSTEMS. WE WERE ALSO PROUD
TO PARTNER WITH SENATOR WEINER
AND THE KENNEDY FORUM ON SB 855.
BUT PASSING THIS BILL WAS ONLY A
PIECE OF INSURING ACCESS TO
AFFORDABLE, HIGH QUALITY CARE.
OUR IMPLEMENTATION MUST MEET OUR
ASPIRATIONS ANY LIES ONLY AS
STRONG AS OUR ABILITY TO ENFORCE
IT IN THE 2021 BUDGET, THE MHC
RECEIVED $2.7 MILLION TO CONDUCT
BEHAVIORAL HEALTH INVESTIGATIONS
OF ALL FULL SERVICE. COMMERCIAL
HEALTH PLANS TO EVALUATE THEIR
COMPLIANCE WITH PARODY AND TO
ASSESS WHETHER THEIR ENROLLEES
HAD CONSISTENT ACCESS TO
MEDICALLY NECESSARY BEHAVIORAL
HEALTH SERVICES. THE LEGISLATURE
CLEARLY INTENDED THAT GMHC
THOROUGHLY EVALUATE PARODY
COMPLIANCE AS A PART OF THEIR
INVESTIGATIONS WHEN IT APPROVED
THIS BUDGET. RIGHT NOW. THEIR
COMPLIANCE, A VIOLENT
EVALUATIONS ARE FUNDAMENTALLY
FLAWED. HERE'S WHY IN ADDITION
TO SB 855, THE FEDERAL PARITY
LAW, THE MENTAL HEALTH PARITY
AND ADDICTION EQUITY ACT, IS ONE
OF THE STRONGEST TOOLS AVAILABLE
FOR STATE REGULATORS. THIS TOOL
REFERENCED IN OUR STATE LAW
REQUIRES COMMERCIAL HEALTH PLANS
TO CONDUCT DETAILED PARITY
COMPLIANCE ANALYSIS ON TREATMENT
LIMITATIONS IN EACH CLASS
CLASSIFICATION OF CARE. THESE
ANALYSES OFTEN SHOW A FAIR
FAILURE TO COMPLY WITH COMMON
PARODY VIOLATIONS, SUCH AS
LIMITATIONS ON AUTISM SERVICES.
LIMITATIONS ON MEDICATIONS FOR
OPIOID USE DISORDERS AND PRIOR
AUTHORIZATION REQUIREMENTS. IN
THE BATCH OF COMPLIANCE REPORTS
THAT WERE RELEASED YESTERDAY.
THE AGENCY DID NOT INCLUDE THIS
ANALYSIS, SAYING IT WAS TOO
COMPLICATED. THIS EXPLANATION
DOESN'T HOLD WATER. THE PLANS
ARE ALREADY REQUIRED TO COMPLETE
THESE ANALYSES FOR THE FEDERAL
GOVERNMENT, AND ALL GMHC HAS TO
DO IS RELEASE THEM. IN ILLINOIS
AND NEW YORK REGULATORS LOOKED
AT THIS ANALYSIS AND FOUND
WIDESPREAD NONCOMPLIANCE ACROSS
ALL TYPES OF SERVICES AMONGST
PLANS. OTHER STATES CAN DO IT.
WHY CAN'T WE PUBLIC TRANSPARENCY
IS A CRITICAL PIECE OF
ENFORCEMENT. IT IS ESSENTIAL
THAT ANY RESULTS FROM THESE
FEDERAL PARODY ANALYSES BE MADE
PUBLIC AS A PART OF BEHAVIORAL
HEALTH INVESTIGATIONS. WE
FURTHER ASSERT THAT FAILURE TO
ANALYZE COMPLIANCE WITH FEDERAL
PARITY IS IN DIRECT OPPOSITION
TO THE LEGISLATURE'S INTENT WHEN
IT IMPROVED THE DEPARTMENT'S
BUDGET CHANGE PROPOSAL IN THE
2021 BUDGET. THE MHC S FAILURE
TO RELEASE THE RESULTS OF THE
PARODY COMPLIANCE REVIEWS AS A
PART OF THESE PUBLIC BEHAVIORAL
HEALTH INVESTIGATIONS IS DEEPLY
DISTURBING. WE UNDERSTAND THAT
THE FULFILLING THE PROMISE OF
FEDERAL AND STATE PARODY ARE
HARD WORK, AND WE EXPECT NOTHING
LESS FOR CALIFORNIANS. LAST
WEEK, THE GMHC ANNOUNCED A
RECORD SETTLEMENT AGREEMENT
AFTER AN EXTENSIVE INVESTIGATION
OF KAISER PERMANENTE IS
BEHAVIORAL HEALTH PRACTICES. WE
SEE THIS AS AN IMPORTANT
PRECEDENT AND BELIEVE THAT
CONTINUED VIGILANCE IS REQUIRED,
AS THESE PRACTICES ARE NOT JUST
RESERVED TO KAISER AND ARE
HURTING CALIFORNIANS ON OTHER
PLANTS. WE CALL UPON GMHC TO
RELEASE COMPLETE SUMMARIES OF
ALL REVIEWS CONDUCTED OF PLANS.
FEDERAL PARITY COMPLIANCE
ANALYSIS WHEN IT RELEASES THE
RESULTS OF THE BEHAVIORAL HEALTH
INVESTIGATIONS. WE APPRECIATE
TODAY'S DISCUSSION AND WOULD
WELCOME THE OPPORTUNITY. TO
DISCUSS HOW THE MHC IS
INCORPORATING THESE REVIEWS OF
PLANS FEDERAL PARITY COMPLIANCE
INTO THEIR BEHAVIORAL HEALTH
INVESTIGATIONS. THANK YOU,
SENATOR WIENER FOR YOUR
PARTNERSHIP ON TO ADVANCED
PARITY IN CALIFORNIA AND TO THE
COMMITTEE FOR YOUR COLLECTIVE
EFFORTS TO IMPROVE THE MENTAL
HEALTH OF ALL CALIFORNIANS.
THANK YOU VERY MUCH NOW. LAUREN
FINKE FROM THE CANDIDATE FORUM.
THANK YOU. CHAIR WIENER AND
MEMBERS OF THIS COMMITTEE FOR
TODAY'S INVITATION AND FOR YOUR
LEADERSHIP ON THIS ISSUE. MY
NAME IS LAUREN FINKE, MY POLICY
DIRECTOR WITH THE COUNTY FORUM.
WE CO SPONSORED SB 855 AND 2020
ALONGSIDE A COALITION OF OVER 20
ACTIVE ADVOCATES REPRESENTING
PATIENTS, THEIR FAMILIES AND
PROVIDERS. HAVE REGULARLY MET
WITH THE REGULATORY AGENCIES
DETAILING OUTSTANDING ACCESS
ISSUES TO ENSURE HEALTH PLANS
ARE FOLLOWING THE REQUIREMENTS
OF SB 855 AND THE FEDERAL PARITY
ACT. THE LEGISLATURE HAS HEARD
SEEMINGLY COUNTLESS STORIES FROM
PATIENTS, THEIR FAMILIES AND
PROVIDERS CONCERNING WRONGFUL
DENIALS FROM MEDICALLY NECESSARY
MENTAL HEALTH AND ADDICTION
CARE. ON PAPER. CALIFORNIA HAS
AMONG THE STRONGEST MENTAL
HEALTH ACCESS LAWS IN THE
COUNTRY. BUT THE UNACCEPTABLE
REALITY IS THAT THERE ARE WIDE
GAPS BETWEEN WHAT IS THE LAW AND
WHAT IS EXPERIENCED BY
CALIFORNIANS SEEKING CARE. IN
THE MIDST OF AN ONGOING MENTAL
HEALTH AND ADDICTION CRISIS.
HEALTH PLANS CONTINUE TO
INAPPROPRIATELY LIMIT ACCESS TO
CARE. THE FIRST CRITICAL STEP
REGULATORS MUST TAKE IS TO ISSUE
STRONG AND COMPREHENSIVE SP 855
REGULATIONS AS SOON AS POSSIBLE.
SPF 55 WAS SIGNED INTO LAW MORE
THAN THREE YEARS AGO, WHILE
HEALTH PLANS HAVE BEEN REQUIRED
TO FOLLOW THE STATUTORY
REQUIREMENTS OF THE LAW. SINCE
THEN, EVERY DAY WITHOUT
REGULATIONS IS A DAY IN WHICH
PLANS ARE NOT CONSISTENTLY
FOLLOWING COMPONENTS OF EXISTING
LAW BANKING ON A LACK OF
GUIDANCE FROM THE DEPARTMENT.
PLANS UTILIZATION REVIEW
PRACTICES ARE OF TOP CONCERN.
WHILE GMHC S PROPOSED RULES ARE
CLEAR THAT NONPROFIT
PROFESSIONAL ASSOCIATION
CRITERIA ARE THE ONLY CRITERIA
ALLOWED, WE BELIEVE THE PRACTICE
OF USING NONCOMPLIANT CRITERIA
TO DENY CARE CONTINUES TO BE
WIDESPREAD. ONLY LAST WEEK GMHC
SETTLEMENT WITH KAISER FOUND
THAT ALTHOUGH KAISER REPRESENTED
THAT IT USED REQUIRED CRITERIA
OF THE 100 FILES REVIEWED ZERO
SHOWED EVIDENCE. THAT THE
REQUIRED CRITERIA HAD BEEN USED.
REGULATORS SIMPLY CANNOT TAKE
HEALTH PLANS WORD THAT THEY ARE
COMPLYING WITH PARITY LAWS.
CRISIS SERVICES ALSO REMAIN IN
URGENT CONCERN. DÍAS DRAFT
LANGUAGE INCLUDES CRISIS
SERVICES TÌM HCS PROPOSED
PROPOSED REGULATIONS ARE SILENT.
SPIRIT 55 REQUIRES COVERAGE OF
MEDICALLY NECESSARY CARE FOR ALL
MENTAL HEALTH AND SUBSTANCE USE
DISORDERS. THIS UNEQUIVOCALLY
INCLUDES EMERGENCIES AND CRISIS
SERVICES, WHICH ARE ROUTINELY
DENIED BY HEALTH PLANS. THESE
SERVICES ARE CRITICAL TO SAVING
LIVES. PLANS ARE ALSO FEELING TO
ARRANGE OUT OF NETWORK SERVICES
AFTER THEY FAILED TO ARRANGE
TREATMENT FROM AN IN NETWORK
PROVIDER WITHIN TIME AND
DISTANCE STANDARDS. WE BELIEVE
GMHC IS NOT APPROPRIATELY
ENFORCING THIS REQUIREMENT BY
ALLOWING PLANS TO INTERRUPT
ONGOING COURSES OF TREATMENT AND
FORCING PATIENTS TO RETURN TO AN
IN NETWORK PROVIDER, EVEN WHEN
IT IS INCONSISTENT WITH THE
STANDARD OF CARE, OR IS BEING
DONE FOR THE ECONOMIC BENEFIT OF
THE PLAN. CITY IS DRAFTED
LANGUAGE PROHIBITS THIS PRACTICE
OUTRIGHT. IT IS NO COINCIDENCE
THAT SB 855 WAS FREQUENTLY CITED
IN LAST WEEK'S SETTLEMENT WITH
KAISER. THE SETTLEMENT MAKES IT
EVER CLEAR THE CRITICAL ROLE
THAT INVESTIGATIONS CAN PLAY AND
ASSESSING HEALTH PLAN COMPLIANCE
. REGULATORS SHOULD CONDUCT
THOROUGH INVESTIGATIONS OF EVERY
HEALTH PLAN AND INCLUDE DETAILED
REVIEWS OF PLANS COMPLIANCE WITH
BOTH STATE AND FEDERAL LAWS.
UNFORTUNATELY JUST YESTERDAY,
GMHC RELEASED FINDINGS FROM ITS
FIRST PHASE OF FLAWED BEHAVIOR
HEALTH INVESTIGATIONS. DMH
STATED THAT DAME HD STATED THAT
IT DID NOT REVIEW NON
QUANTITATIVE TREATMENT
LIMITATIONS, OR NQ TLS, WHICH IS
WHERE NEARLY ALL PARODY
VIOLATIONS EXIST. NUMEROUS OTHER
STATES HAVE DONE SUCH REVIEWS
AND FOUND WIDESPREAD NON
COMPLIANCE. CMHC STATED. SUCH
REVIEWS ARE COMPLEX AND WOULD
HAVE TAKEN SIGNIFICANT TIME TO
DETERMINE PLANT COMPLIANCE.
CALIFORNIANS REGULARLY FACE
COMPLEX COVERAGE BARRIERS AND
DON'T HAVE THE LUXURY OF MORE
TIME WHILE REGULATORS DETERMINE
COMPLIANCE. WITHOUT STRONG AND
CONTINUED OVERSIGHT FROM
REGULATORS, CALIFORNIANS WILL
CONTINUE TO EXPERIENCE A LEGAL
BARRIERS AND DELAYS OF CARE. THE
RECENT SETTLEMENT FINDINGS ARE
VERY SIMILAR TO THOSE WE SAW IN
2017 KAISER SETTLEMENT.
INVESTIGATIONS AND SUBSEQUENT
SETTLEMENTS MUST LEAD TO
PRACTICE CHANGE, AND GMHC SHOULD
MAKE EVERY EFFORT TO DO SO. IT
IS ALSO CRITICAL THAT GMHC
ENSURE ALL FINDINGS ARE REMEDIED
AND INDIVIDUAL ENROLLEES THAT
WERE INAPPROPRIATELY DENIED
ACCESS TO CARE ARE MADE WHOLE.
GIVING CALIFORNIANS ONGOING
MENTAL HEALTH AND ADDICTION
CRISIS. IT IS AS CRITICAL AS
EVER THAT REGULATORS KEEP UP
THIS MOMENTUM TO ENSURE THAT
CALIFORNIANS GET THE CARE TO
WHICH THEY ARE ENTITLED. THANK
YOU. THANK YOU VERY MUCH
COLLEAGUES. ANY QUESTIONS FOR
THIS PANEL? SENATOR CORTESI.
VERY MUCH APPRECIATE ALL THE ALL
THE TESTIMONY. UM IT SEEMS VERY
CONSISTENT. ACTUALLY YOU KNOW,
ACROSS THE PANEL, I DON'T KNOW
IF IT SEEMS THAT WAY TO YOU, BUT
IF NOT, YOU CAN CORRECT ME ON
THAT. YEAH I APPRECIATE IT IS
SORT OF THE EMPHASIS ON IF I CAN
PUT IT THIS WAY. IN THE
VERNACULAR. HURRY UP AND GET THE
REGULATIONS DONE, BECAUSE, UM,
YOU KNOW THIS. THIS THIS THIS
PROBLEM THAT'S HAPPENING WITHOUT
THEM THAT WE'VE ALL BEEN TALKING
ABOUT TODAY. IS THERE ANOTHER
OPTION A QUICKER OPTION AND I'M
NOT ASKING YOU TO STEP US ON
LEGISLATIVE OPTIONS. BUT IT
SEEMS TO ME THAT WHEN AGENCIES
ARE SLOW AND THE RULEMAKING
PROCESS THE LEGISLATURE CAN COME
IN IN SPEED THINGS UP BY
BASICALLY TAKING ITS OWN ACTION.
UM DO YOU THINK THE REGULATIONS
THAT NEED TO BE IN PLACE OR TOO
COMPLEX FOR THAT? I MENTIONED SB
9 99 EARLIER IS MAYBE A STABAT
TAKING. YOU KNOW A PORTION OF
WHAT NEEDS TO BE DONE LISTENING
TO ALL OF YOU. IT SOUNDS LIKE,
UM THE MORE THOROUGH RULEMAKING
PROCESS NEEDS TO JUST GET DONE,
BUT AGAIN, WE'RE THE LEGISLATURE
AND I'M JUST CURIOUS. AS TO ANY
KIND OF SPECIFIC RECOMMENDATIONS
, IF YOU WERE IF YOU HAD THE
ABILITY TO AUTHOR A BILL LIKE WE
DO, AND YOU CAN MOVE THINGS
ALONG MORE QUICKLY THAN THEY'RE
MOVING RIGHT NOW, WHAT WOULD YOU
DO IT? YOU KNOW ANYONE WHO FEELS
LIKE THEY WOULD LIKE TO RESPOND
TO THAT LIKE TO HEAR. OH I'M
HAPPY TO START. UM I SP 855. I
THINK FOR MANY OF US THAT WE
SPONSOR WITH THE STEINBERG
INSTITUTE. WAS REALLY AN IDEAL
PARODY BILL. IT HAS SO MUCH IN
IT IN TERMS OF CONSUMER
PROTECTIONS, AND THIS HAS BEEN A
MULTI YEAR PROCESS OF WAITING
FOR THE DEPARTMENT AND ENGAGING
WITH THE DEPARTMENT'S REALLY AND
WE DO APPRECIATE THAT ENGAGEMENT
THAT THEY HAVE HAD WITH US TO
REALLY HAVE THE MOST
COMPREHENSIVE SET OF REGULATIONS
POSSIBLE. IN MY TESTIMONY, I
NOTE A COUPLE AREAS WHERE WE'RE
REALLY HOPING FOR THAT TO BE AS
DETAILED AS POSSIBLE SO THAT THE
BURDEN ISN'T PLACED ON CONSUMERS
TO FIGHT DENIALS. BUT IT'S JUST
SORT OF ON THE FRONT END THAT
THEY'RE GETTING THAT CARE. AND I
WILL NOTE THAT THE DEPARTMENT
HAS UNTIL THE END OF THIS YEAR,
SO ONLY A COUPLE OF MONTHS FROM
NOW TO ISSUE THOSE REGULATIONS
AND SO WHAT WE'RE REALLY HOPING
FOR IS TO PUSH THE MOST
COMPREHENSIVE SET OF
RECOMMENDATIONS AS POSSIBLE AND
REGULATIONS FOR HEALTH PLANS TO
FOLLOW ACROSS A LARGE NUMBER OF
CATEGORIES THAT S BEING BY FIVE
PRETTY PAINSTAKINGLY DETAILED
OUT, AND SO I THINK IT'S REALLY
IMPORTANT THAT WE CONTINUE TO
ASK FOR THOSE THINGS AND GET
THOSE AS SOON AS POSSIBLE. EVERY
DAY WITHOUT THOSE REGULATIONS IS
REALLY DAYS IN WHICH WE SEE AND
HEAR FROM PROVIDERS AND FROM
PATIENTS THAT THEY JUST AREN'T
GETTING THAT CARE, AND THEIR
ENGAGEMENT WITH THE DEPARTMENTS
HAS BEEN TOUGH FOR THEM, AND
THAT'S WHAT WE'VE BEEN
CONTINUING HERE. JUST TO CLARIFY
. I'M I'M FIRST OF ALL, I'M A
BIG SUPPORTER OF SUSTAINABILITY.
55. I AGREE THAT IT'S THE RIGHT.
PRESCRIPTION IF YOU WILL FOR
GOING FORWARD A ROADMAP.
OBVIOUSLY THE RULEMAKING WAS
SUPPORT THE SUPPOSED TO SORT OF
BUILD ON THE BILL ITSELF. RIGHT?
UM BUT IT IS POSSIBLE FOR US TO
WORK AROUND RULEMAKING WITHOUT
WITHOUT CEASING THE RULEMAKING
PROCESS OR OR STOPPING THE
RULEMAKING PROCESS, SO I
UNDERSTAND IF YOU KNOW THE RULE
MAKING IS DONE, AND IT'S
ADEQUATE BY THE END OF THE YEAR,
THEN WE SHOULDN'T HAVE TO DO
THAT, OR LEGISLATIVE SESSION
REALLY DOESN'T PICK UP UNTIL
AFTER THEN, BUT IF IT'S DELAYED
OR INADEQUATE, I GUESS WHERE I'M
GOING IS UM THERE'S A
LEGISLATURE JUST COME IN AND
SAY, YOU KNOW, WITHOUT
PREJUDICING ANY FURTHER
RULEMAKING PROCESS. THESE ARE
THE ELEMENTS THAT NEED TO HAPPEN
RIGHT NOW, YOU KNOW WOULD BE IN
EFFECT CALENDAR YEAR, 2024.
MAYBE I'M PUTTING PEOPLE YOU
KNOW, IN A BAD SPOT TO RESPOND
TO THAT. I DO APPRECIATE YOUR
RESPONSE. SO AND IT'S BOTH A
COMMON QUESTION, I GUESS.
SENATOR I WOULD BE HAPPY TO
RESPOND, AND I CAN'T TELL IF
THIS IS ON. I THINK IT'S ON NOW.
UM I DO THINK THAT ANY TIME THE
LEGISLATURE PUTS REALLY SPECIFIC
REQUIREMENTS IN LEGISLATION THAT
WILL EASE THE IMPLEMENTATION AND
IN SOME CASES OBVIATE THE NEED
FOR RULEMAKING RULEMAKING. IT'S
DONE TO CLARIFY OR MAKE SPECIFIC
STATUTORY REQUIREMENT. AND SP
855 DOES TACKLE SOME VERY
COMPLEX AREAS THAT CAN BE VERY
TECHNICAL, SO I THINK THAT S B
IF I DID GO VERY FAR IN PUTTING
IN VERY SPECIFIC REQUIREMENTS,
BUT ANY TIME A BILL CAN BE MORE
SPECIFIC ON A PARTICULAR
REQUIREMENTS AND PUT IN THOSE
PARAMETERS AND GUARDRAILS IT
WILL HELP FACILITATE. RULEMAKING
OR MAYBE EVEN AVOID THE NEED FOR
ONE. OR AUGMENTED OR AUGMENTED?
ABSOLUTELY THANK YOU. HEY
SENATOR REBEL. THANK YOU, MR
CHAIR AND FORGIVE ME FOR NOT
KNOWING THIS, BUT I KNOW WE
TALKED ABOUT THE RULEMAKING AND
REGULATIONS BEING COMPLETED AT
THE END OF THIS YEAR. AND YOU
KNOW, AS I BELIEVE MY COLLEAGUE
HERE STATED, THEN WE HAVE TO SEE
WHAT THAT LOOKS LIKE. CAN
SOMEONE SHARED AS WE'RE GOING
THROUGH THE RULEMAKING PROCESS?
JUST A LITTLE BIT OF HOW THAT
HAPPENS. IS THERE LIKE INPUT
FROM YOU KNOW PROVIDERS
YOURSELVES? CAN YOU GIVE ME A
LITTLE BIT OF SENSE OF WHO'S
DOING THE RULEMAKING? UM IS
THERE INPUT? I GUESS THAT'S THE
QUESTION. I'M GETTING TO I WOULD
BE HAPPY TO ANSWER THAT. THERE
ARE FORMAL PUBLIC COMMENT
PERIODS THAT ARE PROVIDED IN
STATUE IN THE GOVERNMENT CODE.
AND SO THAT IS SOMETHING THAT
WILL HAPPEN IN THE COURSE OF
REGULAR RULE MAKINGS THAT WOULD
BE TRUNCATED. IF IT'S AN
EMERGENCY WILL MAKING NOT
SOMETHING THAT'S AT ISSUE HERE.
BUT YES, THERE WILL BE AND HAVE
BEEN PUBLIC COMMENT PERIOD
ANYTIME AN AGENCY PUTS OUT
PROPOSED RULES. OKAY THANK YOU.
THANK YOU. JUST A FEW QUESTIONS.
FIRST OF ALL, AND WE'LL HAVE YOU
KNOW SENIOR FOLKS FROM GMHC AND
CITY HERE. BUT FOR THE, UM THE
FACT THAT THE FINAL REGULATION
HAS NOT BEEN ADOPTED. BY D. M. H
C. CAN YOU JUST PUT THAT IN
CONTEXT IS THAT UM USUAL FOR IT
TO TAKE THAT LONG. I KNOW
RULEMAKING IS CAN TAKE A LONG
TIME, BUT SOMETIMES THEY CAN BE
QUICK. CAN YOU JUST SORT OF PUT
THAT IN CONTEXT? YEAH, I MEAN,
CERTAINLY, RULEMAKING HAS BEEN
KNOWN TO TAKE A LONG TIME, I
WOULD THINK JUST REITERATE HOW
DIRE THIS IS FOR PATIENTS. WE
KEEP HEARING THESE STORIES.
WE'VE KNOW THAT THIS IS NOT THE
FIRST TIME YOU BOTH SAT HERE AND
LISTENED TO FOLKS TELL YOU
STORIES AND PEOPLE IN YOUR
DISTRICTS ARE TELLING YOU
STORIES REALLY IS SORT OF A
CRISIS SITUATION AND I THINK THE
NEED TO HAVE REALLY DETAILED
REGULATIONS. WE MAYBE JUST SPEAK
TO SENATOR RUBIO'S QUESTION
EARLIER, TOO. IN THE SAME WAY IS
WE HAVE BEEN WITH A GROUP OF 20
PLUS ADVOCATES WORKING TOGETHER
TO SUBMIT DETAILED LETTERS TO
THE DEPARTMENT OVER THE LAST FEW
YEARS ON THE ISSUES WE'RE SEEING
AND CLEAR WHAT WE WHAT WE FEEL
ARE CLEAR, DETAILED SOLUTIONS
FOR HOW TO SOLVE THOSE ISSUES
THROUGH THE REGULATIONS. SO THE
LAST COMMENT ON THE LAST LETTER
WENT OUT JUST RECENTLY. AND THAT
HAS MADE SOME PROGRESS FROM THE
FIRST TIME WE SAW IT. SO I THINK
WE'VE WE'VE BEEN MAKING PROGRESS
AND SEEING MORE PROTECTIONS
BEING PUT IN, BUT IT HAS BEEN A
LENGTHY PROCESS. OKAY AND THEN,
UM, YOU TALKED ABOUT A NON
QUANTITATIVE TREATMENT
LIMITATION. THANK YOU, TL JUST
TO BE CLEAR. THAT IS THINGS LIKE
UTILIZATION. AH! MANAGEMENT AND
OTHER WAYS THAT HEALTH PLANS
SOMETIMES EMPLOYED TO
EFFECTIVELY DENY COVERAGE, EVEN
THOUGH EVEN IF IT'S NOT A
EXPLICIT. BLANKET DENIAL OF
COVERAGE. IT'S SORT OF OTHER
TOOLS THAT THE PLAN SOMETIMES
USED TO MAKE IT IMPOSSIBLE TO
ACTUALLY ACCESS CARE. YES THAT'S
RIGHT. NON QUANTITATIVE
LIMITATIONS ARE WHERE THE
MAJORITY OF PARODY VIOLATIONS
ARE HAPPENING, AND THE
QUANTITATIVE TREATMENT STATIONS
OR THE OTHER SIDE OF THAT, AND
THEY'RE A LITTLE BIT EASIER TO
REGULATE BECAUSE THEY'RE THEY'RE
MORE STRAIGHTFORWARD, SO IT IS
MORE COMPLEX IN TERMS OF
REGULATING DMH C IS SAYING THAT
IT WOULD JUST BE TOO TIME
INTENSIVE, AND I KNOW WHAT LAST
THE DIRECTOR WHEN SHE'S UP THE
TABLE, BUT JUST IT'S TOO TIME
INTENSIVE TO SORT OF ANALYZE
THAT. YESTERDAY'S BEHAVIOR.
HEALTH INVESTIGATION SUMMARY HAD
SORT OF A THEY BASICALLY SAID AS
MUCH THOSE TOO COMPLEX AND WOULD
TAKE QUITE A BIT OF TIME AND
EFFORT. AND THAT WAS YESTERDAY'S
SUMMER. I DON'T KNOW COLLEAGUES.
OTHER STATES HAVE HAVE ANALYZED.
YEAH THANK YOU TAILS FOR THE
DIFFERENT PLANS. YES, SO THE
FEDERAL GOVERNMENT HAS ALSO IN
TWO DIFFERENT REPORTS RECENTLY
FOUND SORT OF NON WIDESPREAD
NONCOMPLIANCE WITH THE TLS AND I
THINK, AS AS KAREN MENTIONED
JUST EARLIER. NEW YORK AND
ILLINOIS HAVE ISSUED A LARGE
AMOUNT OF FINES AND FOUND
WIDESPREAD NONCOMPLIANCE. PRETTY
UNIVERSAL COMPLIANCE ALONG MANY
OF THEIR STATE PLANS, SO OTHER
STATES HAVE DONE IT AND HAVE
USED THOSE PARODY COMPLIANCE
ANALYSES EFFECTIVELY. UM GREAT.
THANK YOU. AND I JUST RUBIO JUST
REQUEST IF I MAY SAY THAT YOU'VE
PROVIDED A LETTER WITH CLEAR
DETAILS ON SOLUTIONS. CAN WE GET
A COPY OF THAT? IT? WOULD THAT
BE OKAY? ABSOLUTELY. THANK YOU.
OKAY WANTED TO ADD IN FROM THE
PROVIDERS SIDE IS THAT THE NQ
TLS ARE THE BANE OF OUR
EXISTENCE RIGHT? BECAUSE WE
CAN'T FIGURE OUT WHAT THEY ARE
FOR EACH EACH INSURANCE COMPANY
FOR EACH PATIENT. THERE ARE
COMPLETELY DIFFERENT. SO NOT
ONLY DOES IT LEAD US TO HAVE
THESE VERY DIFFICULT REGULATIONS
THAT ARE HOLDING UP THE PATIENT
CARE, BUT WE HAVE TO LIKE ONLY
THE ONLY WAY WE CAN GET THROUGH
THEM IS SORT OF BY TRIAL AND
ERROR, AND THAT'S THAT'S REALLY
A STRUGGLE. THANK YOU. OKAY
WELL, THANK YOU TO OUR PANEL
WILL NOW PROCEED TO OUR THIRD
PANEL, WHICH ARE THE AGENCIES OR
DEPARTMENTS. WE HAVE DIRECTOR
WATANABE FROM THE DEPARTMENT OF
MANAGED CARE OR APPRECIATIVE
DIRECTOR BEING HERE, AND STARSIA
HODGES, WHO IS THE ASSISTANT
CHIEF COUNSEL DEPARTMENT OF
INSURANCE. THANK YOU FOR JOINING
US APPRECIATE IT, AND WE'LL
START WITH THE DIRECTOR. DISHES
ON THE AGENDA FIRST, BUT I'M
HAPPY TO GO. OKAY WE'LL START
WITH I'M SORRY. FIRST, OKAY?
GOOD MORNING, MR SHARON MEMBERS
TO HODGES IN MY PRONOUNS. ARE
SHE HER HERS? ASSISTANT CHIEF
COUNSEL AND CHIEF OF INSURANCE
COMMISSIONER, RICARDO LAURA'S
HEALTH, EQUITY AND ACCESS OFFICE
AT THE CALIFORNIA DEPARTMENT OF
INSURANCE. COMMISSIONER LARA
ESTABLISHED THIS OFFICE TO
ENSURE CONTINUITY AND
COORDINATION OF HIS MAJOR HEALTH
INITIATIVES FOCUSING ON HEALTH
EQUITY COVERED INACCESSIBILITY,
ESPECIALLY FOR HISTORICALLY
DISADVANTAGED AND UNDERSERVED
COMMUNITIES. FIRST COMMISSIONER
LARA WOULD LIKE TO TAKE THANK
THE CHAIRMAN MEMBERS FOR
CONVENING THIS HEARING TO BRING
MORE ATTENTION TO PROBLEMS WITH
COVERAGE OF MENTAL HEALTH AND
SUBSTANCE TO THIS USE DISORDER
CARE AND WOULD LIKE TO THANK
SHARE WIENER FOR AUTHORING SP
855 AND 2020 CHAPTER BILL THAT
WE BELIEVE TO BE INSTRUMENTAL IN
STRENGTHENING CALIFORNIA'S
MENTAL HEALTH PARITY LAW. THIS
MORNING, I WILL DISCUSS EFFORTS
THAT THE DEPARTMENT HAS
UNDERTAKEN TO ENFORCE SP 855 AND
THE FEDERAL MENTAL HEALTH PARITY
AND ADDICTION EQUITY ACT OR
FEDERAL ACT, INCLUDING SOME
AREAS WHERE WE HAVE FOUND NON
COMPLIANT BY HEALTH INSURERS
THAT WE REGULATE. I WILL
CONCLUDE BY IDENTIFYING AREAS
WHERE ADDITIONAL TOOLS SUCH AS
LEGISLATION COULD BE EXPLORED.
2021 THE DEPARTMENT ISSUED A
CONSUMER FACT SHEET AND IN 2020
ENSURE NOTICE ON COMPLIANCE WITH
SB 855. THE NOTICE SPECIFIES
THAT THE NONPROFIT PROFESSIONAL
ASSOCIATION GUIDELINE THAT
INSURERS MUST USE FOR SUBSTANCE
USE DISORDER LEVEL OF CARE
PLACEMENT IS THE AMERICAN
SOCIETY OF ADDICTION, MEDICINE
OR A SOUND CRITERIA. AND FOR
MENTAL HEALTH CONDITIONS. IT IS
THE LEVEL OF CARE UTILIZATION
SYSTEM OR LOCUST FAMILY OF
INSTRUMENTS. ADDITIONALLY,
HEALTH INSURERS MUST PROVIDE
BENEFITS FOR GENDER DYSPHORIA
AND CONDUCT UTILIZATION REVIEW
CONSISTENT WITH THE WORLD
PROFESSIONAL ASSOCIATION OF
TRANSGENDER HEALTH OR W. PAST
STANDARDS OF CARER. IN 2022
PURSUANT TO SB 855. THE
DEPARTMENT NOTICED THE PROPOSED
REGULATION TEXT IN OCTOBER AND
HELD A PUBLIC WORKSHOP IN
NOVEMBER. WE HAVE MADE CHANGES
TO THE PROPOSED TEXT IN RESPONSE
TO STAKEHOLDER COMMENTS RECEIVED
IN CONNECTION WITH THAT WORKSHOP
, AND WE HAVE ALSO AMENDED IN
RESPONSE TO 988, WHICH WAS
SIGNED BY THE GOVERNOR IN 2022
BY INTEGRATING RULES FOR
COVERING BEHAVIORAL HEALTH
CRISIS SERVICES INTO THE
REGULATION. CURRENTLY THE
PROPOSED TEXT IS IN FINAL FORM
FOR NOTICING AND THE RULEMAKING
PACKAGES AND PROCESS WE EXPECTED
NOTICE THE REGULATION THE FIRST
QUARTER OF NEXT YEAR. IN THE
MEANTIME, I WANT TO HIGHLIGHT A
FEW POINTS IN OUR PROPOSED
REGULATIONS. UNDER THE
REGULATION, INSURERS MUST
EXCLUSIVELY USED GUIDELINES THAT
WILL BUY NONPROFIT PROFESSIONAL
ASSOCIATIONS FOR THE RELEVANT
CLINICAL SPECIALTY. IF NONPROFIT
GUIDELINES DO NOT EXIST, THEN
INSURERS MUST FOLLOW, CURRENTLY
GENERALLY ACCEPTED STANDARDS OF
MENTAL HEALTH AND SUBSTANCE USE
DISORDER, OR MH, SAID CARE. WE
INTEND TO ADOPT STANDARDS FOR
THE QUALIFICATIONS OF PROVIDERS
WHO CONDUCT UTILIZATION REVIEW
OF MHC BENEFITS TO ENSURE THEY
HAVE APPROPRIATE TRAINING AND
EXPERTISE TO MAKE MEDICAL
NECESSITY DETERMINATIONS. FOR
SUBSTANCE USE DISORDERS OR SUDS
PROVIDERS WHO ISSUE ADVERSE
BENEFIT DETERMINATION FOR
INTENSIVE OUTPATIENT RESIDENTIAL
AND IN PATIENTS SAID CARE MUST
BE ACTIVELY PRACTICING
PHYSICIANS WHO ARE BOARD
CERTIFIED SPECIALISTS IN
ADDICTION CARER. THE REGULATION
SPECIFIES THAT ANY NON
QUANTITATIVE TREATMENT
LIMITATION OR AN ACUTE TL
RELATED TO UTILIZATION REVIEW
THAT ENSURE IMPOSES ON MHC
BENEFITS MUST COMPLY WITH THE
FEDERAL ACT. IN TERMS OF THE
DEPARTMENT'S ENFORCEMENT
EFFORTS. WE HAVE REVIEWED HEALTH
INSURANCE POLICIES AS WELL AS
POLICIES AND PROCEDURES. FRIEDEL
IZATION REVIEW FOR COMPLIANCE
WITH SB 855 AND THE FEDERAL ACT.
AS PART OF THIS, WE HAVE
ENFORCED THE FEDERAL ACTS RULE
ON NQ TLS REGARDING UTILIZATION
MANAGEMENT OF INMATES SAID
BENEFITS SINCE 2014 IN THOSE
REVIEWS. WE HAVE FOUND THAT
HEALTH INSURERS CANNOT
DEMONSTRATE THAT THEY COMPLY
WITH THE FACT FEDERAL ACT WITH
REGARD TO PRIOR AUTHORIZATION
FOR OUTPATIENT, EMMETT SAID.
BENEFITS AND THEREFORE THEY
CANNOT APPLY THAT IN Q T. L
SINCE 2016. THE DEPARTMENT HAS
REVIEWED PRESCRIPTION DRUG
FORMULARIES FOR CLINICALLY
APPROPRIATE DRUG COVERAGE AND
UTILIZATION MANAGEMENT
RESTRICTIONS FOR CONDITIONS.
THIS REVIEW INCLUDES MANY DRUG
CLASSES, INCLUDING
ANTIDEPRESSANTS, ANTIPSYCHOTICS
FOR SCHIZOPHRENIA AND MEDICATION
, ASSISTED TREATMENT AND
REVERSAL. DRUGS FOR OPIOID USE
DISORDER. IN RESPONSE TO S B A
55. THE DEPARTMENT INCORPORATED
A SPECIFIC REVIEW OF GEOGRAPHIC
NETWORK ADEQUACY FOR FACILITIES
THAT PROVIDE ADULT RESIDENTIAL
SUCH TREATMENT, AS WELL AS
OUTPATIENT NARCOTIC TREATMENT
PROGRAMS FOR OPIOID USE
DISORDER. WE ALSO REVIEW FOR
GEOGRAPHIC ACCESS TO INPATIENT
MH SAID FACILITIES AND NINE
PROVIDERS SPECIALTIES. THROUGH
ASSISTING CONSUMERS WITH
COMPLAINTS. WE HAVE RECENTLY
CITED INSURERS FOR VIOLATION OF
S. V 855 REQUIREMENT TO ARRANGE
OUT OF NETWORK COVERAGE. ONE
CARRIES AN AVAILABLE FROM
NETWORK PROVIDERS WITHIN THE
DEPARTMENT, GEOGRAPHIC AND
TIMELY ACCESS STANDARDS. ONE OF
THESE CASES IS THE SUBJECT OF AN
ONGOING ENFORCEMENT ACTION. AND
THE DEPARTMENT'S MARKET CONDUCT
DIVISION IS CURRENTLY CONDUCTING
OUR FIRST HEALTH AND YOUR EXAM
THAT INCLUDES A REVIEW FOR
COMPLIANCE. SP 855 WHILE THE
EXAM RESULTS ARE NOT YET PUBLIC,
WE HAVE FOUND ONE INSTANCE OF
WRONGFUL DENIAL OF SAID
TREATMENT BASED UPON MEDICAL
NECESSITY AND ANOTHER INSTANCE
OF ENFORCEMENT OF A BENEFIT
EXCLUSION THAT IS INCONSISTENT
WITH SB EIGHT BY FIVE I WOULD
ALSO LIKE TO HIGHLIGHT AREAS
WHERE THE DEPARTMENT CAN USE
ADDITIONAL TOOLS TO PROTECT
CONSUMERS ARE UTILIZATION
MANAGEMENT STATUTE WAS
ORIGINALLY ENACTED IN 1999, AND
IT WAS UPDATED TO COMPLY WITH
THE FEDERAL AFFORDABLE CARE ACT
AND ONLY ONE RESPECT IN 2010. WE
RECOMMEND FURTHER LEGAL
AUTHORITY ON ADVERSE BENEFIT
DETERMINATIONS, INGREDIENTS
HANDLING THAT ALIGNS WITH THE
AFFORDABLE CARE ACT. THE
DEPARTMENT ALSO BELIEVES
SPECIFIC ADMINISTRATIVE
ENFORCEMENT AND MONETARY PENALTY
AUTHORITY FOR ALL HEALTH
STATUTES, NOT JUST SB 855 WOULD
BE BENEFICIAL TO HELP PROTECT
CONSUMERS. WE HAVE MADE GREAT
STRIDES IN THE ALMOST DECADES
SINCE THE AFFORDABLE CARE ACT
AND FULLY IMPLEMENTED WAS FULLY
IMPLEMENTED TO EXPAND THE
FEDERAL ACT. ALL AMERICANS
SEGMENTS SV 855 BUILT UPON THESE
REQUIREMENTS BY MAKING,
CALIFORNIA'S MH SAID PARODY THE
LAW, THE STRONGEST IN THE
NATION. THANK YOU AGAIN FOR
INVITING ME HERE TO TALK TODAY
ON BEHALF OF COMMISSIONER LARA
HERE WITH ME. I HAVE TWO
ATTORNEYS JESSICA RYAN AND KATIE
FISHER, WHO ALSO WORK IN MY
OFFICE ON MENTAL PARODY ISSUES
OVER THE LAST 10 YEARS TO ASSIST
ME WITH ANY QUESTIONS THAT YOU
MAY HAVE. THANK YOU. THANK YOU
SO MUCH NOW DIRECTION, RIGHT.
GOOD MORNING. GOOD AFTERNOON.
YET MORNING WITH MORTY. SENATOR
WIENER MEMBERS OF THE SELECT
COMMITTEE. I'M MARY WATANABE AND
THE DIRECTOR OF THE DEPARTMENT
OF MANAGED HEALTH CARE BEFORE I
GET STARTED. I JUST WANT TO TAKE
A MOMENT TO REALLY EXPRESS MY
APPRECIATION FOR THE OPPORTUNITY
TO BE HERE TO SPEAK ABOUT THE
IMPORTANT WORK THAT THE
DEPARTMENT DOES. WELL, I KNOW
EVERYBODY IS FRAMING THIS AS I
AM IN THE HOT SEAT. I'M HAPPY TO
BE HERE. THIS IS AN ISSUE THAT
IS DEEPLY IMPORTANT AND PERSONAL
. TO ME. IT'S THE ONE ISSUE IF
I'M GOING TO DIG IN ON ANYTHING,
IT'S THIS. SO IT'S AN HONOR TO
BE HERE. SENATOR WIENER ALSO
JUST WANT TO THANK YOU FOR YOUR
LEADERSHIP AND PARTNERSHIP WITH
THE DEPARTMENT ON THE
IMPLEMENTATION ACTIVITIES
RELATED TO THIS LANDMARK MENTAL
HEALTH PARITY STATUTE. AS YOU'RE
GOING TO HEAR TODAY, THIS IS ONE
OF MY HIGHEST PRIORITIES IS THE
DIRECTOR AND I WANT TO MAKE SURE
THAT ALL HELP THE HEALTH FINDING
ROLLERS AND URGES JURISDICTION
TO APPROPRIATE BEHAVIORAL HEALTH
SERVICES WHEN THEY NEED THEM
WITH THAT THE DEPARTMENT'S
MISSION IS TO PROTECT CONSUMERS
HEALTHCARE RIGHTS AND ENSURE A
STABLE HEALTHCARE DELIVERY
SYSTEM. IF YOU DON'T KNOW WHO WE
ARE, WE LICENSE AND REGULATE 143
HEALTH PLANS. THAT PROVIDE
HEALTH CARE COVERAGE TO ALMOST
30 MILLION CALIFORNIANS. WE
REGULATE 96% OF STATE REGULATED
COMMERCIAL AND GOVERNMENT HEALTH
PLAN. ENROLLMENT IN THE STATE
AUTHORED BY SENATOR WEINER AND
SIGNED IN LAW BY GOVERNOR NEWSOM
. SPF 55 SUBSTANTIALLY
OVERHAULED CALIFORNIA'S MENTAL
HEALTH PARITY LAW, BOTH IN TERMS
OF COVERAGE AND ACCESS TO
SERVICES. I'M GOING TO SKIP THE
OVERVIEW OF ALL THAT IT DID
BECAUSE I THINK YOU'VE HEARD A
LOT ABOUT THAT. I DO JUST WANT
TO NOTE THAT WHILE SP 8 55 MADE
SIGNIFICANT CHANGES TO HEALTH
PLAN COVERAGE OF BEHAVIORAL
SERVICES, IT DID PRESERVE A
HEALTH PLANS ABILITY TO IMPOSE
COMMON MANAGED CARE TOOLS SUCH
AS WHAT YOU'VE HEARD TODAY, THE
REQUIREMENTS FOR PRIOR
AUTHORIZATION. THE GMHC HAS
TAKEN A NUMBER OF STEPS TO
IMPLEMENT SB 8 55, SINCE IT'S IN
AN ACTIVE AND IN 2020 ISSUED TO
ALL PLANNED LETTERS TO THE
HEALTH PLANS REQUIRING THEM TO
DEMONSTRATE COMPLIANCE WITH SPF
55. THEY WERE REQUIRED TO SUBMIT
UPDATED EVIDENCE OF COVERAGE,
DOCUMENTS, DISCLOSURE DOCUMENTS,
POLICIES AND PROCEDURES. AS WELL
AS PROOF OF CONTRACTUAL
ARRANGEMENTS WITH THE NONPROFIT
ASSOCIATIONS DEMONSTRATING
COMPLIANCE WITH SB 55. THE
DAMAGE HAS ALSO CREATED A
CONSUMER FACT SHEET TO HELP
HEALTH PLAN ENROLLEES UNDERSTAND
THE CHANGES UNDER SP 8 55 THAT
FACT SHEET IS PUBLICLY AVAILABLE
ON OUR WEBSITE AND CAN BE
DOWNLOADED FOR IS OF ACCESS.
ADDITIONALLY AS YOU'VE HEARD
QUITE A BIT TODAY, WE'RE IN THE
PROCESS OF PROMULGATING
REGULATIONS RELATED TO THE
IMPLEMENTATION OF SB 8 55. WHICH
WILL PROVIDE GREATER SPECIFICITY
AND SUPPORT OUR ENFORCEMENT OF
EXISTING LAW. THE D MHC
INITIATED THE FORMAL RULEMAKING
PROCESS IN EARLY 2023. THE FINAL
COMMENT PERIOD ENDED EARLIER
THIS MONTH, AND WE ARE CURRENTLY
REVIEWING THE MOST RECENT
COMMENTS. WE ANTICIPATE THE
REGULATION WILL GO TO THE OFFICE
OF ADMINISTRATION STRAIGHT OF
LAW IN THE FIRST HALF OF
NOVEMBER. WE'RE HOPING THAT ALL
GOES WELL AND IT WILL TAKE
EFFECT ON APRIL 1ST 2024. THE
DAMAGE THE MONITORS COMPLIANCE
WITH SPF 55 IN SEVERAL WAYS. IF
YOU'VE HEARD ME TESTIFY ON THE
DEPARTMENT'S ACTIVITIES, THESE
WILL NOT BE NEW TO YOU. WE HAVE
OUR ROUTINE MEDICAL SURVEYS,
WHICH WE CONDUCT. REALLY THIS IS
AN AUDIT OF HEALTH PLAN
OPERATIONS EVERY THREE YEARS.
WELL ROUTINE MEDICAL SURVEYS.
SURVEYS CURRENTLY INCLUDE A
REVIEW OF ACCESS TO BEHAVIORAL
SERVICES. ONCE THE SP 8 55
REGULATIONS ARE FINAL, THE
SURVEYS WILL EXPAND
SIGNIFICANTLY TO INCLUDE ALL OF
THE ADDITIONAL DETAIL AND
SPECIFICATIONS IN THE
REGULATION. THIS WILL INCLUDE A
REVIEW OF HOW PLANS ARE
AUTHORIZING SERVICES AND USING
THE NONPROFIT CRITERIA AND ALSO,
MOST IMPORTANTLY, HOW THEY WERE
ARRANGING FOR OUT OF NETWORK
SERVICES. WHEN SERVICES ARE NOT
AVAILABLE IN NETWORK WITHIN THE
TIMELY AND GEOGRAPHIC ACCESS
STANDARDS. GMHC ALSO CONDUCTS
NON ROUTINE SURVEYS WHEN
SPECIFIC ISSUES OR PROBLEMS
REQUIRE A FOCUSED REVIEW OF THE
HEALTH PLANS OPERATIONS. AS WAS
NOTED YESTERDAY WE ANNOUNCED OUR
FIRST PHASE OF THE BEHAVIORAL
HEALTH THAT INVESTIGATIONS IN
FISCAL YEAR 2021. WE RECEIVED
AUTHORITY AND FUNDING TO CONDUCT
INVESTIGATIONS TO ASSESS
COMMERCIAL PLANS, DELIVERY OF
MENTAL HEALTH AND SUBSTANCE USE
DISORDER SERVICES. THE
INVESTIGATIONS WERE REALLY
FOCUSED ON THE CONSUMER
EXPERIENCE AND IDENTIFYING AND
EVALUATING BARRIERS EXPERIENCED
BY ENROLLEES. IN OBTAINING
BEHAVIORAL HEALTH SERVICES AND
UNVEILING PROVIDER CHALLENGES.
WE ARE CONDUCTING INVESTIGATIONS
OF FIVE COMMERCIAL HEALTH PLANS
A YEAR AND IT IS POSSIBLE THAT
THROUGH THESE INVESTIGATIONS, WE
WILL ALSO SEE VIOLATIONS OF SPF
55. SINCE SB 8 45 TAKE EFFECT
THE DMH SEE HELP CENTER HAS SEEN
A 28% DECREASE IN THE NUMBER OF
BEHAVIORAL HEALTH INDEPENDENT
MEDICAL REVIEWS, WHICH LIKELY
MEANS THERE ARE FEWER DENIALS
RELATED TO MEDICAL NECESSITY.
HOWEVER WE HAVE SEEN AN INCREASE
IN WHAT WE CALL CONSUMER
STANDARD COMPLAINTS. THESE MEANS
THESE ARE OTHER ISSUES.
ENROLLEES ARE HAVING THAT ARE
NOT MEDICAL NECESSITY, DENIALS
OR DENIALS RELATED TO
EXPERIMENTAL OR INVESTIGATIONAL
ISSUES ARE BEHAVIORAL HEALTH
STANDARD COMPLAINTS CONCERNING
BENEFITS OR COVERAGE INCREASED
BY BY 16. PROBABLY MOST
SIGNIFICANTLY THE COMPLAINTS
RELATED TO ACCESS TO CARE
INCREASED BY NEARLY 100% IN THE
IN THE LAST YEAR. WE WILL
CONTINUE TO MONITOR HELP CENTER
COMPLAINTS AND MAY CONDUCT AN
ONEROUS ROUTINE SURVEY OR TAKEN
FORKS ENFORCEMENT ACTION IF WE
FIND PATTERNS OF NONCOMPLIANCE
AS YOU ARE LIKELY AWARE LAST
WEEK, WE ANNOUNCED A HISTORIC
SETTLEMENT AGREEMENT WITH KAISER
TO MAKE SIGNIFICANT CHANGES TO
THE PLANS, DELIVERY OF BEHAVIOR,
BEHAVIORAL SERVICES. THE
SETTLEMENT AGREEMENT INCLUDES A
$50 MILLION ADMINISTRATIVE
PENALTY. AND REQUIRES KAISER TO
TAKE CORRECTIVE ACTION TO
ADDRESS THE DEFICIENCIES IN THE
PLANTS. DELIVERY OF BEHAVIORAL
HEALTH CARE TO ENROLLEES.
ADDITIONALLY KAISER HAS PLEDGED
TO MAKE SIGNIFICANT INVESTMENTS
TOTALING 150 MILLION OVER FIVE
YEARS INTO INNOVATIVE PROGRAMS
TO IMPROVE THE DELIVERY OF
BEHAVIORAL SERVICES FOR ALL
CALIFORNIANS BEGAN. KAISER'S
EXISTING OBLIGATIONS UNDER THE
LAW. THE SETTLEMENT AGREEMENT IS
A RESULT OF THE DM AGENCIES NON
ROUTINE SURVEY OF KAISER'S
BEHAVIOR, BEHAVIORAL HEALTH
DELIVERY SYSTEM AND AN
ENFORCEMENT ACTION. BOTH WERE
INITIATED LAST YEAR. THE
SETTLEMENT AGREEMENT INCLUDES
SEVERAL FINDINGS RELATED TO
KAISER'S COMPLIANCE WITH SB 55,
INCLUDING THAT THE PLAN WAS NOT
CONSISTENTLY ARRANGING FOR OUT
OF NETWORK APPOINTMENTS WHEN
THEY COULD NOT PROVIDE TIMELY
ACCESS TO AN APPOINTMENT IN
NETWORK. THE PLAN WAS NOT
DOCUMENTING THE USE OF NON
PROFIT CLINICAL CRITERIA IN THE
ENROLLEES MEDICAL RECORDS AND
THE PLAN FAILED TO DEMONSTRATE
IT CONDUCTED RELIABILITY TESTING
TO ENSURE CONSISTENCY AND HOW
THOSE UTILIZATION REVIEW
DECISIONS WERE MADE. I DO WANT
TO MENTION ONE ISSUE THAT WE ARE
SEEING AT THE HELP CENTER. SP 8
55 ADDED POWERFUL CONSUMER
PROTECTIONS TO ENSURE HEALTH
PLAN ENROLLEES HAVE TIMELY
ACCESS TO MEDICALLY NECESSARY
BEHAVIORAL HEALTH SERVICES.
UNFORTUNATELY WE ARE SEEING AN
INCIDENT WHERE PROVIDERS APPEAR
TO BE USING THE REQUIREMENTS OF
SB 8 55 TO CONCERT TO CIRCUMVENT
THE REQUIREMENT THAT ENROLLEES
MUST FIRST ATTEMPT TO OBTAIN A
TIMELY APPOINTMENT FROM AN IN
NETWORK PROVIDER. IN ADDITION,
THESE PROVIDERS ARE USING OUR
INDEPENDENT MEDICAL REVIEW AND
COMPLAINT PROCESS TO DEMAND THAT
THE PLAN AUTHORIZED SERVICES OUT
OF NETWORK AND PAY BILL CHARGES
THAT ARE MORE THAN FOUR TIMES
THE MARKET RATE. IF THE DMH SEES
REVIEW DETERMINES THE PLAN IS
NOT REQUIRED TO PAY FOR THE OUT
OF NETWORK CHARGES. IN SOME
CASES, THE PROVIDER IS
ATTEMPTING TO BALANCE BILL THE
ENROLLEE. TO DATE, THE GMHC HELP
CENTER HAS HELPED CONSUMERS
AVOID $4.2 MILLION RELATED TO
THESE BALANCE BILLING PRACTICES.
THESE ARE VERY CHALLENGING CASES
BECAUSE THE PROVIDER OFTEN TELLS
THE CONSUMERS NOT TO TALK TO THE
D MHC. IN ADDITION, THE PROVIDER
REFUSES TO PROVIDE MEDICAL
RECORDS TO THE HEALTH PLAN AND
IN SOME INSTANCES, EVEN TO THE
DEPARTMENT, WHICH IMPEDES OUR
ABILITY TO DETERMINE WHETHER THE
SERVICES WERE MEDICALLY
NECESSARY AND FOR THE GMHC TO
DETERMINE WHETHER THE PLAN
COMPLIED WITH SPF 55. I JUST
WANT TO REITERATE THAT THE
PROTECTIONS OF SB 8 55 ARE
INVALUABLE IN HELPING TO ENSURE
ENROLLEES RECEIVED TIMELY AND
APPROPRIATE BEHAVIORAL SERVICES.
IT IS UNFORTUNATE THAT A SMALL
SUBSET OF PROVIDERS APPEAR TO BE
ABUSING SB EIGHT FOR DEVICE
PROTECTIONS, POSSIBLY TO THE
DETRIMENT OF THESE VERY
VULNERABLE PATIENTS. THESE
PRACTICES CAN ALSO LEAD TO A
SIGNIFICANT INCREASE IN COST TO
OUR HEALTH CARE SYSTEM. FOR MANY
OF US THAT JUST WENT THROUGH
OPEN ENROLLMENT WERE WELL AWARE
OF THE INCREASES THAT ARE COMING
TO OUR PREMIUMS. NEXT YEAR.
WE'RE SEEING DOUBLE DIGIT
PREMIUM INCREASES FOR MANY
CONSUMERS, SO I AM ACUTELY AWARE
OF THE POTENTIAL IMPACT OF THIS
TO THE COST OF THE HEALTH CARE
SYSTEM. IN CONCLUSION. I WOULD
LIKE TO ENCOURAGE ANYONE WHO IS
HAVING A PROBLEM ACCESSING
BEHAVIORAL HEALTH SERVICES TO
CONTACT OUR HELP. CENTER OR
PHONE NUMBER IS 188846622. OR
HEALTH, HELP DOT CA.GOV. THIS
REALLY ALLOWS US TO HELP
INDIVIDUAL CONSUMERS GET THE
CARE THEY NEED AND DESERVE. IN
ADDITION TO PROVIDING VALUABLE
INFORMATION, THE DEPARTMENT OR
WHERE ABOUT WHERE PLANS MAY NOT
BE COMPLYING WITH THE LAW. IT
ALSO INFORMS THE OTHER WORK WE
DO, INCLUDING SOME OF THE
ACTIVITIES I CITED EARLIER, SUCH
AS OUR ROUTINE AND NON ROUTINE
SURVEYS AND OUR BEHAVIORAL
HEALTH INVESTIGATIONS WITH THAT,
I'M SURE YOU HAVE LOTS OF
QUESTIONS. I'LL PAUSE AND SEE IF
YOU HAVE ANYTHING FOR ME. THANK
YOU, DIRECTOR. I DO HAVE A FEW
QUESTIONS, OKAY? I APPRECIATE
YOU BEING HERE AND IT'S HOT SEAT
IN A GOOD WAY, RIGHT? I'M HAPPY
TO BE IN THE HOSPITAL. I THINK
WE'RE ALL TRYING TO ROW IN THE
SAME DIRECTION, AND I KNOW IT'S
A DEPARTMENT AS A CHALLENGING
TOP. AND SO A FEW QUESTIONS
FIRST OF ALL, WHAT? WHEN DO YOU
ANTICIPATE THAT THE FINAL
REGULATION WILL BE ADAPTED? SO
WE'RE HOPING IT WILL GO OVER TO
THE OFFICE OF ADMINISTRATIVE LAW
HERE IN THE NEXT COUPLE OF
WEEKS? WE ARE ON THE CLOCK. IF
YOU'RE FAMILIAR WITH THE
REGULATION PROCESS, WE HAVE A
ABOUT A YEAR TO GET FINALIZED.
OR HOPING THAT GOES SMOOTHLY AND
IT WILL BE IN EFFECT. APRIL 1ST
2024. UM AND DO YOU KILL
SOMETHING TO SIT IN GENERAL
LEVEL? DO YOU THINK THAT HEALTH
PLANS RIGHT NOW ARE IN
COMPLIANCE WITH SB 855? I SURE
HOPE SO. STAY IN FEDERAL PARODY.
SO MAYBE ONE OF THE THINGS LET
ME TALK A LITTLE BIT ABOUT
PARODY. I THINK WHEN I HEAR
PARODY, THERE'S ALWAYS SOME
CONFUSION. WE HAVE THE STATE
PARITY WHICH SP 8 55
SIGNIFICANTLY OVERHAULED. WE
HAVE THE FEDERAL PARITY
REQUIREMENTS SUCH WE CALL THEM.
APIA THERE WAS RECENTLY NEW
FEDERAL GUIDANCE AROUND NOT A
QUALITATIVE TREATMENT. LIMITED
LIMITS SPECIFICALLY. THE
DEPARTMENT DID A COMPREHENSIVE
REVIEW OF FEDERAL PARITY
REQUIREMENTS BACK IN 2020 2014.
I BELIEVE WE DID SURVEYS TO
VERIFY COMPLIANCE, SO WE HAVE
BEEN LOOKING AT FEDERAL PARITY
COMPLIANCE FOR A VERY LONG TIME.
I KNOW THERE WERE SOME OTHER
STATES THAT WERE CITED AS BEING
AHEAD OF US. THAT'S ACTUALLY NOT
TRUE. AS WE'VE TALKED TO SOME OF
THESE OTHER STATES, THEY'RE
ACTUALLY DOING A REVIEW. THAT'S
VERY SIMILAR TO WHAT WE DID BACK
IN 2014 TO 2017. THERE IS NEW
REQUIREMENTS THAT CAME OUT AND
I'M FORGETTING THE CONSOLIDATED
APPROPRIATION ACT. THAT'S
CORRECT. OKAY THERE'S AN ACRONYM
FOR THAT. BUT THIS IS GUIDANCE
THAT CAME OUT ACTUALLY, AFTER SP
8 55. SO THIS IS, I THINK, 2021.
AND THAT IS THE PIECE THAT IN
RESPONSE TO SOME OF THE
STAKEHOLDER FEEDBACK WE
INITIALLY WE'RE GOING TO INCLUDE
IN OUR BEHAVIORAL HEALTH
INVESTIGATIONS. UM WE TRY VERY
HARD TO BE RESPONSIVE TO OUR
STAKEHOLDERS, AND I'LL
ACKNOWLEDGE THIS IS ONE OF THOSE
WHERE I THINK IF WE HAD PAUSED
AND MAYBE LOOKED MORE INTO WHAT
THAT WAS GOING TO REQUIRE, IT IS
A VERY COMPLEX REVIEW. THIS IS
NOT JUST PLAN SAYING YES, I'M
MEETING ALL THE REQUIREMENTS AND
OUR POLICIES AND PROCEDURES ARE
PRIOR AUTHORIZATION REQUIREMENTS
FOR BEHAVIORAL HEALTH ARE NOT
MORE STRINGENT THAN WHAT WE DO
ON THE MEDICAL SURGICAL SIDE.
THIS IS FILING BOTH THEIR
BEHAVIORAL HEALTH POLICIES AND
PROCEDURES AND THEIR MEDICAL
SURGICAL POLICIES AND
PROCEDURES. AND DOING. OUR WORK.
THEY'RE ACTUALLY SHOWING HOW
THEY CAME TO THE CONCLUSION THAT
THEY ARE IN COMPLIANCE JUST TO
GIVE YOU SOME SENSE OF THIS OUR
TEMPLATE THAT WE'RE GOING TO ASK
TO HAVE PLANS FILL OUT WITH A
MINIMAL AMOUNT OF INSTRUCTIONS
IS OVER 70 PAGES. THEY WILL NEED
TO FILL THAT IN WITH THE
NARRATIVE EXPLANATION OF SHOWING
THEIR WORK, THEY WILL HAVE TO
FILE THOSE POLICIES AND
PROCEDURES WITH US AND WE WILL
DO THAT REVIEW PART OF WHY WE
REMOVED THESE FROM THE
BEHAVIORAL HEALTH INVESTIGATIONS
IS THE INTENT OF THE BEHAVIORAL
INVESTIGATIONS WAS TO REALLY SAY
WE HAVE SOME OF THE STRONGEST
PROTECTIONS IN CALIFORNIA. WE'RE
WE'VE DONE EVERYTHING IN LAW
THAT WE COULD POSSIBLY THINK OF
TO DATE, RIGHT? I THINK THERE'S
MORE IN THE WORKS. BUT WHAT I
HEAR AND WHAT I HAVE EXPERIENCED
IS IT IS TOO HARD. IF YOU ARE IN
CRISIS. YOU CANNOT CALL 50
PEOPLE ON A PROVIDER DIRECTORY.
YOU CANNOT NAVIGATE A BUNCH OF
WEBSITES. YOU'RE GOING TO MAKE
ONE CALL, AND THEN YOU'RE GOING
TO THE EMERGENCY ROOM. THIS IS
WHY OR TO OUR COUNTY SYSTEMS.
WHAT WE REALLY WANTED TO
UNDERSTAND IS DESPITE ALL THESE
STRONG CONSUMER PROTECTIONS,
WHAT ARE THE OTHER BARRIERS? IF
YOU READ OUR BEHAVIORAL OF THE
INVESTIGATION REPORT, I THINK
WHAT I THOUGHT WE WOULD SEE AS A
LOT MORE BARRIERS, THINGS WE MAY
NEED TO SHORE UP IN THE LAW.
WHAT WE SAW WERE A LOT OF THE
POLICIES AND PROCEDURES SAY
THEY'RE GOING TO DO X AND IN
PRACTICE RECEIVING WHY SOME OF
THESE THINGS THAT APPEARED TO BE
BARRIERS WE ACTUALLY FEEL THEY
FALL SQUARELY INTO A VIOLATION
OF THE LAW. SO AGAIN THAT
COMPREHENSIVE IT IS. IT IS A
COMPLEX REVIEW OF COMPLIANCE
MAKES MORE SENSE TO US FOR US TO
HAVE A DEDICATED TEAM OF
ATTORNEYS REALLY DIGGING INTO
LOOK AT THAT, JUST TO REMIND OUR
BEHAVIORAL HEALTH INVESTIGATIONS
ARE GOING TO SPAN PROBABLY 5 TO
6 YEARS, WE'VE ADDED MORE PLANS.
THAT'S A LONG TIME TO WAIT FOR A
PARODY COMPLIANCE REVIEW. WE'RE
GOING TO START WITH THE FIRST
FIVE LARGE COMMERCIAL PLANS,
WHICH COVER ABOUT 95% OF THE
STATE. OUR GOAL WITH THESE
REVIEWS IS NOT JUST TO SAY
PLANS. YOU DIDN'T GET IT RIGHT.
BECAUSE THIS IS TOO COMPLICATED.
IT'S TO WORK WITH THEM TO BRING
THEM INTO COMPLIANCE AND
ACTUALLY VERIFY THAT THOSE
POLICIES AND THOSE PROCEDURES
ARE COMPLIANT. THAT WAS A LONG
EXPLANATION. I KNOW I APPRECIATE
. I MEAN, IN TERMS OF COMPLIANCE
, AND I'LL BE HONEST, LIKE FROM
WHAT WE HEAR ON THE GROUND, IT
SEEMS THAT THERE IS PRETTY
WIDESPREAD NON COMPLIANCE. UM
AND YOU KNOW, I'M SURE THE TRUTH
IS PROBABLY SOMEWHERE IN BETWEEN
, BUT I THINK THERE IS A PROBLEM
AND I JUST WANT TO STRESS THE
IMPORTANCE WHICH I KNOW YOU
AGREE WITH ROBUST ENFORCEMENT.
AND WHAT HAPPENED WITH KAISER
WAS GREAT. AND I HOPE THAT THAT
CAN BE A TEMPLATE, YOU KNOW, FOR
OTHER PROBLEMS. SITUATIONS SO IN
TERMS OF THE ANC, UT ELS WHAT?
WHAT IS THE EXACT PLAN FOR THAT?
ARE YOU COMMITTING TO DO IT
DOING THAT ANALYSIS? SURE. YEAH,
NO, AND JUST JUST TO BE CLEAR,
UM WE DIDN'T STOP DOING PARODY
COMPLIANCE REVIEW. IT IS
SOMETHING WE DID BACK IN 2014 TO
2017 AND THEN INCORPORATED INTO
EVERYTHING THAT WE DO, INCLUDING
WHEN PLANTS COME TO US FOR NEW
LICENSURE WHEN THEY HIRE A NUDE
SUB DELEGATE SOMETHING SOMEONE
THEY'RE CONTRACTING WITH. THEY
MAKE CHANGES. WE HAVE BEEN DOING
THOSE REVIEWS EVER SINCE. SO WE
ARE GOING TO START THIS ONE. I'M
GOING TO CALL IT A NON
QUANTITATIVE TREATMENT LIMIT
COMPLIANCE PROJECT. WE WILL BE
ISSUING GUIDANCE TO THE PLANTS
HERE, PROBABLY IN THE NEXT MAYBE
A MONTH OR TWO AGAIN. WE'RE
STARTING WITH THE FIVE LARGEST
PLANS AND SO THAT WORK WILL GO
ON INTO THE COMING YEAR. JUST TO
BE VERY CLEAR. WE GOT SOME
SOMEWHAT LIMITED RESOURCES AS
PART OF THE BEHAVIOR HEALTH
INVESTIGATIONS TO DO THIS WORK
BECAUSE THAT WAS OUR INITIAL
PLAN. THOSE RESOURCES ARE MOVING
TO DO THIS COMPLIANCE PROJECTS,
SO IT'S WE'RE STILL DOING THE
WORK. WE'RE JUST GOING TO DO IT
AS A VERY FOCUSED PROJECT RATHER
THAN THE BEHAVIOR HEALTH
INVESTIGATIONS BECAUSE WE WANT
THOSE TO MOVE QUICKLY TO REALLY
IDENTIFY THOSE BARRIERS. AND
WILL THOSE REVIEWS BE MADE
PUBLIC IN ONE OF THE CONCERNS
WAS THAT THE PARODY COMPLIANCE
REVIEWS WERE NOT NECESSARILY
RELEASED SO. SO WE WILL BE
SHARING AND WE HAVE ALREADY
SHARED A LOT OF OUR DOCTORS,
TEMPLATES AND INSTRUCTIONS FOR
THAT PARODY. REVIEW ANYTHING
THAT THE PLANS SUBMIT TO US ARE
DISCLOSED. HERBAL. SOMEONE CAN
REQUEST ANYTHING WE HAVE NOW
THROUGH PUBLIC REPRESENT REQUEST
WERE THINKING THROUGH HOW WE CAN
KIND OF SHARE THE OUTCOME OF
THOSE. BUT AGAIN, THE FILINGS
ARE AVAILABLE. THERE ARE THE
PLANTS HAVE THE ABILITY TO
REQUEST A CONFIDENTIALITY OF
SOME DOCUMENTS. THERE MAY BE
SOME THINGS THAT RELATED TO
REIMBURSEMENT THAT WOULDN'T BE
DISPOSABLE. FOR THE MOST PART.
ALL OF THOSE CAN BE SHARED AND
DISCLOSED TO ANYBODY WHO WANTS
THEM. OKAY BUT THANK YOU. TL
REVIEWS THAT YOU'RE GOING TO DO
THOSE WILL BE PUBLIC. SO YES, SO
THE PLAN FILINGS CAN BE
DISCLOSED. SOMEONE CAN REQUEST
THOSE WHAT? WE'RE THINKING ABOUT
IT. WHAT WE'RE THINKING ABOUT IS
HOW WE HOW WE SHARE OUR REVIEW
IN THE OUTCOMES OF THOSE THEY
COULD RESULT IN POTENTIALLY
ENFORCEMENT REFERRAL, BUT I
THINK WE'RE TRYING TO THINK
ABOUT HOW WE SUMMARIZE OUR
REVIEW IN THE OUTCOMES. BUT
AGAIN, IF SOMEONE WANTS TO SEE
WHAT THE PLANS ARE FILING THEY
COULD REQUEST THOSE BUT IN TERMS
OF IN TERMS OF THE DEPARTMENT'S
OWN REVIEW WILL THAT BE PUBLIC?
UM SO THE OUTCOMES? YES I THINK
THE KIND OF OUR INTERNAL
WORKINGS OF WHAT OUR REVIEW
LOOKS LIKE. WE'RE JUST TRYING TO
THINK ABOUT HOW WE COULD SHARE
THAT IN A SUCCINCT WAY. YEAH I
MEAN, I DO THINK THAT THAT
TRANSPARENCY IS IMPORTANT SO
THAT THE PUBLIC AND NO. YOU KNOW
WHAT'S HAPPENING BECAUSE
OTHERWISE IT BECOMES A LITTLE
BIT ANECDOTAL, SO I WANT TO
ENCOURAGE THAT TRANSPARENCY. UM
A COUPLE OF IN TERMS OF SOME OF
THE EARLIER TESTIMONY WE HEARD
FROM THE COUNTY BEHAVIORAL
HEALTH DIRECTORS THAT YOU HAD
COMMERCIAL INSURED. PATIENTS WHO
ARE SEEKING SERVICES FROM THE
COUNTIES, AND THEN THE COUNTIES
WERE BEING DENIED COVERAGE FROM
THE HEALTH PLANS. ARE YOU
DEPARTMENT FAMILIAR WITH THAT
ISSUE? AND CAN YOU JUST TALK TO
ME ABOUT IT? YEAH NO, I'VE
WORKED AT HEALTHCARE NOW FOR 22
YEARS, AND I WILL SAY THIS IS
ONE OF THOSE ISSUES THAT I HAVE
HEARD IT PERSONALLY, IF YOU HAVE
A FAMILY MEMBER WITH A SERIOUS
MENTAL ILLNESS FIGURE OUT HOW TO
GET INTO MEDICAL. IT'S SOMETHING
THAT WE'VE HAD MANY DISCUSSIONS
SINCE MY TIME AT THE DEPARTMENT,
AND I THINK YOU HEARD SOME GOOD
EXAMPLES OF WHY THAT IS PIERS.
FAMILY SUPPORT IN HOME SUPPORT.
INTENSE CARE MANAGEMENT IS A BIG
ONE. FOR ME. SOME OF THOSE ARE
NOT REQUIRED FOR COMMERCIAL
PLANS TO COVER PIERS IS A REALLY
GOOD EXAMPLE. WE WOULD NEED A
STATUTORY CHANGE TO REQUIRE
COMMERCIAL HEALTH PLANS TO COVER
PIERS. WE'VE TRIED THAT BEFORE,
BUT YES, THEY'RE TECHNICALLY NOT
LOT LICENSED THEIR LICENSE, I
BELIEVE UNDER A WAIVER OR
SOMETHING FOR THE MEDICAL
PROGRAM. ABSOLUTELY APPRECIATE
THE EMPLOYMENT IMPORTANT ROLE
THAT PEERS AND THOSE WITH THE
LOWER LEVEL OF EDUCATION CAN
PROVIDE A PARTICULARLY WE LOOK
AT WORKFORCE SHORTAGES, ONE OF
THE THINGS THAT THE GOVERNOR
ANNOUNCED IN HIS STATE OF THE
STATE ROAD TOUR WAS FOR THE
DEPARTMENT TO WORK WITH THE
DEPARTMENT OF HEALTH CARE
SERVICES TO REALLY UNDERSTAND
AND DO THE CROSSWALK OF WHAT IS
REQUIRED FOR CAR COMMERCIAL
PLANS TO COVER WHAT IS COVERED
IN OUR MEDICAL PROGRAM, BOTH
THROUGH THE MEDICAL MANAGED CARE
PLANS AS WELL AS THROUGH THE
COUNTY. SO I'M EXCITED BECAUSE I
DON'T KNOW THAT I HAVE EVER
FULLY UNDERSTAND WHAT THOSE
DIFFERENCES ARE. I HEAR THINGS
LIKE WRAPAROUND SERVICES,
WHATEVER IT TAKES TO HELP
ENROLLEES, BUT I THINK, UM
HISTORICALLY, EVEN HOW WE BILL
ENCODE THINGS ON THE COMMERCIAL
SIDE VERSUS MEDICAL HAVE BEEN
VERY DIFFERENT OR MOVING IN A
DIRECTION FOR MORE ALIGNMENT, SO
I'M EXCITED TO SEE WHAT COMES
OUT OF THAT KIND OF THAT
ANALYSIS OF THE DIFFERENCE IN
THE RECOMMENDATIONS FOR
POTENTIAL ALIGNMENT. I WILL JUST
CAUTION THAT WE ARE BEING VERY
MINDFUL THAT WE DON'T WANT TO,
UM, POLAR SAFE IN ITS SAFETY
NETWORK FORCE OUT TO SUPPORT
COMMERCIAL ENROLLEES AS WE
INCREASE COVERAGE REQUIREMENTS
ON THE COMMERCIAL SIDE THAT ALSO
CAN LEAD TO INCREASED COSTS. SO
I THINK THERE'S A LOT OF MORE
WORK THAT WILL BE DOING ENGAGING
WITH STAKEHOLDERS AS WE HEAD
INTO THE NEXT YEAR ON KIND OF
RECOMMENDATIONS, ALTHOUGH I
SUSPECT THAT ONE OF THE REASONS
THAT COMMERCIALLY INSURED PEOPLE
ARE SEEKING PUBLIC. MENTAL
HEALTH SERVICES BECAUSE THAT'S
THE ONLY WAY THEY CAN GET IT.
RIGHT LIKE YOU LIKE, IF YOU'RE
IF YOU'RE HELPING THESE PEOPLE
WHO ARE AT THEIR WITS END THEY
CAN JUST SIMPLY CANNOT ACCESS IT
BECAUSE THROUGH PRIVATE, THEY
HAVE PERHAPS GOOD INSURANCE AND
ENSURING THE HEALTH PLANS,
MAKING IT ABSOLUTELY IMPOSSIBLE
TO GET CARE. AND THIS IS
SOMETHING I'M JUST SORT OF BIG
PICTURE. PEOPLE JUST CANNOT GET
CARE. THEY'RE JUST CANNOT GET
COVERAGE AND THEY CAN'T AFFORD
TO PAY IT OUT OF POCKET UNTIL
THEY'RE DESPERATE. AND THEY GO
TO THE COUNTY WHERE YOU KNOW YOU
CAN GET IT AND THE COUNTY IS
LEFT HOLDING THE BAG. THE HEALTH
PLAN IT HAS SHIFTED. ALL THIS
COST TO THE TAXPAYERS WERE JUST
TOTALLY INAPPROPRIATE. WHAT DO
WE NEED TO DO TO STOP THAT? YEAH
SO AGAIN, I THINK THERE'S A LOT
OF PIECES THAT ARE HAPPENING
WITH THE WITH THE BEHAVIOR,
HEALTH REFORM AS WELL. THERE
WILL BE SOME TRANSPARENCY ABOUT
REPORTING ABOUT JUST HOW MANY
PEOPLE THE COUNTIES ARE SEEN.
THAT'S A BIG UNKNOWN. I'VE
HEARD. I HAVE HEARD HUGE NUMBERS
OF SMALL NUMBER, SO I THINK
THERE'S SOME TRANSPARENCY THERE.
THE OTHER PIECE THAT I DON'T
WANT TO MAKE EXCUSES, BUT IT IS
THE REALITY OF OUR MANAGED CARE
SYSTEM IS ESSENTIALLY, ENROLLEES
NEED TO ATTEMPT TO GO IN NETWORK
BEFORE THEY GO OUT OF NETWORK.
AND SO A LOT OF TIMES WHAT WE
SEE IS PEOPLE END UP IN THE
COUNTY ACCESSING SERVICES, AND
THEY HAVEN'T TRIED TO ACCESS
SERVICES AND NETWORK AND SO
THAT'S WHERE WE SEE A LOT OF THE
HEALTH PLAN DENIALS. UM OF CARE
BECAUSE THEY DIDN'T TRY TO
ACCESS SERVICES AND NETWORK
AGAIN. I DON'T WANT TO MAKE
EXCUSES BECAUSE I ABSOLUTELY
AGREE. WE HAVE TO HOLD THE
COMMERCIAL HEALTH PLANS
ACCOUNTABLE BECAUSE PEOPLE ARE
ENDING ENDING UP IN OUR PUBLIC
SYSTEM BECAUSE WE'RE FAILING
THEM ON THE COMMERCIAL SIDE. I
THINK YOU HEARD ABOUT SOME OF
THE COMMENTS ABOUT THE
CONTRACTING THAT WILL BE
ENCOURAGED BETWEEN OUR
COMMERCIAL HEALTH PLANS IN THE
COUNTIES. WE WILL ACTUALLY BE
GETTING A POSITION I BELIEVE TO
HELP WITH WILL BE REQUESTING A
POSITION TO HELP WITH THE
COORDINATION ON THAT WHEN
THERE'S CHALLENGES WITH THE
CONTRACTING OF THE REIMBURSEMENT
. WE WANTED TO TRY TO HELP
EITHER LIAISON WITH THAT, SO I
THINK ALL OF THAT TO SAY WE
ABSOLUTELY NEED TO HOLD THE
COMMERCIAL HEALTH PLANS
ACCOUNTABLE FOR DOING THEIR JOBS
SO THAT WE'RE MAXIMIZING THOSE
COUNTY RESOURCES FOR THOSE THAT
NEED IT. AND THEN, UM, THEY
HEARD. I THINK YOU HEARD
TESTIMONY ABOUT THE HEALTH
PLANS, NOT NECESSARILY EMPLOYING
IN TERMS OF THE PEOPLE WHO ARE
REVIEWING REGULARLY SUBSTANCE
USE. DISORDER. TREATMENT CLAIMS
ARE NOT AS VERILY, UM,
SPECIALIZE IN THAT AREA. UM CAN
YOU COMMENT ON THAT ISSUE? I
MEAN, THEY DO HAVE TO HAVE THE
CLINICAL EXPERTISE TO REVIEW
CLAIMS THEY HAVE TO BE TRAINED
ON THE NONPROFIT CRITERIA
SPECIFIC TO SPF 55. THEY DO NOT
HAVE TO GO THROUGH THE
CERTIFICATION. I THINK ONE OF
THE CHALLENGES YOU RAISED WITH
THE SP 999 IS IF THE REVIEWER
HAD TO HAVE THE SAME TRAINING
AND CREDENTIALS AT FOUR AS THE
PERSON MAKING THE DECISION ON
THE PROVIDER SIDE. THE PLANS
WOULD NEED TO EMPLOY A HUGE
NUMBER OF PROVIDERS. AND I THINK
THAT WAS ONE OF THE CHALLENGES
AND CONCERNS THAT WE HAD IS JUST
GIVEN THE HUGE NUMBER OF
SERVICES THAT MAY NEED TO BE
REVIEWED. HOW DO YOU EMPLOY
ENOUGH PEOPLE TO REVIEW THOSE
BEING MINDFUL TO WE DON'T WANT
TO PULL MORE PEOPLE OUT OF THE
WORKFORCE SEEN PATIENTS TO DO
UTILIZATION MANAGEMENT REVIEWS,
SO THE LAW IS CLEAR RIGHT NOW
THAT THEY HAVE TO HAVE THE
EXPERTISE. THEY HAVE TO GO
THROUGH THE NONPROFIT CRITERIA
TRAINING. THEY HAVE TO USE THE
NONPROFIT CRITERIA WHEN MAKING
THOSE DECISIONS, BUT THEY DO NOT
HAVE TO HAVE THE EXACT TRAINING
AND CREDENTIALS AS THE PERSON
WHO'S WHO'S PRESCRIBING THE
SERVICE. BUT IN TERMS OF THE
TESTIMONY I KNOW YOU WERE HERE
WHEN THAT TESTIMONY HAPPENED AND
WHAT DO YOU THINK IT'S JUST NOT
AN ISSUE AT ALL? UM I DON'T WANT
TO SAY IT'S NOT AN ISSUE AT ALL.
I MEAN, I THINK THIS IS REALLY
THIS IS PART OF THE INTENT WITH
OUR INDEPENDENT MEDICAL REVIEW
PROCESS IS THERE IS A NEXT LEVEL
OF APPEAL TO COME TO THE
APARTMENT AND WHEN WE SEND THESE
OUT FOR AN INDEPENDENT MEDICAL
REVIEW, IT IS SOMEONE WITH AN
EXPERTISE. POLITICAL EXPERTISE
IN THAT CONDITION. UM WHEN THOSE
REVIEWS COME BACK, THEY CITE TO
THE LATEST, UM JOURNAL ARTICLES
OR THE EVIDENCE TO SUPPORT THEIR
DECISION, ONE OF THE THINGS THAT
THE PLAN SHOULD BE DOING AND WE
TALKED TO THEM ABOUT THIS IS
THEY SHOULD BE REVIEWING THOSE
DECISIONS WHEN THE DECISIONS
COME BACK AND THE REVIEWERS
SAYING HERE'S THE LATEST SCIENCE
OR GUIDELINES ON THIS ISSUE,
THEY SHOULD BE LOOKING AT THAT
TO SEE IF THEIR POLICIES NEED TO
BE UPDATED. UM SO OKAY, UM, AND
SPEAKING ABOUT A MARS WE'VE
GOTTEN A LOT OF FEEDBACK THAT
THEY'RE TAKING TOO LONG. AND
ALSO THAT I THINK YOU HEARD THE
TESTIMONY ABOUT HEALTH. GMHC HAS
THE AUTHORITY TO ACT WITHIN FIVE
DAYS OF TEXT MONTHS. CAN YOU
TALK ABOUT TIMELINESS? BOTH OF
THE DEPARTMENT REVIEWS AND ALSO
OF THE I M R S SO AND JUST TO BE
CLEAR WE HAVE THE I AM OUR
PROCESS, WHICH IS FOR DENIALS OF
THE BASED ON MEDICAL NECESSITY
OR EXPERIMENTAL OR
INVESTIGATIONAL. WE HAVE AN
EXPEDITED PROCESS. WE HAVE THE
NORMAL TIME FRAME. WE ALSO HAVE
A COMPLAINT PROCESS FOR AS I
MENTIONED ISSUES THAT DON'T MEET
THE CRITERIA OF A MEDICAL
NECESSITY. DENIAL FOR EXAMPLE,
THESE COVER ANYTHING FROM TIMELY
ACCESS, BENEFITS AND COVERAGE
NOW CLAIMS PAYMENT ARE WE HAVE A
NUMBER OF TIMEFRAMES THAT ARE
ASSOCIATED WITH ALL OF THOSE. I
WILL TELL YOU THAT I BELIEVE MR
BANDITS. UM PLAME IS PRIMARILY
RELATED TO HOW LONG IT TAKES US
TO QUALIFY, AND I AM OUR
COMPLAINT BEFORE IT GOES TO OUR
REVIEW ORGANIZATION FOR REVIEW.
FOR THE MOST PART, WE ARE
MEETING MOST OF THOSE TIME
FRAMES THE TRICKY PIECES. WE
HAVE A SHORT FORM. IT'S ABOUT
TWO PAGES. YOU CAN GIVE US A
MINIMAL AMOUNT OF INFORMATION.
JUST DESCRIBING YOUR ISSUE. WE
THEN HAVE TO TAKE THAT AND
QUALIFY IT FOR HIM ARE PART OF
WHAT WE HAVE TO FIND OUT. IS
THIS CASE EVEN UNDER OUR
JURISDICTION? SOME OF THE
EXAMPLES I HEARD TODAY I BELIEVE
OR NOT UNDER EITHER OUR
JURISDICTION OR CDS, AND SO THEY
DON'T HAVE TO FOLLOW SB 55. SO
WE HAVE TO MAKE THAT
DETERMINATION IS THAT EVEN UNDER
OUR JURISDICTION DO WE SEND IT
OVER TO CD TO REVIEW THEN WE
NEED MEDICAL RECORDS WE HAVE TO.
SOMETIMES IF THIS IS AN OUT OF
NETWORK PROVIDER, WHICH WE SEE,
SOMETIMES ON THE BEHAVIORAL SIDE
, WE HAVE TO GET MEDICAL RECORDS
. THEN WE HAVE TO REVIEW AND
SAY, OKAY, IS THIS AN MYANMAR OR
DOES THIS FALL INTO THE
COMPLAINT CATEGORY? THAT CAN
TAKE TIME. AND SO WE DO ALL OF
THAT REVIEW TO QUALIFY IT, THEN
IT EITHER GOES THE PATH. OR THE
COMPLAINT PATH. UM I WILL SAY
THAT WE HAVE HAD A SIGNIFICANT
AMOUNT OF GROWTH IN OUR
DEPARTMENT. WE HAD A GROWTH IN
THE NUMBER OF CONSUMERS UNDER
OUR JURISDICTION. WE ALWAYS SEEM
TO NEED MORE PEOPLE. THESE CASES
ARE GETTING MORE COMPLEX. BUT I
THINK THE TRICKIER PIECES THAT
INITIAL REVIEW OFTEN TAKES MORE
TIME AS WE GET NEW INFORMATION
OF SOMEONE EMAILS US OR CALLS US
AND SAYS, OH, I FORGOT TO TELL
YOU THIS. WE HAVE TO PAUSE THE
WHOLE PROCESS, THE CLOCK STOPS.
WE REVIEW THAT INFORMATION, GO
TO THE PLANS TO GET ADDITIONAL
INFORMATION AND THINGS RESTART.
SO UM, I SAY THAT JUST TO SAY
IT'S VERY NUANCED IN CASE
SPECIFIC, BUT APPRECIATE THE
URGENCY AND THE NEED TO MOVE
THESE AS QUICKLY AS POSSIBLE.
OKAY. THANK YOU. SENATOR FOR
THOSE THANK YOU, MR CHAIR. UM. I
GUESS WE'LL JUST START OFF BY
MAKING A COMMENT. CERTAINLY
WELCOME TO RESPOND TO IT IF YOU
WANT TO, BUT, UM I AM TROUBLED.
BY THE RESISTANCE. WHAT I'M
HEARING IS RESISTANCE TO
ENFORCING, UM SM. QUALIFICATIONS
BASICALLY MY UNDERSTANDING OF
THOSE AT A MINIMUM AT A MINIMUM.
AS WELL AS WHAT I AGAIN WHAT I'M
HEARING. I'LL GO BACK TO MY
EARLIER COMMENTS. I MADE IT SORT
OF A PREFERENCE. SUCH A
PREFERENCE OVER THE MEDICAL
DIAGNOSIS, REGARDLESS OF THE
BACKGROUND OF THAT PRACTITIONER.
THAT'S WHAT WE'VE SEEN THAT
EVIDENCE IS OUT THERE. WITHOUT
FOLDING IN. WITHOUT FOLDING IN
OTHER ADDICTION TREATMENT
PRACTICE. STANDARDS IF HE WILL
THAT HAVE BEEN AROUND THAT WE
USE IN OUR SYSTEMS. BOTH IN
COUNTIES AND THE STATE. I TALKED
ABOUT JUSTICE SYSTEMS EARLIER,
THERE JUST SEEMS TO BE A
COMPLETE DISCONNECT BETWEEN WHO
GETS TO QUALIFY THESE CLAIMS
WHEN PEOPLE OR ON THE OUTSIDE
WHO ARE SYSTEM. VERSUS WHO GETS
TO QUALIFY. PEOPLE FOR TREATMENT
AND WHAT'S PRESCRIBED WHEN
THEY'RE INSIDE OUR SYSTEMS, AND
I THINK THAT NEEDS TO BE
RECONCILED. DO YOU WIN? WILL
LITTLE CONFUSED ABOUT THE
REGULATIONS IN TERMS OF WHERE
THE WHERE THEY ARE RIGHT NOW, IN
THE RULEMAKING PROCESS WILL WORK
DRAFT ACTUALLY BE AVAILABLE? YES
LET ME LET ME TAKE THE
REGULATION QUESTION. I WANT TO
GO BACK TO YOUR A STAMP
QUESTION. THE REGULATIONS HAVE
BEEN IN DRAFT FORM AVAILABLE.
WE'VE ACTUALLY BEEN THROUGH
SEVERAL PUBLIC COMMENT PERIODS
IF YOU IF YOU WANT TO SEE HIM
THERE, THERE INCREDIBLY DETAILED
. THEY ARE ON OUR WEBSITE.
HEALTH HELP DOT CA.GOV GO TO
ABOUT US THAT THERE'S
REGULATIONS. I THINK IT'S OPEN
PENDING REGULATIONS. WE HAVE
BEEN THROUGH A SERIES OF PUBLIC
COMMENTS, SO ONCE WE START
REGULATIONS, EVERYTHING HAS TO
BE KIND OF ON THE RECORD. PEOPLE
SENT US A LETTER. MANY OF THE
PEOPLE HERE HAVE SENT US LETTERS
AND THEN WE REVIEW THOSE MAKE
UPDATES TO THE REGULATION. WE GO
OUT FOR ANOTHER COMMENT PERIOD.
I THINK WE JUST MENTIONED WE
CLOSED OUR THIRD COMMENT PERIOD.
WE HAVE A CLOCK WHERE WE NEED TO
GET THIS TO THE OFFICE
ADMINISTRATIVE LAW, SO WE ARE
PROBABLY DONE WITH OUR COMMENT
PERIODS. THOSE WILL GET FILED.
THERE'S A WHOLE CLOCK ASSOCIATED
WITH REGULATIONS. I DO HAVE MY
GENERAL COUNSEL HERE IF YOU WANT
TO DO A DEEP DIVE ON THAT, BUT
THEY'LL BE THEY'LL TAKE EFFECT
IN APRIL. I JUST WANT TO KNOW IF
WE'RE GOING TO HAVE YOUR FINAL
DRAFT BEFORE LEGISLATIVE
DEADLINE FOR INTRODUCING BILLS
TO BE BLUNT ABOUT IT. SO YOU
DON'T WANT TO GET SANDBAGGED ON
THERE SO YOU COULD SEE THE
LATEST VERSION RIGHT NOW. GREAT
WEBSITE. YOU'RE SAYING THERE'S
STILL GOING TO BE ITERATIVE?
WELL NO, PROBABLY NOT. WE'RE OUT
OF TIME. SO THERE'S JUST THIS
PROCESS WHERE WE HAVE GONE
THROUGH THE PUBLIC COMMENT
PERIOD, AND THEN WE NEED TO FILE
THEM WITH THE OPPOSITE
MINISTRATIONS LAW BECAUSE WE
WANT THEM TO TAKE EFFECT.
QUICKLY ALRIGHT, WELL, THEN THAT
WOULD BE VERY HELPFUL FOR US IN
THIS INTERIM RECESS PERIOD. THIS
IS OUR TIME TO TAKE A LOOK AT
WHAT WE THINK NEEDS TO BE DONE.
GOING FORWARD. THAT MAY BE
SOMETHING THAT WOULD BE NOTHING.
I DON'T KNOW. AS SENATOR RUBIO,
YOU KNOW LITTLE TO UNTIL WE SEE.
WHAT YOUR BEST SHOT IS AT THIS
CERTAINLY BE OPEN MINDED ABOUT
WHETHER WE NEED TO DO ANYTHING,
BUT I ALSO WANT TO BE PREPARED.
IF WE NEED TO MOVE FORWARD WITH
SOMETHING SIMILAR OR BEYOND OR
DIFFERENT THAN SB 9 99. UM I AM.
THERE HAS BEEN AN ISSUE BROUGHT
UP BUT YOU KNOW, OVER AND OVER
AGAIN TO ME, UM, MOSTLY BY
PROVIDERS. THAT. THE PATTERNS
THAT ARE OUT THERE IN TERMS OF
DENIALS IN TERMS OF WHO GETS TO
DO PEER TO PEER REVIEW. UM
BEFORE THE INSURERS. UM IS. IS
TROUBLING IN TERMS OF A PATTERN
THAT APPEARS TO BE REWARD. YOU
KNOW FOR HIGH DENIALS. IS THAT
SOMETHING THAT POSE INTO YOUR
JURISDICTION OR IS THAT AT SOME
POINT JUST AN ATTORNEY GENERAL
ISSUE OR PRIVATE ATTORNEY
GENERAL ISSUE IS IF YOU FEEL
LIKE THAT, I WOULD ASSUME THAT'S
FRAUD. AND THAT'S CRIMINAL AT
SOME POINT OR SOMETHING THAT
FALLS AT THE HIGHEST LEVEL OF
CIVIL PENALTIES. AND IN REALLY
AGAIN I'M JUST I CAME TO THIS
HEARING TODAY TO FIGURE OUT WHAT
ACTION I WANT TO TAKE BECAUSE
I'M ABSOLUTELY CONVINCED WE GET
HUNDREDS OF CONSTITUENT
INQUIRIES IN OUR OFFICES,
SOMETIMES THOUSANDS. IT DEPENDS
ON WHAT THE ISSUE IS. YOU COULD
CALL IT ANECDOTAL. BUT AS PEOPLE
WHO GET GET. A DETERMINATION
THAT THEY SHOULD BE IN
TREATMENT. AND THEN GET DENIED
TWO WEEKS LATER. SUSTAINING THAT
TREATMENT AS IF YOU WERE HEALED,
YOU SHOULD BE HEALED. I'M A
DOCTOR. YOU SHOULD BE DONE BY
NOW. AND, UM, THE FREQUENCY
THAT'S HAPPENED, I THINK IS NOT
ONLY CONCERNED ABOUT HOW DO WE
DEAL WITH THAT AND DO WE
INCREASE COSTS IN TERMS OF
INSURANCE PREMIUMS, BUT IT CAN
WITHOUT EVEN REALLY GOING. Tð
INTENTIONAL PATIENT DUMPING OR
ANYTHING LIKE THAT. HOW ABOUT
THE COSTS AND OUR COMMERCIAL
SYSTEMS? HOW ABOUT THE COSTS
THAT WE JUST PUT $20 BILLION IN
SINCE 2019 INTO HOMELESSNESS?
OUR DATE IN SANTA CLARA COUNTY,
SAYS ABOUT 38% OF THOSE FOLKS.
OR DUAL DIAGNOSIS OUT IN THE
STREET OUT ON THE STREET.
UNSHELTERED COMPLETELY
UNSHELTERED. AND. IN IN, YOU
KNOW, SOME OF THOSE FOLKS WERE
PRIVATE COVERED. BEFORE THEY
ENDED UP OUT IN THE STREET.
WE'RE HEARING THAT TESTIMONY. WE
ALL KNOW THAT. SO I AM JUST
TRYING TO GET TO A POINT HERE OF
WHAT ACTIONS DO WE TAKE IN WHAT
IS AN EXTRAORDINARILY URGENT
SITUATION OF HUMANITARIAN
CRISIS. UM QUICKLY. AND THAT'S
THAT'S THE REASON I'M ASKING
THESE QUESTIONS. NO. AND I
APPRECIATE YOUR QUESTIONS. I
THINK THAT THE EXAMPLES YOU GAVE
OF THE DENIALS AND THE EARLY
DISCHARGE. ARE THERE EXAMPLES OF
A LOT OF THE CASES THAT COME
INTO OUR HELP CENTER OUR HELP
CENTER, PARTICULARLY WHEN THOSE
ARE THE TYPES OF CASES THAT DO
GO DOWN THE IMAR ROUTE. WE HAVE
ABOUT A 60.8% AVERAGE OVERTURN
RATE THAT OVERTURNS THE PLANS
DECISION. JUST TO BE CLEAR.
AGAIN 96% OF STATE REGULATED
GOVERNMENT AND COMMERCIAL
ENROLLMENT IS UNDER MY
JURISDICTION OR THE GMHC. SO IT
IS VERY LIKELY THAT MANY OF
THESE CASES DO FALL UNDER OUR
JURISDICTION. THIS THE POLICIES
AND PROCEDURES FOR HELP PLANS
MAKE WHAT WE CALL UTILIZATION
MANAGEMENT DECISIONS ABOUT WHAT
YOU GET. WHAT YOU DON'T GET IS
PART OF WHAT? WE'RE REVIEWING
ACROSS ALL OF THESE THINGS THAT
I TALKED ABOUT, UM, SO AGAIN. I
MEAN, WE WOULD BE HAPPY TO WORK
WITH YOU. IF YOU HAVE SPECIFIC
EXAMPLES. I KNOW THE ONES THAT
WERE CITED HERE. WE HAVE MET
WITH MANY OF THE FOLKS THAT WERE
IN THE ROOM AND GAVE TESTIMONY
TODAY. SO THESE ARE EXAMPLES OF
THINGS THAT WE ARE CURRENTLY
LOOKING AT. UM SP 8 55
SIGNIFICANTLY STRENGTHEN THOSE
PROTECTIONS BY REQUIRING THE USE
OF THE NONPROFIT CRITERIA AGAIN.
THE PERSON REVIEWING DOESN'T
HAVE TO HAVE A CERTIFICATION
FROM EACH OF THESE NONPROFIT
CRITERIA ORGANIZATIONS, BUT THEY
DO HAVE TO GO THROUGH TRAINING
ON HOW TO USE THEM. THEY HAVE TO
USE THE GUIDELINES. THIS IS A
BIG CHANGE FROM WHERE WE USED TO
BE WHERE UTILIZATION MANAGEMENT
DECISIONS WERE MADE, ESSENTIALLY
IN A BLACK BOX. NOBODY KNEW HOW
THEY WERE BEING MADE, SO THERE'S
TRANSPARENCY THAT'S BROUGHT
THROUGH THIS PROCESS. SO AGAIN.
I THINK WE'VE MADE SOME BIGGER
PRUDE IMPROVEMENTS. YOU SAW THE
BIG ENFORCEMENT ACTION WE TOOK
LAST WEEK AND PART OF WHAT WE
SAW WAS SOME VIOLATIONS OF THESE
PROTECTIONS. SO UM, YOU KNOW, WE
WILL CONTINUE TO LOOK INTO THIS.
IF YOU HAVEN'T WORKED WITH OUR
OFFICE. PLEASE ON THE SPECIFIC
CASES WILL WORK WITH YOU TO GET
THOSE TWO ARE HELPS THAT WE WANT
TO BE ABLE TO HELP THOSE
INDIVIDUAL CONSUMERS WHILE WE
WORK ON THE BIGGER, BIGGER
POLICY ISSUES. ALRIGHT. UM THANK
YOU FOR RESPONDING AGAIN. I
THINK FOR ME THE. THE PROOF WILL
BE IN THE PUDDING. I MEAN, THE
IDEA THAT THE DRAFT THAT YOU SEE
IS ESSENTIALLY FINAL. UM IT'S
EITHER GOING TO GET US THERE OR
NOT, AND I THINK WE NEED TO BE
THE JUDGE OF THAT AS LEGISLATORS
AS TO WHETHER OR NOT WE NEED TO.
TO GO BEYOND OR AUGMENT OR USE
OTHER TOOLS THAT WE HAVE,
INCLUDING AUDIT TOOLS AS A
MEMBER OF THE JOINT LEGISLATIVE
AUDIT COMMITTEE OCCURS TO ME
THAT THIS ISSUE HAS BEEN BROUGHT
UP BY OUR COUNTY ASSOCIATIONS IS
PROBABLY SOMETHING THAT SHOULD
BE DRILLED INTO DRILL DOWN ON BY
AN EXTENSIVE AUDIT TO FIGURE OUT
WHAT THE COST. OH THESE DENIALS
IS. TO OUR GOVERNMENT SYSTEMS. I
THINK IT WOULD PROBABLY TAKE
FIVE OR 6000 HOURS OF AUDIT TO
COME TO A CONCLUSION ON THAT.
BUT WE HAVE IT SOUNDS LIKE WE
ALSO HAVE THAT INFORMATION IN
THE 58 COUNTIES. AVAILABLE TO US
I KNOW WHEN WE DID A BASIC COST
STUDY OF WHAT IT WAS COSTING US
IN SANTA KIRK COUNTY. UM JUST A
LITTLE MORE RECENT THAN THE
REVIEW THAT YOU DID. THE COST.
WHO OF HAVING PEOPLE UNTREATED.
UM IT WAS ABOUT $85,000 PER
PERSON TO THE COUNTY. I DON'T
KNOW WHAT THAT IS IN TODAY'S
DOLLARS AND I DON'T KNOW. WHAT
THE WHAT? THE ANALYTICS WILK
LIGHT THAT WAS SOME YEARS AGO.
UM BUT AGAIN, IT STRIKES ME THAT
THAT'S THE DIRECTION ONE
DIRECTION THAT WE MIGHT WANT TO
GO SO THAT WE'RE NOT SITTING
HERE SAYING, WELL, YOU KNOW, I
DON'T KNOW IF WHAT WE'RE HEARING
IS TRUE. I DON'T KNOW HOW MUCH
COST SHIFTING THERE IS. I DON'T
KNOW WHAT THE REASONS ARE THAT
PEOPLE ARE SEEKING. COUNTY
ASSISTANCE VERSUS THEIR PRIVATE
INSURANCE. THERE'S TOO MANY IDLE
KNOWS THERE FOR ME, UM IN. YOU
KNOW AGAIN, WE POTENTIALLY HAVE
OTHER AVENUES TO GO INVESTIGATE
AND FIND OUT WHAT THOSE ANSWERS
REALLY ARE. UM BUT AGAIN, I
APPRECIATE OBVIOUSLY THE VERY
IMPORTANT HEARING TODAY AND
APPRECIATE YOUR TESTIMONY. TRUE
RUBIO. THANK YOU. WELL, FIRST OF
ALL, I THINK BOTH OF THESE
GENTLEMEN HERE TACKLE SOME OF
THE QUESTIONS I HAD, SO I'M GLAD
TO KNOW THAT THE BEHAVIORAL
HEALTH INVESTIGATION REPORTS ARE
PUBLIC. BUT WHAT I'M HEARING IS
YOU'RE SOMEWHAT TRYING TO
PROTECT, I SUPPOSE REALLY
IMPORTANT INFORMATION. SO YOU'RE
TRYING TO SUMMARIZE VERSUS PUT
OUT THE ENTIRE INVESTIGATION
THAT YOU DO, WHICH I CAN
APPRECIATE, BUT THEY'RE OUT. ON
YOUR WEBSITE AND WE CAN LOOK TO
SEE OR REQUESTED THROUGH PUBLIC
RECORDS REQUESTS OUT OF WHAT I'M
HEARING JUST TO BE CLEAR, SO OUR
BEHAVIOR HALT INVESTIGATIONS. WE
RELEASED THE REPORT YESTERDAY,
SO IT'S POSTED ON OUR WEBSITE.
AND IT'S NOT. THERE'S A SUMMARY
REPORT THAT SUMMARIZES ALL OF
OUR FINDINGS. IF YOU REALLY WANT
TO DIG INTO IT. THERE'S AN
INDIVIDUAL REPORT FOR EACH OF
THE FIVE PLANS THAT SUMMARIZES
OUR REVIEW AND THE VIOLATIONS WE
FOUND AS WELL AS THE BARRIERS.
WHAT THE PIECE THAT THAT YOU CAN
REQUEST THROUGH PUBLIC RECORDS
ACT REQUEST IS OUR NON
QUANTITATIVE TREATMENT LIMIT
REVIEW, WHICH IS RELATED TO
FEDERAL MENTAL HEALTH PARITY
AGAIN. I THINK THIS IS HOW DO
YOU SHOW THE ANALYTICAL WORK
THAT AN ATTORNEY IS DOING TO GO
THROUGH THESE MASSIVE DOCUMENTS?
I THINK WHAT YOU WILL BE
INTERESTED IN. WHAT DID WE
CONCLUDE? WHAT DID THEY FIX? AND
SO THAT'S THE PIECE. I THINK
WE'LL THINK ABOUT HOW WE CAN
SUMMARIZE OUR FINDINGS, BUT KIND
OF THE IF YOU WANT TO SEE WHAT
THE PLANS FILED WITH US, YOU
COULD REQUEST THAT. THANK YOU. I
HEARD YOU SAY EARLIER TODAY THAT
YOU DO ROUTINE MEDICAL SERVICE,
AND THAT'S HOW YOU GATHER YOUR
DATA. BUT I ALSO HEARD YOU SAY
SOMETHING VERY SPECIFIC. YOU
SAID BY WAY, OF EXAMPLE, THAT
PROVIDERS ARE TELLING PEOPLE NOT
TO SPEAK TO YOU. SO IN CHINA
DETERMINE LIKE, HOW DO YOU GET
THAT SPECIFIC? SO DO YOU CONDUCT
THESE VERBALLY SURVEYS? LEADING
QUESTIONS. WHAT DOES THAT LOOK
LIKE TO GET THAT SPECIFIC ANSWER
? YEAH I'M GONNA I'M GONNA
SEPARATE THOSE A LITTLE BIT. SO
OUR ROUTINE SURVEY WE DO EVERY
THREE YEARS OF ALL OF OUR PLANS.
AND SO WHAT WE DO IS WE HAVE
WHAT I'M GOING TO GET. SORRY A
LITTLE TECHNICAL. WE HAVE WHAT'S
CALLED A TECHNICAL ASSISTANCE
GUIDE OR A TAG THAT IT'S POSTED
OUR WEBSITE. WE'RE TRANSPARENT
ABOUT THIS. THAT WALKS THROUGH
ALL THE THINGS WE LOOK OUT WHEN
WE GO OUT AND DO AN AUDIT OF THE
PLANS, SO AS WE HAVE NEW LAWS
THAT ARE PASSED PLANS
DEMONSTRATE THEIR COMPLIANT WITH
ALL THE FILE A LOT OF PAPER WITH
US. THE ROUTINE SURVEYS ARE
INTENDED TO GO OUT AND SAY OKAY,
YOU TOLD US YOU'RE DOING ALL OF
THIS. BUT HOW IS THAT REALLY
WORKING IN PRACTICE? GIVE US
DATA. WE DO INTERVIEWS. THAT'S
OUR ROUTINE SURVEY PROCESS. THE
PROVIDERS TELLING ENROLLEES NOT
TO TALK TO US THAT COMES THROUGH
OUR HELP CENTER. SO WE GET A
COMPLAINT FROM A ROLY SAYING I'M
NOT GETTING A SERVICE OR MY
PROVIDER IS TRYING TO BALANCE
BUILD ME AND WE WILL ASK
QUESTIONS, THEY'LL EMAIL AS I
GET THESE EMAILS. THEY'LL CALL
US AND THAT'S WHERE THEY WILL
TELL US. I WAS TOLD NOT TO TALK
TO YOU. SO THOSE ARE DIFFERENT
ISSUES WE LOOK AT, UM, BOTH WHEN
WE MEET WITH STAKEHOLDERS WHEN
WE GET HELP CENTER COMPLAINTS.
WE LOOK AT THAT TO GIVE YOU AN
EXAMPLE THE KAISER ENFORCEMENT
ACTION WE TOOK LAST WEEK. PART
OF THAT WAS RELATED TO A NON
ROUTINE SURVEY THAT WAS STARTED
BECAUSE WE SAW AN UPTICK IN
COMPLAINTS TO OUR HELP CENTER
FOR KAISER ENROLLEES. AND WE
SAID SOMETHING'S GOING ON THERE,
SO WE OPENED AS SPECIFIC NON
ROUTINE SURVEY RELATED TO TIMELY
ACCESS TO BEHAVIORAL SERVICES.
NOTES IT'S I HOPE I ANSWERED
YOUR QUESTION. NO IT HELPED
TREMENDOUSLY. THANK YOU. BUT I
GUESS ULTIMATELY, YOU KNOW, AND
JUST LIKE MY COLLEAGUES HERE,
YOU KNOW, TODAY I SHOWED UP JUST
LIKE SENATOR CORTEZ WAS, YOU
KNOW DISCUSSING THAT
BALLISTICALLY FOR ME IS TRYING
TO SEE IT. WHAT CAN WE DO ON OUR
END? BECAUSE WE NEED TO SEE WHAT
ARE THE ACTIONS NEEDED TO NOT
ONLY STRENGTHEN THE PROCESS IS
CLEARLY THERE IS DEFICIENCIES
THROUGHOUT THE PROCESS, BUT ALSO
HOW DO WE IMPROVE OUTCOMES, AND
IT'S TRYING TO FIGURE OUT WHAT I
CAN DO ON THE LEGISLATIVE SIDE.
WHAT IS OUR RESPONSIBILITY AS I
MENTIONED
EARLIER? A LOT OF
TIMES WE CAN COMPLAIN A LOT
ABOUT WHAT PEOPLE ARE DOING
OUTSIDE. BUT IS THERE A ROLE
THAT WE HAVE TO PLAY TO MAKE
SURE THAT WE'RE DOING OUR PART
TO SUPPORT THE DEPARTMENT AND
JUST, YOU KNOW, UM, WHAT IS
NEEDED, SO I WILL CONTINUE TO
REACH OUT AND LET US KNOW IF
THERE'S ANYTHING MORE THAT
HASN'T BEEN DISCUSSED HERE THAT
WE CAN DO TO STRENGTHEN WHAT YOU
DO. IN FACT, I WORKED WITH YOUR
DEPARTMENT LAST YEAR EARLIER
THIS YEAR ACTUALLY HAD A WEEK.
YOU KNOW, PROVIDE THAT SUPPORT
TO ENSURE THAT AT LEAST WE'RE
DOING WHAT WE CAN SO THAT YOU
CAN DO IT. YOU CAN. SO THANK YOU
FOR THE WORK. APPRECIATE IT.
THANK YOU, MR CHAIR. THANK YOU.
THANK YOU. THANK YOU TO BOTH OF
YOU FOR TAKING THE TIME THAT
AFTER YOUR WORK, APPRECIATE IT.
UM OKAY, SO, UM. THOSE ARE ALL
OF OUR PANELS WILL NOW PROCEED
TO PUBLIC SUPPORT. I'M SORRY. MY
APOLOGIES. UM WE HAVE ONE FINAL
PANEL OF ONE PERSON FOR THE
HEALTH PLANS AND MY APOLOGIES,
AND THAT WILL BE JUDD HAMPTON
FROM THE WHO'S THE DIRECTOR OF
LEGISLATIVE AFFAIRS WITH THE
CALIFORNIA ASSOCIATION OF HEALTH
PLANS. UM WE INVITED THE VARIOUS
PLANS AND MR HAMPTON WAS
REPRESENTING THE PLANS. SO
WELCOME AND THANK YOU FOR COMING
TODAY.
THANK YOU, MR CHAIR. MEMBERS OF
THE COMMITTEE. THANK YOU FOR NOT
FORGETTING ME. I APPRECIATE THE
OPPORTUNITY TO SPEAK HERE TODAY
AGAIN. MY NAME IS JERRY HAMPTON.
I AM THE DIRECTOR OF LEGISLATIVE
AFFAIRS FOR THE CALIFORNIA
ASSOCIATION HEALTH PLANS. WE
APPRECIATE THE OPPORTUNITY TODAY
TO DISCUSS OUR ROLE IN
DELIVERING HIGH QUALITY,
AFFORDABLE HEALTH CARE COVERAGE
FOR OUR ENROLLEES, WHICH
INCLUDES COVERAGE FOR MENTAL
HEALTH AND SUBSTANCE USE
DISORDER TREATMENT. CAPSULE
MEMBERSHIP INCLUDES 44 PUBLIC
AND PRIVATE HEALTHCARE SERVICE
PLANS THAT PROVIDE HEALTH CARE
COVERAGE TO NEARLY 28 MILLION
CALIFORNIANS. I JUST WANT TO
START BY BY BEING ABSOLUTELY
CLEAR THAT CALIFORNIA'S HEALTH
PLANS ABSOLUTELY UNDERSTAND THAT
MENTAL HEALTH IS AN ESSENTIAL
PART OF ONE'S OVERALL HEALTH AND
WELL BEING, AND WE SUPPORT
ESTABLISHED STATE AND FEDERAL
LAWS REQUIRING PARODY BETWEEN
COVERAGE FOR MENTAL HEALTH AND
PHYSICAL HEALTH. HEALTH PLANS
HAVE BEEN WORKING
COLLABORATIVELY WITH STATE
NATIONAL LEADERS TO ENSURE
COMPLIANCE WITH EXISTING MENTAL
HEALTH PARITY LAWS. AND TO
ENSURE PATIENTS RECEIVE THE
MENTAL HEALTH SERVICES THEY NEED
THAT ARE ON PAR WITH MEDICAL AND
SURGICAL CARE. AS YOU KNOW THE
DEMAND FOR BEHAVIORAL HEALTH
SERVICES AND SUBSTANCE USED FOR
TREATMENT HAVE HAS BEEN STEADILY
INCREASING AND THE MAIN REALLY
HAS PEAKED QUITE EXPONENTIALLY
SINCE THE COVID 19 PANDEMIC.
DESPITE MANY SYSTEMIC CHALLENGES
THAT EXIST WITHIN THE BEHAVIOR
HEALTH DELIVERY SYSTEM.
INCLUDING A PERSISTENT
BEHAVIORAL HEALTH PROVIDERS
SHORTAGE ANOTHER WORKFORCE
RELATED ISSUES. HEALTH PLANS
HAVE TAKEN A NUMBER OF POSITIVE
STEPS TO STRENGTHEN CALIFORNIA'S
MENTAL HEALTH CARE SYSTEM AND
ITS WORKFORCE TO MEET THE
CALIFORNIA'S EXISTING AND FUTURE
BEHAVIORAL HEALTHCARE DEMAND.
ADDRESSING THE CURRENT WORKFORCE
CHALLENGES WILL BE CRITICAL AS
I'M SURE MANY OF YOU ON THE
COMMITTEE NOW IN 2019, THE
CALIFORNIA FUTURE HEALTH
WORKFORCE COMMISSION HAS STATED
BY THAT BY 2028, WHICH IS ONLY
FOUR YEARS AWAY. 4.5 YEARS AWAY
HERE NOW. THAT CALIFORNIA WILL
HAVE 28% FEWER PSYCHOLOGISTS,
MARRIAGE AND FAMILY THERAPIST,
LICENSED COUNSELORS AND SOCIAL
WORKERS AND 50% FEWER
PSYCHIATRISTS. HEALTH PLANS
RECOGNIZED THE IMPACT THAT THE
EXISTING WORKFORCE CHALLENGES
HAVE ON ACCESS TO BEHAVIORAL
HEALTHCARE AND HAVE UNDERTAKEN A
CONCERTED EFFORT TO INCREASE THE
LEVEL OF PROVIDERS WITHIN OUR
BEHAVIORAL HEALTH CARE SYSTEM.
FOR EXAMPLE, HEALTH PLANS ARE
MAKING SUBSTANTIAL INVESTMENTS
TO BUILD BROADER NETWORKS OF
BEHAVIORAL HEALTH PROVIDERS THAT
WILL BOOST THE PIPELINE OF
ETHNICALLY AND GEOGRAPHICALLY
DIVERSE CLINICIANS REQUIRED TO
MEET THE INCREASING DEMAND FOR
CARE. AND CONNECT MEMBERS WITH
WITH THE RIGHT SUPPORT WHEN THEY
NEED IT. HEALTH PLANS ARE ALSO
INVESTING IN THEIR OWN IN HOUSE
MENTAL HEALTH, CLINICIANS,
RECRUITMENT EFFORTS, EDUCATION
AND TRAINING PROGRAMS TO MEET
THIS GROWING DEMAND. MANY
HEALTHLAND'S ARE ALSO OFFERING
SCHOLARSHIPS AND LOAN
FORGIVENESS PROGRAMS TO PROMOTE
INCENTIVIZED QUALIFIED
CANDIDATES TO CHOOSE MENTAL
HEALTH CARE AS A CAREER MOVING
FORWARD. IN ADDITION TO SOME OF
THE WORK THAT HEALTH PLANS ARE
DOING TO ADDRESS THE BEHAVIORAL
HEALTH WORKFORCE SHORTAGE FANS
ARE WORKING CLOSELY WITH
PROVIDERS TO HELP MEMBERS
RECEIVE MENTAL HEALTH CARE AT
MANY DIFFERENT TOUCH POINTS
BEYOND THE TYPICAL OFFICE
SETTING, INCLUDING BY EMBEDDING
MENTAL HEALTH PROVIDERS AND
EMERGENCY ROOM DEPARTMENT AND
PRIMARY CARE CLINICS AND
OFFICES. HEALTH AND ARE ALSO
PROVIDING ONLINE WELLNESS AND
COACHING PROGRAMS AND FREE
ACCESS TO TRUSTED MENTAL HEALTH
APPS ENGAGING IN INVESTING IN
ANTI STIGMA, EDUCATIONAL
CAMPAIGNS TO INCREASE AWARENESS
ENCOURAGE CALIFORNIANS TO SEEK
MENTAL HEALTHCARE AND SUPPORT
WHEN THEY NEED IT, AND WE
UNDERSTAND THAT THESE ADDITIONAL
BENEFITS ARE NOT INTENDED TO
REPLACE TREATMENT IN ANY WAY.
BUT EVIDENCE DOES SHOW THAT
THESE TYPES OF ADDITIONAL
BENEFITS CAN PROVIDE SIGNIFICANT
RELIEF TO THOSE, ESPECIALLY WITH
MILD TO MODERATE ANXIETY OR
DEPRESSION. AS MENTIONED
PREVIOUSLY, HEALTH PLANS ARE
CONTINUING TO FOCUS ON
COMPLIANCE WITH EXISTING MENTAL
HEALTH PARITY LAWS, INCLUDING
WORKING IN GOOD FAITH, THE
DEPARTMENT OF MANAGED HEALTH
CARE AND THE CALIFORNIA
DEPARTMENT OF INSURANCE ON THE
IMPLEMENTATION OF SB 855. WHILE
IT IS NOT YET CLEAR TO DETERMINE
THE FULL IMPACT OF THE LAW,
SINCE THE REGULATIONS HAVE YET
TO BE FINALIZED, HEALTH PLANS
HAVE COME ACROSS SOME SOME
CHALLENGES AND HURDLES WITH
RESPECT TO IMPLEMENTATION. SOME
OF THOSE CHALLENGES REALLY
CENTER AROUND THE USE OF THE
SPECIFIED NOT FOR PROFIT
ASSOCIATION GUIDELINES THAT HAVE
BEEN MENTIONED EARLIER TODAY.
PRIOR TO THE PASSAGE OF SB 855
HEALTH PLANS REALLY UTILIZED
WELL ESTABLISHED CRITERIA LIKE
ASSAM AND THEIR UTILIZATION
REVIEW PROCESSES TO DETERMINE
THE MEDICALLY NECESSARY LEVELS
OF CARE FOR TREATMENT. THE
REQUIREMENTS OUTLINED IN SB 55
TO USE VARIOUS NONPROFIT
ASSOCIATION GUIDELINES IN THE
UTILIZATION REVIEW PROCESS.
DETERMINED MEDICALLY NECESSARY
LEVELS OF CARE. HAS REGRETTABLY
CREATED A SITUATION WHEREBY
HEALTH HANDS HAVE BEEN SUBJECTED
TO SOMETIMES UNEVEN AND
OFTENTIMES CONTRADICTORY
GUIDELINES. SOME OF THESE
GUIDELINES, INCLUDING VERY
EXPLICIT OBJECTIVE PARAMETERS
REGARDING THE FREQUENCY OF
SERVICES, THE INTENSITY OF
TREATMENT AND SO FORTH. OTHER
GUIDELINES DO NOT IT DOES CREATE
SORT OF THIS IMBALANCE OR THE
THIS IN CONGRUENCE C OF WHICH
GUIDELINES SHOULD BE APPLIED.
YOU KNOW, AT WHAT PARTICULAR
TIME? GIVEN THE CONFUSION AROUND
WHICH GUIDELINES SHOULD BE USED
AND HOW TO ADDRESS NEWLY
EMERGING GUIDELINES MIDSTREAM
HAS CREATED SOME OF THESE
CHALLENGES WITH RESPECT TO
COMPLIANCE, WHICH WHICH WE
ACKNOWLEDGE. CAT BELIEVES THAT
THE FINAL REGULATIONS SHOULD
STRIVE TO PROVIDE CLARITY FOR
EVERYONE WHO IS COVERING AND
PROVIDING AND RECEIVING THESE
IMPORTANT SERVICES. ADDITIONALLY
HEALTH PLANS HAVE FACED SOME
CHALLENGES WITH RESPECT TO THE
ADDED NETWORK REQUIREMENTS
OUTLINED IN SP 85555 THAT HEALTH
PLANS COVER AND PAY FOR OUT OF
NETWORK CARE IF THE SERVICE IS
NOT AVAILABLE IN NETWORK, AND
WHILE WE CERTAINLY UNDERSTAND
THE BENEFITS OF THAT REQUIREMENT
GLOBALLY, IT CERTAINLY HAS
CREATED SOME UNINTENDED
UNINTENDED CONSEQUENCES. EXCUSE
ME, AND WE HAVE STARTED TO SEE
THEM BEAR OUT. HEALTH PLANS HAVE
SEEN SEVERAL INSTANCES OF
QUESTIONABLE AND SOMETIMES
DOWNRIGHT FRAUDULENT PRACTICES
FROM CERTAIN OUT OF NETWORK
PROVIDERS WHEREBY SUMMER
CHARGING EXORBITANTLY HIGH RATES
FOR OUT OF NETWORK CARE, WHICH
ONLY INCREASES COSTS TO THE
HEALTH CARE SYSTEM AS A WHOLE.
UM I BELIEVE THAT DEPARTMENT
MANAGED HEALTHCARE AND THEIR
TESTIMONY HAD MENTIONED ONE
EXAMPLE OF THIS REGRETTABLE
TREND, BUT THIS IS SOMETHING
THAT WE ARE STARTING TO SEE WITH
MORE FREQUENCY. UM RIGHT NOW. IT
IS IMPORTANT TO NOTE THAT THAT
THE VALUE OF IN NETWORK
PROVIDERS I'M GOING TO HEALTH
AND BRINGS PROVIDERS IN NETWORK
GIVES THE PLANS THE OPPORTUNITY
TO VET PROVIDERS THOROUGHLY AND
ENSURE THAT THEY'RE MEETING
HEALTH PLAN QUALITY STANDARDS
AND OTHER STANDARDS AND
REGULATIONS ESTABLISHED BY OUR
REGULATORS. WHILE HEALTHLAND'S
ARE COMPLYING WITH THE
PROVISIONS. WE ARE ULTIMATELY
CONCERNED ABOUT THE HEALTH CARE
COST COMPONENT SHOULD ADAM
NETWORK PROVIDERS CONTINUED THIS
REGRETTABLE PRACTICE? WHAT
CHALLENGES REMAIN. HEALTH PLANS
ARE COMMITTED TO ENSURING THAT
WE MEET OUR RESPONSIBILITY TO
DELIVER HIGH QUALITY AND
AFFORDABLE CARE TO OUR
ENROLLEES. WE UNDERSTAND AS AN
INDUSTRY THAT THERE'S MORE THAT
WE MUST DO TO INCREASE THE
TREATMENT NEEDS OF THOSE
SUFFERING FROM ADDICTION AND
MENTAL ILLNESS. AND WE'LL
CONTINUE TO INVEST THE MENTAL
AND WILL CONTINUE TO INVEST IN
THE MENTAL HEALTH OF ALL
CALIFORNIANS BY WORKING
COLLABORATIVELY WITH THE SPIRIT
OF SHARED RESPONSIBILITY, HEALTH
PLANS, PROVIDERS, STATE LEADERS
AND ADVOCATES CAN EFFECTIVELY
ADDRESS THE MENTAL HEALTH
CHALLENGES IN CALIFORNIA SAVE
LIVES AND IMPROVE THE MENTAL AND
PHYSICAL WELL BEING OF ALL
CALIFORNIANS. THANK YOU VERY
MUCH AGAIN FOR THE OPPORTUNITY
TO TESTIFY TODAY AND I AM HAPPY
TO ANSWER ANY QUESTIONS. THANK
YOU. SO UM, DO YOU, UM. IN TERMS
OF JUST PLAN COMPLIANCE OVERALL,
WITH SPH WORTH, I SHOULD SAY
WITH STATE AND FEDERAL PARITY
LAWS, LIKE JUST GENERALLY, HOW
DO YOU THINK THAT'S GOING? YOU
KNOW, I THINK AS I MENTIONED IN
MY TESTIMONY, THERE ARE SOME
CHALLENGES. I THINK IT WOULD BE
DISINGENUOUS FOR US TO NOT
ACKNOWLEDGE THAT THERE ARE SOME
CHALLENGES WITH SOME OF THE
CLINICAL GUIDELINES AND
UNDERSTANDING HOW THOSE WORK
TOGETHER TO CREATE A SYSTEM
WHERE WE'RE ALL OPERATING ON THE
SAME PAGE. I THINK YOU KNOW THE
HEALTH PLANS ARE CERTAINLY
COMMITTED TO THAT CHALLENGE. YOU
KNOW, WE ARE HEAVILY INVESTED IN
I MEAN, ARE ARE ARE, UM, THE
AMOUNT OF MONEY THAT WE SPENT IN
BEHAVIORAL HEALTH SERVICES JUST
IN THE LAST SEVERAL YEARS HAS
NEARLY DOUBLED. SO WE THERE'S A
STRONG COMMITMENT TO CONTINUE TO
INVEST IN THAT A STRONG AND
INVESTMENT INTO BEING IN
COMPLIANCE WITH BOTH FEDERAL AND
STATE PARITY LAWS. OBVIOUSLY,
THERE ARE QUITE A FEW, UM
CARROTS AND STICKS. IF YOU WILL
TO ENSURE THAT WE ARE IN
COMPLIANCE, AND WE TAKE THAT
RESPONSIBILITY VERY SERIOUSLY.
SO AGAIN, I THINK WE ARE. WE ARE
WORKING OUR HARDEST TO BEING
POOR COMPLIANCE WITH BOTH
FEDERAL AND STATE PARITY LAWS.
WE UNDERSTAND THAT THERE'S STILL
SOME CHALLENGES OUT THERE AND
WORKING TO ADDRESS THOSE SENATOR
COURTESY. THE QUESTION. JUST
WONDERING IN YOUR COMMENT ABOUT.
CASES OF FRAUD THAT YOU'VE SEEN
ON THE PROVIDER SIDE. UM. WHAT
PERCENTAGE OF CLAIMS ARE DENIED
FOR THAT REASON. YOU KNOW, I
DON'T HAVE A SPECIFIC NUMBER OR
PERCENTAGE OF CLAIMS THAT ARE
DENIED. IF THEY'RE SUSPECTED
FRAUD. I HAVE HEARD ANECDOTALLY
FROM MY MEMBER PLANS THAT
OFTENTIMES WHEN WE SEE A CASE
WHERE YOU KNOW CERTAIN SERVICE,
OR PARTICULARLY PRESCRIPTION
DRUG THERE'S RATHER OBVIOUSLY,
UM. INFLATED YOU KNOW, WELL
ABOVE MARKET MARKET VALUE AGAIN,
345 TIMES HIGHER THAN WHAT WOULD
NORMALLY BE IN PAIN. THAT THE
PLAN MAY INITIALLY DENY. NOT
ALWAYS, UM, YOU KNOW, I HAVE AN
EXAMPLE OF ONE PLAN WHO HAD
PROVIDED THAT THEY SUSPECT THAT
THERE IS A FRAUDULENT, UM FUDGE.
I SHOULD SAY A BAD ACTOR. LET ME
LET ME REPHRASE THAT. THERE'S A
BAD ACTOR, YOU KNOW, OUT OF
NETWORK PROVIDER IN THE SYSTEM,
WHO HAS REQUESTED CERTAIN
SERVICES AND DRUGS FOR ONE
PARTICULAR MEMBER THAT HAS AT
THIS POINT COST, YOU KNOW,
ALMOST $1.2 MILLION AND IN
SERVICES, UM THEY REFUSED TO
COME IN NETWORK WHERE THAT
SERVICE COULD COULD BE PROVIDED.
UM AND SO THERE'S THAT'S ONE
PARTICULAR EXAMPLE OF A
CHALLENGE, BUT AGAIN TO YOUR
POINT CENTER. I DON'T THINK AT
THIS JUNCTURE I CAN TELL YOU
THIS IS THE PERCENTAGE OF CLAIMS
THAT COME IN THAT WE THINK ARE
FRAUD THAT WE ARE DENYING. UM
YOU KNOW, THOSE ARE TYPICALLY
HANDLED ON A CASE BY CASE BASIS.
SOME ARE VERY AUDIENCE AND
EGREGIOUS. SOME MAY NOT BE, UM
AND I DO WANT TO HIGHLIGHT THIS
IN MY TESTIMONY AGAIN. WE ARE
SEEING THIS AS AN EMERGING
TREND. I CERTAINLY DON'T WANT TO
CAST A WIDE NET AND SAY IT NEEDS
TO SORT OF OUT OF NETWORK CARE
IS FRAUDULENT. OBVIOUSLY, WE DO
NOT BELIEVE THAT'S THE CASE. BUT
WE JUST STARTED TO SEE THAT THAT
IS BECOMING, YOU KNOW, MORE
COMMONPLACE, AS YOU KNOW, THE
REGULATIONS GET CLOSER TO BEING
FINALIZED THAT THAT'S SOMETHING
THAT WE STARTED TO SEE. WHICH
MEMBERS BE WANT TO SHARE THAT
INFORMATION WITH THE COMMITTEE.
I CAN CERTAINLY FOLLOW UP WITH
YOU AND TALK WITH THEM AND SEE
IF THEY WOULD BE ABLE TO THERE
IS SOMETIMES PROPRIETARY
INFORMATION THAT THEY WOULD
PROBABLY HAVE TO PARSE THROUGH.
BUT I CAN CIRCLE BACK THEM AND
SEE IF WE CAN AT LEAST GET YOU
SOMETHING TO LOOK AT AN EXAMINED
TO GIVE YOU A BETTER PICTURE OF
WHAT IS POTENTIALLY GOING ON. BE
INTERESTING TO KNOW. UM WHETHER
YOU KNOW ALL THIS DISCUSSION
WE'VE BEEN DOING AROUND THE
PROCESS. UM. AND I DON'T THINK
ANYBODY ARGUES WITH THE IDEA OF
UTILIZATION REVIEW. WE HAVE TO
HAVE UTILIZATION REVIEW IN THE
IN THE SYSTEM. BUT WHETHER THE
QUALITY OF THE UTILIZATION
REVIEW AND THE GUIDELINES AND
THE STANDARDS UM THE
QUALIFICATIONS OF THE
INDIVIDUALS DOING IT OR
APPROPRIATE AND THEN YOU KIND OF
JUST THREW A LITTLE BOMBSHELL
OUT THERE AND SAYING WELL, THEIR
DENIALS ARE HAPPENING BECAUSE OF
FRAUD, WHICH IS TO ME A WHOLE
OTHER ISSUES, SO I WANT TO KNOW
WHAT PERCENTAGE OF YOUR MEMBERS
THE PERCENTAGE OF DENIALS THAT
YOUR MEMBERS ARE ACTUALLY
ATTRIBUTING TO FRAUD BECAUSE
MAYBE WE'RE CHASING THE WRONG
PROBLEM HERE. I DON'T THINK WE
ARE. I SUSPECT THAT'S A FRACTION
THAT BEST OF THE DENIALS BASED
ON WHAT I'VE SEEN, BUT I THINK
YOU'VE GOT TO PUT YOUR YOUR
ANALYTICS WHERE YOUR MOUTH IS ON
THIS IF YOU IF YOU SIT HERE IN
FRONT OF THE SENATE COMMITTEE
AND SAY FRAUDS, THE PROBLEM THAT
ENSURES THE NUMBERS ON THAT YET,
SO I DON'T THINK THAT'S THE CASE
IT HAD DON'T EVEN KNOW THAT IT
WAS APPROPRIATE TO BRING IT UP,
BUT MAYBE IT WAS, BUT IF IT IS
SHOW US SHOW US THE NUMBERS IN.
AND SO, SENATOR. THANK YOU FOR
THAT. I APPRECIATE IT. I AM IN
NO WAY WAS ALLUDING TO THE FACT
THAT ALL DENIALS ARE RELATED TO
FRAUD OR EVEN A MAJORITY AGAIN.
IT'S JUST A TREND THAT WE'VE
BEEN SEEING THAT'S BEEN
INCREASING. YOU KNOW? IN TERMS
OF DENIALS. THERE'S A VARIETY OF
REASONS WHY A PLAN MAY ISSUE A
DENIAL FOR A CERTAIN SERVICE OR
CERTAIN TREATMENT. AND AGAIN ALL
OF THOSE ARE NOT RELATED TO
FRAUD IN ANY WAY. WE'RE JUST
WE'RE JUST HIGHLIGHTING A TREND
THAT WE'VE BEEN NOTICING. UM YOU
KNOW, IN THAT SPACE SO AGAIN, I
DON'T WANT TO WANT TO BE CLEAR
THAT WE DON'T THINK THAT YOU
KNOW ALL THAT WE'RE ONLY DENYING
CLAIMS BECAUSE WE THINK THEY'RE
FRAUDULENT THAT THAT WAS NOT MY
INTENT IN BRINGING THAT UP. IT
WAS JUST TO HIGHLIGHT SOMETHING
THAT WE'VE BEEN NOTICING AS AN
EMERGING TREND WITHIN THIS SPACE
AND, YOU KNOW, WANTED TO
HIGHLIGHT THAT. SO IF SORT OF A
STANDARD CASE THAT ARE FACT
PATTERN THAT WE RUN INTO
REGULARLY. UM AND I SPEAK OF MY
OWN. WELL, LET ME JUST SAY I RUN
INTO REGULARLY. AND SO I'M NOT
IMPUTING THERE ANYONE ELSE HERE?
IS AN INDIVIDUAL WHO. IN EFFECT,
STOOL DIAGNOSE, YOU KNOW HAS
BEEN UNDERLINED BY POOR
CONDITION, FOR EXAMPLE, STARTS
SELF MEDICATING WITH METH.
STALLION PATIENT AT THAT POINT
TO STABILIZE IF THERE'S ANY HOPE
OF MOVING ON. IN TREATING THAT
ADDICTION AND THEN TWO WEEKS
LATER, TWO WEEKS INTO INPATIENT
IS TOLD BY UM. THE INSURER THAT
THERE'S NO MORE COVERAGE. HE
SHOULD BE FINE NOW. ESSENTIALLY
IS THE MESSAGE IS THE MESSAGE.
SO THAT'S THAT'S THE ISSUE. I'M
HERE AT THE CHASE AS AS OPPOSED
TO FRAUD, BUT IF FRAUDS AN ISSUE
AGAIN, YOU KNOW, UM IF THOSE
KIND OF CASES ARE BEING VIEWED
AS FRAUD, I'D LIKE TO KNOW THAT
BECAUSE BECAUSE WE MAY HAVE A
PROBLEM IN TERMS OF HOW THEY'RE
BEING ANALYZED, BUT I WOULD SAY
THAT THERE ARE. THOUSANDS AND
THOUSANDS OF FACT PATTERNS OUT
THERE IN THE STATE OF CALIFORNIA
AND HUNDREDS AND HUNDREDS OF
THEM IN MY OWN COUNTY THAT JUST
LIKE THE ONE DESCRIBED RIGHT
NOW. MORE PEOPLE ARE BEING CUT
OFF. UM VERY PREMATURELY IN
TERMS OF SUSTAINED TREATMENT ON
THE ADDICTION SIDE. UM NOT
BECAUSE THEIR MEDS ARE TOO
EXPENSIVE, NOT BECAUSE. THERE IS
A QUESTION ABOUT THE DIAGNOSIS,
BUT JUST IN EFFECT, WHAT SEEMS
TO BE AN ARBITRARY COST SAVING
MEASURE BY BY THE INSURER, YOU
KNOW, UM EITHER. THEY DON'T
KNOW. WHAT WHAT IT TAKES TO
STABILIZE SOMEBODY. WHO'S IN THE
THROES OF METH ADDICTION, FOR
EXAMPLE, LIKE THAT FACT PATTERN
OR THEY DO KNOW AND THEY JUST
DON'T WANT TO PAY FOR IT. AND
AGAIN, THAT'S YOU KNOW, WE COULD
TALK OFFLINE IF YOU THINK I'M
I'M CHASING A PHANTOM PROBLEM
WOULD WANT TO HEAR ABOUT THAT.
BUT THAT'S WHAT WE SEE. THAT'S
WHAT I SEE. JUST ONE QUESTION IN
TERMS IN TERMS OF THE COSTS
ASSOCIATED WITH OUT OF NETWORK.
THAT'S THE QUESTION IS, WHAT ARE
THE PLANS DOING TO ACTUALLY BEEF
UP THEIR NETWORKS? SO THAT
PEOPLE CAN GET IN NETWORK HERE
BECAUSE THAT'S THAT'S A REAL
CHALLENGE. YEAH, SO YOU KNOW, I
HAD MENTIONED, YOU KNOW, SENATOR
IN MY TESTIMONY ABOUT SOME OF
THE THINGS THAT WE'RE DOING IN
TERMS OF INCREASING ACCESS TO
HEALTHCARE PROVIDERS. OBVIOUSLY
YOU KNOW THERE IS THE ISSUE
AROUND WORKFORCE, BUT YOU KNOW,
AS I HAD MENTIONED, UM MY NOTES
HERE. SORRY. AH. YOU KNOW, WE
ARE INVESTING IN BUILDING THAT
NETWORK TO BOOST THE PIPELINE OF
ETHNICALLY AND GEOGRAPHICALLY
DIVERSE CLINICIANS. WE'RE
INVESTING IN OUR OWN CLINICIANS
AND PUTTING THEM IN, YOU KNOW,
PRIMARY CARE CLINICS, SCHOOLS,
YOU KNOW, ETCETERA WERE
OBVIOUSLY BUILDING OUT OUR
NETWORKS YOU KNOW, FOR THOSE WHO
ARE CONTRACT WITH ADDITIONAL
PROVIDERS TO ENSURE THAT WE HAVE
A BROAD BASED NETWORK. OBVIOUSLY
WE HAVE. PRETTY PRESCRIPTIVE
REGULATIONS AND STATUTES THAT WE
FOLLOW AROUND HOW BROADER
NETWORKS ARE, UM, SO THERE'S A
VARIETY OF THINGS THAT WE'RE
TRYING TO DO, BECAUSE WE
CERTAINLY UNDERSTAND THAT WITH
SOME OF THE CHALLENGES IN THE
WORKFORCE AND THE INCREASING
DEMAND FOR THE SERVICES THAT
HEALTH PLANS NEED TO INVEST AS
MUCH AS POSSIBLE AND TO ENSURING
THAT WE HAVE A STRONG, STABLE
WORKFORCE TO MEET THE DEMAND FOR
THESE SERVICES. OKAY? YEAH I
THINK ONE OF THE CHALLENGES
AROUND NETWORK ADEQUACY IS JUST
THE REIMBURSEMENT. RATES ARE NOT
WHERE THEY NEED TO BE. AND SO
YOU HAVE A LOT OF MENTAL HEALTH
PROVIDERS WHO CHOOSE NOT TO GO
AND NETWORK UM BECAUSE OF THOSE
INADEQUATE REIMBURSEMENT RATES,
SO I THINK IT'S TOUGH FOR THE
PLANS TO SORT OF KNOW THAT THEIR
COST COSTS ASSOCIATED WITH OUT
OF NETWORK CARE WHEN THE REASON
THAT'S HAPPENING IS BECAUSE OF
NETWORK AND ADEQUACY, I THINK IN
SIGNIFICANT PART BECAUSE OF
INADEQUATE REIMBURSEMENTS. YEAH,
I MEAN, IT'S CERTAINLY A
CHALLENGE IN TERMS OF BUILDING
UP THAT THAT NETWORK YOU KNOW, I
WOULD SAY, WE KNOW WE OFTEN
OFTENTIMES COME ACROSS PROVIDERS
, YOU KNOW, LIKE YOU SAID, YOU
DON'T WANT TO CONTRACT WITH THE
PLANS AND THOSE RATES ARE
NEGOTIATED BETWEEN THE PROVIDER
AND THE PLANS. YOU KNOW, WE'RE
HAVING DISCUSSIONS ABOUT COMING
IN NETWORK PROVIDERS ARE AT THE
TABLE TO HAVE THOSE DISCUSSIONS
AND THOSE NEGOTIATIONS. UM SO
YOU KNOW, OFTENTIMES THAT IT IS
UNFORTUNATE BECAUSE YOU KNOW
THERE ARE TWO PARTIES AT THE
TABLE TO NEGOTIATE THOSE RATES.
YOU KNOW, AND I KNOW ANECDOTALLY
. WE'VE HAD SOME OF OUR MEMBER
PLANS GO ABOVE AND BEYOND TO
REALLY GO BEYOND REASONABLE AND
CUSTOMARY PAYMENTS TO BRING
FOLKS IN NETWORK, BUT
UNFORTUNATELY, AT TIMES WE DO
SEE THAT THAT PROVIDERS
SOMETIMES JUST DON'T WANT TO
WORK WITH THAT BY COMING IN
NETWORK, AND THERE ARE A VARIETY
OF REASONS FOR THAT, FROM THE
PERSPECTIVE OF THE PROVIDER. UM
BUT IT HAS BEEN A CHALLENGE TO
BRING SOME FOLKS IN NETWORK AND
SO WE KNOW WE WILL CONTINUE TO
WORK WITH PROVIDERS. UM YOU KNOW
, NEGOTIATING GOOD FAITH AND GET
OUR NETWORKS AS AS LARGE AS WE
CAN TO SERVE THROUGH THE REST OF
THE CALIFORNIANS. THANK YOU.
OKAY WE WILL NOW GO TO PUBLIC
COMMENTS. AND FOCUS IN COMMON.
MAKE PUBLIC COMMENT HERE, AND WE
WILL THEN GO TO THE PHONE LINES.
SO YOU MAY. HI I'M KAREN FESS
ALIGNED WITH THE MENTAL HEALTH
AND AUTISM INSURANCE PROJECT. WE
ARE NON PROFIT AND WE, UM WE
MAINLY WORK WITH FAMILIES TRYING
TO GET MENTAL HEALTH AND AUTISM
ISSUES COVERED THROUGH INSURANCE
, AND WE WORK A LOT WITH THE D
MHC HELP CENTER IN TRYING TO GET
THEM COVERED. AND WE'VE HAD A
LOT OF OBSTACLES. SOME OF THEM I
DO THINK THEY PROBABLY NEED MORE
MONEY TO HIRE MORE STAFF. BUT
THERE'S BEEN A LOT OF RECENT
ISSUES WITH COMPETENCE. THERE'S
GMHC HAS AN ONGOING POLICY THAT
THEY'VE HAD FOR ABOUT THREE OR
FOUR YEARS NOW WHERE THEY WILL
NOT, UM THEY WILL NOT HAVE THEIR
PEOPLE. THEIR FRONTLINE PEOPLE
THAT WORK THE CASES YOU DON'T
GET TO COMMUNICATE WITH THEM AS
A CONSUMER, AND IT'S VERY HARD
TO THEY DON'T LEAVE THEIR FULL
NAMES, AND THEY DON'T LEAVE
THEIR EMAILS OR THEIR PHONE
NUMBERS. AND WHAT HAPPENS IS
THEY TALK BACK AND FORTH. THEY
HAVE A LOT OF BACK AND FORTH
WITH THE HEALTH PLANS. AND THEN,
UM, AND THEN WE'LL GET A
DISPOSITION AND THEY WON'T HAVE
EITHER UNDERSTOOD OUR POSITION
OR THEY HAVE BEEN MANIPULATED BY
THE HEALTH PLAN. AND I HAVE A
CASE WHERE THEY THERE WAS A
SINGLE CASE AGREEMENT WITH A
PROVIDER AND THE CLIENT WAS
TRYING TO CONSUMER WAS TRYING TO
GET PAID, AND THEY DIDN'T
UNDERSTAND HOW MUCH MONEY THE
PROVIDER HAD BEEN PAID. THEY
HADN'T BEEN FULLY PAID SO THAT
THAT IS ONE EXAMPLE. I HAD I
HAVE SEVERAL EXAMPLES OF THESE.
I DON'T KNOW IF YOU WANT ME TO
GO INTO DETAIL, BUT THERE'S BEEN
SEVERAL ISSUES WITH COMPETENCE
AND INCOMPETENCE AND FOR
TRAINING, UM OF STAFF. UM LET'S
SEE, I HAVE SUBMITTED MANY
PARODY DISCLOSURE REQUEST
FEDERAL PARITY DISCLOSURE
REQUESTS, AND I DON'T THINK I'VE
EVER GOTTEN A RESPONSE FROM A
CALIFORNIA PLAN. TYPICALLY IN
WASHINGTON STATE. I GET A
RESPONSE. I GET A RESPONSE RIGHT
AWAY. AND IF I DON'T HAVE GONE
TO THE REGULATOR AND THE
REGULATOR HAS GONE TO THE PLAN,
AND THEY'VE GOTTEN A RESPONSE
BACK, UM THEY'RE OFTEN NOT
ADEQUATE, BUT IT'S CLEAR THAT
CALIFORNIA IS NOT FOLLOWING THE
PARODY DISCLOSURE REQUIREMENTS
THAT THE FEDERAL GOVERNMENT IS
EXPECTING. AH UM LET'S SEE, I
WORK A LOT WITH CLIENTS IN
RESIDENTIAL TREATMENT CENTERS
HAVE HAD CASES WHERE IT'S TAKEN
SO LONG FOR THE DEPARTMENT TO
RESPOND FOR EXPEDITED REQUESTS,
UM, THAT THE CLIENTS HAVE HAD TO
DISCHARGE BECAUSE THEY COULDN'T
AFFORD TO PAY AND THEN THEY WERE
LATER AFTER THE FACT THEY GOT
COVERED, BUT THEY HAD ALREADY
HAD TO DISCHARGE BECAUSE THEY
COULDN'T AFFORD TO STAY THERE.
UM THERE IT THE TURNAROUND IS
OFTEN LIKE ON A ON AN EXPEDITED
WILL BE LIKE 4 TO 6 WEEKS, WHICH
IS TOO LONG IN THE PATIENT IS
PAYING IN THE IN THE PROCESS.
THEY'RE PAYING OUT OF POCKET AND
THAT SHOULDN'T HAPPEN. UM AH OUT
OF NETWORK CLAIMS IT IT, UM I
HAVE HAD SINGLE CASE AGREEMENTS
THAT WHERE THEY HAVEN'T PAID AND
, UM AND SO THE PATIENTS HAVE
BEEN DISCHARGED WHERE THERE HAS
BEEN NO PAYMENT PROVIDERS ARE
SUPPOSED TO WAIT AND THEY
THEY'RE NOT SUPPOSED TO BALANCE
BILL AND THAT'S REALLY HARD FOR
PROVIDER THAT DOES NOT WORK, UM
IN NETWORK WITH PLANS TO WAIT AS
LONG AS THEY HAVE BEEN EXPECTED
TO WAIT TO GET PAID. AH NETWORKS
FOR MENTAL HEALTH IS WAY WORSE
THAN FOR MEDICAL HEALTH. AND SO
NETWORK ADEQUACY HAS BEEN A HUGE
PROBLEM IN RESPONSE TO THE
TESTIMONY FROM THE GENTLEMAN
LAST. I HAVE ABBA PROVIDERS WHO
HAVE NOT RECEIVED RAISES IN 10
YEARS. THEY'VE BEEN IN NETWORK
FOR OVER 10 YEARS, AND THEY'VE
TRIED TO NEGOTIATE RAISES AND
HEALTH PLANS HAVE BEEN UNWILLING
TO NEGOTIATE CHANGES RAISES IN
PAY. FOR OVER 10 YEARS SO THEY
DON'T MAKE IT EASY FOR PROVIDERS
TO WORK WITH THEM. UM LET'S SEE.
THANK YOU IF YOU ALL RIGHT.
THANK YOU VERY MUCH. APPRECIATE
IT. THANK YOU. THANKS FOR YOUR
WORK. THANK YOU. UH GOOD
AFTERNOON. THANK YOU FOR HAVING
US TODAY AND FOR HAVING THIS
REALLY IMPORTANT HEARING. I'M
SURE HE DAILY I'M WITH THE
CALIFORNIA CONSORTIUM OF
ADDICTION PROGRAMS AND
PROFESSIONALS REPRESENTING OVER
100 PROGRAMS THROUGHOUT THE
STATE OVER 20,000 ADDICTION,
FOCUSED COUNSELORS AND OVER 300
RECOVERY RESIDENTS THROUGHOUT
CALIFORNIA. THANK YOU. ALSO TO
SENATOR FOR INTRODUCING 8 55 AND
GETTING IT PASSED AND THANK YOU
TO THE ADMINISTRATION FOR
IMPLEMENTING IT. UM I WANT TO
DRILL DOWN JUST FOR A MOMENT ON
ON WHY SOME OF THE
IMPLEMENTATION OF 8 55 IS WE
PREDICT WILL NOT BE COMPLETELY
SUCCESSFUL FOR PEOPLE SPECIFIC
TO SUD. IT HAS TO DO WITH WHEN A
PERSON WITH ADDICTION IS DENIED
TREATMENT OR STEP DOWN. THEY
AREN'T OUR BEST ADVOCATES FOR
FILING COMPLAINTS. TYPICALLY
THESE PEOPLE WILL RELAPSE. THEY
THERE'S STILL A LOT OF STIGMA
WHERE FAMILY FRIENDS ARE
EXHAUSTED. UM AND SEE THIS AS A
MORAL FAILING THAT THEY HAVE NOT
COMPLETED TREATMENT. THAT LEAVES
IT ON THE BACKS OF THE PROVIDERS
TO CHASE DOWN ALL OF THE
REIMBURSEMENT, WHICH BECOMES
VERY TIME CONSUMING. AND JUST
FROM A PERSONAL PERSPECTIVE, I
THINK CENTER COURT HAS HE KIND
OF WENT AROUND THE EDGES OF THIS
. THERE IS NO BETTER NIGHT'S
REST FOR A PERSON WITH A YOUNG
PERSON WHO IS EXPERIENCING
ADDICTION. THEN WHEN THAT YOUNG
PERSON INTEREST TREATMENT THAT
FAMILY GETS A SIGH OF RELIEF.
IMAGINE THREE DAYS LATER. THAT
YOUNG PERSON IS DEEMED CURED.
AND SENT BACK OUT OF THE SAFETY.
OF MEDICALLY APPROPRIATE
SERVICES BECAUSE INSURANCE
COMPANY HAS PERFORMED BUT WE
WOULD CONSIDER RE REVIEWS THAT
ARE AGAINST PARODY. SO BEING THE
ANCHOR LEG HERE TODAY, I FEEL
VERY SPECIAL IN THAT I CAN
PROVIDE SOME SOLUTIONS FOR YOU
FROM OUR ASSOCIATION. THE FIRST
ONE WOULD BE TO LOOK AT THESE
CIRCUMSTANCES. FROM A GLOBAL
PERSPECTIVE, INDIVIDUAL
COMPLAINT DRIVEN RESPONSES WILL
NOT GET THE JOB DONE. WE BELIEVE
THAT THE CONSTANT RE REVIEW
FIRST SUD AND SPECIFIC IS
AGAINST PARODY. MY MOTHER HAD A
SHOULDER REPLACEMENT. SHE WAS
PRESCRIBED SIX WEEKS OF
REHABILITATION, REHABILITATIVE
THERAPY. SHE WASN'T RE REVIEWED
EVERY THREE DAYS. EVERY TIME SHE
MADE A LITTLE PROGRESS. SHE
WASN'T TOLD. SHE'S DONE WITH
THAT. MEDICALLY NECESSARY
SERVICE SHE WAS GIVEN. WE
BELIEVE IT IS A VIOLATION OF
PARODY TO HAVE FREQUENT RE
REVIEWS THAT ARE NOT SEEN FOR
PHYSICAL AILMENTS. THE OTHER
ISSUE HAS TO DO WITH CONNECTING
REQUIREMENTS AND BEST PRACTICES
TO THE PRIVATE PRACTICE MARKET
UNDER THE ODS WAIVER. COUNTY
SITUATION. EVERYTHING IS
PRESCRIBED DOWN TO THE TO THE
HOW MANY HOURS OF TREATMENT IS
NECESSARY, AND THAT IS THE BEST
PRACTICE IN CALIFORNIA. THE
STATE OF CALIFORNIA IS THE
BIGGEST PROVIDER OF SERVICES.
THAT IS THE MODEL FOR BEST
PRACTICE. WHY IS THAT NOT BEING
REQUIRED OF THE PRIVATE
INSURANCE SERVICES THAT ARE
PROVIDED? AND TWO MORE ITEMS.
ONE TO ANSWER. SENATOR CORTEZ IS
QUESTION ABOUT. SHOULDN'T IT BE
ILLEGAL TO INCENTIVIZE REVIEWER
TO DENY OR PROHIBIT CLAIM? WELL,
YES SECTION 1348.6 OF THE HEALTH
AND SAFETY CODE SPECIFICALLY
PROHIBITS ANY PAYMENTS MADE AS
AN INDUCEMENT TO DENY DELAY,
REDUCE OR LIMIT APPROPRIATE,
MEDICALLY NECESSARY SERVICES TO
ENROLLEES OR GROUPS OF ENROLLEES
WITH SIMILAR MEDICAL CONDITIONS.
THAT'S EXACTLY WHAT THEY'RE
DOING NOW. ME AND JOAN. SHE'S
STILL HERE. WE CAN SAY ALL DAY
WE THINK THAT THEY'RE BEING PAID
EXORBITANTLY TO DO WHAT THEY'RE
DOING, BUT WE CAN'T OPEN THEIR
BOOKS. SO WHAT? WHAT PLACE IN
REGULATION? DO THOSE BOOKS GET
OPENED AND DETERMINE FROM AN
OBJECTIVE STANDPOINT? IS IT
TWICE THE REGULAR PAY TO A
PHYSICIAN FOUR TIMES? FIVE
TIMES, 10 TIMES. NGUYEN DOES
THAT PHYSICIAN PAST THE LIMIT OF
WHAT WOULD BE CONSIDERED AND
INDUCEMENT UNDER 1348.6? AND
LASTLY, I'LL JUST CLOSE WITH
WHAT? UH SENATOR WIENER OPENED
THIS HEARING WITH WHICH IS
TREATING ADDICTION AT STAGE FOUR
IS. HEART WRENCHING, WASTEFUL,
DEADLY IN THIS STATE. WE DON'T
HAVE A STAGE ONE CAPACITY. WE
DON'T HAVE INDEPENDENT LICENSED
PRACTITIONERS FOR ALCOHOL AND
DRUG ABUSE TREATMENT. 32 OTHER
STATES ALMOST EVERY POPULIST
STATE IN THIS COUNTRY LICENSES
THIS PROFESSION AND YOU CAN GO
TO YOUR DROPDOWN MENU. WHICH
MANY NOW WHEN YOU YOU'VE YOU'VE
BEEN ON NORCO FOR EIGHT WEEKS
FOR YOUR BROKEN ANKLE AND ALL
THE SUDDEN THE PAIN IS LESS, BUT
YOU SURE FEEL GOOD. WHEN YOU
TAKE YOUR NORCO. I MIGHT HAVE A
PROBLEM. I WANT TO TALK TO
SOMEBODY ABOUT THAT. BUT GO TO
YOUR PRIVATE INSURANCE PORTAL.
THERE ISN'T A LICENSED ALCOHOL
DRUG COUNSELOR. TO SPEAK TO YOU
ABOUT A PROBLEM YOU'VE
RECOGNIZED AT STAGE ONE. SO THAT
IS SOMETHING THAT CALIFORNIA
REALLY NEEDS TO FIX SO THAT WE
CAN ADDRESS UPSTREAM, UM, HARMS
FROM THIS DISEASE. THANK YOU.
THANK YOU. SPEAKER. GOOD
AFTERNOON CHAIR WIENER AND
MEMBERS TYLER WINDY ON BEHALF OF
THE CALIFORNIA ALLIANCE OF CHILD
AND FAMILY SERVICES REPRESENTING
CHILDREN'S BEHAVIOR, HEALTH
PROVIDERS. WE WERE PROUD
SUPPORTERS OF SB AT 55 AS IT
MOVES THROUGH THE LEGISLATIVE
PROCESS IN 2020. WE APPRECIATE
THE CONTINUED ATTENTION ON THE
BILL AND ITS IMPLEMENTATION BY
THE LEGISLATURE AND ESPECIALLY
ON SENATOR WIENER. WE ALSO
APPRECIATE THE COLLABORATION OF
THE DEPARTMENT OF MANAGED
HEALTHCARE AND IMPLEMENTATION OF
THE ACT AND ARE EAGER TO SEE THE
FINALIZED REGULATIONS. ONE AREA
I WOULD LIKE TO STRESS TODAY IS
THE CONTINUE TO NEED TO SEE IN
ALIGNMENT OF A CONSISTENT
DEFINITION OF THE HEALTH CARE
PROVIDERS IN WITH THE STAFFING
REQUIREMENTS AND SB 8 55. THE
CURRENT DRAFT REGULATIONS
CONTINUES TO REFER TO LICENSE
STAFF WHILE SB 8 55 IS BROADER
THAN THAT AND INCLUDES
ASSOCIATES UNDER SUPERVISION OF
A LICENSED PROFESSIONAL ON THEIR
PATHWAY THEMSELVES TO LICENSURE.
THIS IS IMPORTANT TO ENSURE
COVERAGE IN ALIGNMENT,
BEHAVIORAL HEALTH SERVICES
ACROSS OUR PUBLIC AND OUR
PRIVATE SYSTEMS. AND THIS IS
ALREADY SOMETHING THAT IS DONE
WITHIN MEDICAL. UM IN,
ADDITIONALLY, JUST LIKE TO
MENTION AS HAS BEEN MENTIONED
TODAY AROUND THE WORKFORCE
CRISIS AND THAT WE SHOULD BE
UTILIZING AND MAXIMIZING AS MUCH
OF HEART QUALIFIED WORKFORCE TO
DELIVER AS MUCH CARE TO
CALIFORNIANS AND NEED. THANK
YOU. THANKS, SPEAKER. HOLA
MIYAMOTO, ALICE HERNANDEZ TRAIN
THANOS. MAMA LAST HIMALAYAS,
WHOSE DIEGO RIVERA? I AM A NERD.
MY NAME IS ALICIA HERNANDEZ. I'M
A NURSE OF 30 YEARS AND I HAVE A
SON, WHO WAS VACCINE INJURED
WHEN HE WAS TWO. WITH HIS MMR
VACCINE. HE IS NOW AUTISTIC.
NONVERBAL I'M HERE TODAY BECAUSE
I SIT IN THESE MEETINGS AND I
HEAR A BUNCH OF NONSENSE HOCKEY
FORGIVING GO. IT'S GOOD ESTAS
ZEALOUS PORTAS. ORLANDO
RESTAURANTS EQUALS CRANKY OVER
YOUR PARENT LOOKING STAND WAS
NINOS MENTAL MEANT ISTANBUL
SOUTHERNMOST ROSIE HOSE. DROGAS.
I SIT BEHIND THESE CLOSED DOORS
BEHIND THESE MEETINGS BEHIND
CLOSED DOORS WHEN THEY DON'T
HAVE A CLUE WHAT'S GOING ON. AND
I FEEL THAT OUR CHILDREN THEY'RE
BEING USED. AS TARGETS. FOR
PEOPLE USING THEM TO UNJUST AND
PUT DRUGS INTO THEM. KUNAS
MENTALIST, CANCUN, THOSE BLOOD
CHÁVEZ. CNN. MUTU'S UM, BANANAS,
ADENTRO. AND I THINK THE START
NOT ONLY THINK, BUT I KNOW THE
START OF ALL THESE MENTAL ISSUES
AND HEALTH PROBLEMS COME FROM
VACCINATIONS. VACCINATIONS I'M
NOT TALKING ABOUT COVID. I'M
TALKING ABOUT BABY VACCINES. I
LOOK TO MARCELLUS BACUNA'S W W.
W W. LEARN THE RISK .ORG. IT
WAS. THERE ARE MANY PEOPLE THAT
DON'T KNOW THE SIDE EFFECTS OF
VACCINES AND MEDICATIONS. I DO I
WORKED PSYCH FACILITIES HAVE
BEEN A TRAVELING NURSE FOR 30
YEARS. I WORKED EVERY AREA YOU
CAN THINK OF SURGICAL MEDICAL
PSYCHIATRIC GEL. ASSISTED
LIVING. AND CONVALESCENT AND I
HAVE BEEN ONE TO PASS OUT THESE
DRUGS AND I'M TELLING YOU PEOPLE
THERE ARE NO GOOD AND IT'S ONCE
THEY GET YOU HOOKED ON A DRUG.
THEY GET YOU SICK FIRST TO GET
YOU ON A DRUG AND THEY MAKE TONS
OF MONEY OFF OF IT. AND YOU,
SCOTT WIENER, YOU'RE NUMBER ONE,
YOU KNOW ABOUT THIS, AND I'M
HERE TO TELL YOU YOU'RE GONNA
KEEP YOUR HANDS OFF OUR KIDS.
THIS IS WHERE THE BILL STOPS.
THIS IS WHERE IT STOPS. THIS IS
THE END. THANK YOU VERY MUCH.
THE NEXT SPEAKER. MY NAME IS
ANDREA HEADS FROM AND I AM. THE
MOTHER OF FOUR CHILDREN. AND, UM
, I REPRESENT A NUMBER OF
ORGANIZATIONS. I REPRESENT GOAT
FARMERS FOR GOOD GOVERNMENT. I
REPRESENT MOTHERS WHO ARE
AGAINST THE PHARMACEUTICAL
POISONING OF CHILDREN. I
REPRESENT THE ORGANIZATION.
CALIFORNIANS WHO ARE AGAINST THE
MEDICAL FASCIST TAKEOVER OF
CALIFORNIA AND I COULD KEEP
GOING, BUT I THINK YOU GET MY
POINT. SO I'LL READ SINCE IT
SOUNDS LIKE WE HAVE TIME TO GET
OUR VIEWPOINTS ON RECORD. THERE
IS YOUR EYE CONTACT SCOTT WIENER
. I KNEW YOU HAD IT IN YOU.
MODERN PHARMACEUTICAL INDUSTRY
HAS IN MANY WAYS PROVED TO BE A
GREAT BENEFIT TO HUMANKIND, ITS
ABILITY TO MAKE MEDICINES AND
VACCINES SAFELY AVAILABLE HAS
HELPED SAVE COUNTLESS LIVES. BUT
IN THE WAKE OF AMERICA'S OPIOID
EPIDEMIC AND THE COVID PANDEMIC,
THE REPUTATION OF THIS INDUSTRY
HAS COME UNDER SCRUTINY AND
ATTACK. AMERICA HAS A BROKEN
HEALTHCARE SYSTEM. WE NEED TO
EXAMINE THE RELATIONSHIP BETWEEN
BIG PHARMA AND THE GOVERNMENT.
WE NEED TO CONSIDER THE FIGHTER
DOCUMENTS AND WE NEED TO LOOK AT
THE ORIGINS OF BIG PHARMA AND
THE OPIOID EPIDEMIC AND, FRANKLY
, WE NEED TO EXAMINE ANTHONY
FAUCI AND THE PUBLIC HEALTH
ESTABLISHMENT. WE AS
CALIFORNIANS ARE CONCERNED ABOUT
THE RISE OF BIG PHARMA ITS ROLE
IN THE DECLINING STATE OF
HEALTH. CALIFORNIANS
PARTICULARLY OUR CHILDREN. AND
FRANKLY, HOW TO REFORM THIS
INDUSTRY. THANK YOU FOR YOUR
TIME AND I WILL FINISH WITH THIS
AND THIS IS A QUOTE BY ALEXANDER
SOCIAL MEDICINE. WE KNOW THEY
ARE LYING. THEY KNOW THEY ARE
LYING. WE KNOW. THEY ARE LYING.
THEY KNOW. WE KNOW THEY ARE
LYING. WE KNOW THEY KNOW. WE
KNOW THEY ARE LYING, BUT THEY
ARE STILL LYING. AND IN THIS
CASE THE THEY IS YOU AND WE ARE
DONE WITH YOUR LIES. OKAY ANY
ADDITIONAL PUBLIC COMMENT IN THE
ROOM? SEEING NONE WILL GO TO THE
PHONE LINES. I BELIEVE WE HAVE
SOMEONE ON THE PHONE LINE. YES
AND IF YOU WANT TO ASK QUESTIONS
, PLEASE PRESS ONE THAN ZERO AT
THIS TIME. IT'S NOT A QUESTION.
IT'S NOT A QUESTION OF THE
PUBLIC AND I'M SORRY. COMMENT
ONE THAN ZERO. WE'LL START WITH
LINE 84. PLEASE GO AHEAD. YES HI
. GOOD AFTERNOON. MY NAME IS
STEPHANIE. I JUST WANT TO READ
SOMETHING BECAUSE I LISTENED TO
SEVERAL OF YOU TALK ABOUT THE
501 SEES AND THE BIG HEALTHCARE
SUCH AS CETERA AND KAISER AND
ALL THAT. BUT UNDER THE FEDERAL
AND STATE FAULTS PLANES ACT
HEALTHCARE PROVIDERS THAT NO
ONLY SUBMIT ALL CLAIMS FOR
PAYMENTS AND MEDICARE, MEDICAL
AND OTHER GOVERNMENT PROGRAMS
ARE LIABLE FOR DAMAGES AND
PENALTIES, WHICH OFTEN RANGE IN
MILLIONS OF DOLLARS. THE FALSE
CLAIMS ACT HAS BEEN IMPLEMENTED
IN ABLE PRIVATE CITIZENS SUCH AS
MYSELF, MY GRANDCHILDREN AND
PARENTS. TO SUIT FRAUDULENT
BEHIND THE GOVERNMENT, AND THAT
IS FOR EVERY PHARMACEUTICAL AND
EVERY HEALTHCARE. BONTA SUED
KAISER FOR $40 MILLION PER
GETTING RID OF WEIGHT DAUGHTER
HAS AN AUDIT DEPARTMENT AND WAS
SUED FOR 40 MILLION. WHEN IS
THIS GOING TO STOP? MONEY'S
GOING OUT THE DOOR AND NOTHING
IS BEING DONE. THANK YOU. IS
THERE ANY ADDITIONAL PUBLIC
COMMENT ON THE LINE? YEAH NEXT
LITTLE LINE. 76, PLEASE GO
AHEAD. YES MY NAME IS NICOLE
YOUNG AND I HAVE A MENTALLY ILL
UNCLE. WAS ON STATE MEDICAL AND
THIS STATE SOLUTION FOR HIS
PSYCHOSIS IS TO DRUG HIM INTO
OBLIVION. HE HITS A THREE DAY
STATE AND THEN HE GETS DRAGGED
INTO OBLIVION AND BY OBLIVION, I
KNEW HE IS A ZOMBIE. INCAPABLE
OF ANY HUMAN EMOTION AND THAT
TERRIFYING PART OF THIS WHOLE
HEARING. BUT HEARING THAT
PSYCHIATRIST TALKED ABOUT DOING
THAT TO ARTISTIC CHILDREN. MY
WISH AS SOMEBODY WHO LOVES
SOMEBODY. WITH A SEVERE MENTAL
ILLNESS IS THAT THE CALIFORNIA
DEMOCRATS STAY OUT OF THIS. YOU
MAKE EVERYTHING WORSE.
EVERYTHING YOU TOUCH TURNS THE
TRASH TO GARBAGE. OUR STREETS
ARE LINED WITH A MENTALLY ILL
PEOPLE. THIS SYSTEM HAS FAILED,
PLEASE LET THE BUREAUCRATS
BUREAUCRATS AND YOU POLITICIANS
STAY IN YOUR LANE. THANK YOU.
AND MOVE ON. 85, PLEASE GO
AHEAD. THAT ME? CAN YOU HEAR ME?
YEP 95 GO AHEAD. GREAT GOOD
AFTERNOON. CHURCH AND FELLOW
MEMBERS. MY NAME IS SHAUNA LATCH
BRING FIRSTHAND INSIGHT INTO THE
MENTAL HEALTH CRISIS IN
CALIFORNIA AS LIKE, AS A MOTHER
OF A DAUGHTER GROUP GRAPPLING
WITH HEALTH, MENTAL AND
PSYCHOLOGICAL CHALLENGES TO THE
AGE OF 14. SHE HAS BEEN
MISDIAGNOSED AND UNDERDIAGNOSED.
SUBJECTED TO A BARRAGE OF
MEDICATIONS THAT ONLY
EXASPERATED HER ISSUES INSTEAD
OF ADDRESSING THE ROOT CAUSES,
THE STATE TENDS TO BLAME PARENTS
DUE TO THE STATE'S REGULATIONS
AND LAWS. MY DAUGHTER FOUND
HERSELF HOMELESS RECENTLY, A
CONSEQUENCE OF THE SYSTEM
INCOMPETENCE WITHOUT MY ADVOCACY
. SHE COULD HAVE BEEN HOMELESS
OR WORSE, EVEN DEAD. IT'S
IMPERATIVE TO EXPLORE AND
IMPLEMENT ALTERNATIVE AND
HOLISTIC TREATMENTS TO SOLVING
THESE ISSUES IN DEALING WITH
MENTAL DRUG OR HEALTH ISSUES AND
HAVING INSURANCE COVER IT IF I
DAUGHTER HAD ACCESS TO OTHER
PRESCRIBED TREATMENTS, INCLUDING
NURSING CARE, ABED MONITORING,
SHE WOULD BE SUFFERING WITH
CHEST PAIN AND BACK PAIN NOW NOT
BEING QUALIFIED TO RECEIVE HELP
DUE TO HER AGE. SHE'S 24. YOU'RE
NOT MENTAL HEALTH EXPERTS
SITTING ON THIS PANEL, YOU NEED
TO LISTEN TO THE PARENTS. THE
PARENTS VOICES IN THIS MATTER.
AND YOU NEED TO STAY IN YOUR
LANE. THANK YOU VERY MUCH AND
HAVE A GREAT DAY. THANK YOU. IS
THERE ADDITIONAL PUBLIC COMMENT
ON THE PHONE? YES WE'RE GONNA
LINE 48, PLEASE GO AHEAD. YES
GOOD AFTERNOON. MY NAME IS
BENJAMIN ICHER AND I'M WITH THE
NATIONAL UNION OF HEALTHCARE
WORKERS. WE ARE THE LARGEST
UNION OF PRIVATE SECTOR
BEHAVIORAL HEALTH THERAPISTS IN
CALIFORNIA STATE HAS TAKEN
IMPORTANT STRIDES, THANKS IN
PART TO WORK BY MEMBERS OF THIS
COMMITTEE, ESTABLISH ESTABLISHED
LAWS AND STANDARDS TO IMPROVE
THE AVAILABILITY AND QUALITY OF
BEHAVIORAL HEALTH SERVICES. NOW
THAT THESE LAWS ON THE BOOKS WE
NEED TO ENSURE THAT ENFORCEMENT
IS BOTH THOROUGH AND EFFECTIVE.
ONE OF THE REASONS WE THINK THIS
COMMITTEE FOR CONVENING THIS
HEARING, THAT'S WHY WE STAND
READY TO ASSIST IN THIS WORK
ACROSS THE STATE. THANK YOU VERY
MUCH. AND WHAT A LINE 90 PLEASE
GO AHEAD. HI MY NAME IS RHONDA
MURRAY AND I'M HERE TODAY TO
DISCUSS THE MENTAL ILLNESS
CRISIS AND HOW IT'S GOING TO
AFFECT YOUR NEW L G B T Q
COMMUNITY. THEY ALREADY HAVE A
MENTAL ILLNESS TO WANT TO GO
THAT FAR. AND WHOEVER IS WRITING
THIS BILL HAS A MENTAL ILLNESS
AND NEEDS TO TAKE ALL OF THIS
MONEY. ATTENDED ON THEIR MENTAL
ILLNESS, AND MAYBE THE COUNTRY
WOULD GET A LITTLE BIT BETTER.
IT'S ABSOLUTELY RIDICULOUS. OKAY
WHAT ARE THEY GONNA DO WHEN THE
KIDS WANT TO TURN BACK TO A BOY
OR A GIRL? HOW WAS THE MENTAL
HEALTH CRISIS GOING TO BE
AFFECTED? THEN HOW IS ALL
TAXPAYER DOLLARS ARE GOING TO BE
AFFECTED, THEN? THAT'S WHAT I
WANT TO KNOW. BECAUSE MY
TAXPAYER DOLLARS I WORKED FOR
THE SAME CALIFORNIA FOR 25
YEARS. MY TAXPAYER DOLLARS IS
GOING TO A BUNCH OF FEROCIOUS
CRAP AND HE'S GOT WIENER NEEDS
SOME MENTAL HEALTH PERIOD SELF
GOODBYE. DONE. AND WE'LL GO TO
LINE 71. PLEASE GO AHEAD. OH
GREAT. THANK YOU. MICHAEL
FITZGERALD WAS SAYING THE GROUP
CONSULTING AND COUNTRY PREVIOUS
CALLERS JUST WANT TO THANK
EVERYBODY WORKING ON THIS. BOTH
DEMOCRATS AND REPUBLICANS TO
HAVE NO HEALTH WELLNESS OF
CALIFORNIA VERY MUCH APPRECIATED
THIS EMBASSY WORK. I WANT TO
JUST POINT OUT THAT AMONG THE
PLAYERS THAT MOST DIFFICULT
CHALLENGES WITH PARTIAL
HOSPITALIZATION AND INTENSIVE
ADAPTATION PROGRAMS HAS STEPPED
DOWN. FROM HOSPITAL TREATMENT IS
WITH THE MEDICAL PATIENTS, SO
THEY'RE NOT ELIGIBLE FOR PARTIAL
HOSPITALIZATION IOP SERVICES
UNDER WHAT'S CALLED THE REHAB
MODEL WITH THE EXPANSION OF THE
MEDIC, AL BENEFICIARIES. NOW
IT'S SOMETHING LIKE 30% OF
CALIFORNIANS, SO IT'S MORE OF AN
ECONOMIC PRESIDENT. DISABILITY
REQUIREMENT THAT GETS YOU INTO
THE ENTITLEMENT TO GET YOU INTO
MEDICAL SERVICES NOT BEING
AVAILABLE TO THOSE PATIENTS
REALLY DOES HAMPER. UM THEIR
ACCESS TO MENTAL HEALTH PARITY.
IT'S SOMETHING I THINK THAT
DEPARTMENTS HEALTHCARE SHOULD
SHOULD LOOK OUT VERY MUCH, SO TO
ENSURE BETTER ACCESS FOR ALL
CALIFORNIANS. THANK YOU. AND
AGAIN IF YOU WISH TO COMMENT,
PLEASE PRESS ONE AND ZERO AT
THIS TIME. AND JUST MINISTERIAL.
ONE MORE QUEUE UP.
TAKE AND THANK YOU. MR CHAIR
WILL GO TO LINE 92, PLEASE GO
AHEAD. ON THE END, ALLOWING
PUBLIC TO CALL IN TO HEAR ABOUT
THIS IMPORTANT ISSUE. I WANT TO
COMMENT ON THE TESTIMONY OF DR
WOODS WANT TO BE KNOWN. I DON'T
WANT TO TAKE IT SHOULD TAKE INTO
CONSIDERATION THAT OR SHE USED
INJECTABLE PSYCHIATRIC. WE'RE IN
THE EYE LIKE COUNTY JAIL NOW I
HAVE BEEN IN THERE WATCHING
PEOPLE AFTER WORST, AND THERE
ARE THE WORST SO MUCH HAD TO
DETAIN HIM AND BRING HIM IN, AND
THEY STILL MAINTAIN THE PROBLEM
IN CUSTODY. INJECTABLE MAY HAVE
BEEN NECESSARY AT THAT POINT IN
TIME, BUT SHE DOES. SPEAK THAT
SHE WAS HAVING A HARD TIME
GETTING THOSE QUITE FIELD AND I
DO THINK THAT'S A GOOD THING
BECAUSE THERE'S A LOT OF
REPERCUSSIONS WITH PSYCHIATRIC
STARTED DYSKINESIA WHERE YOU'RE
GOING TO HAVE MENTAL MOTOR
CONTROL, AND THIS HAS HAPPENED
WITH A LOT OF PEOPLE WITH MOST
CONTROL FOR THE REST OF YOUR
LIFE. UM BUT REGARDING L. A
JAILS IN LOS ANGELES. I JUST
WANT TO MENTION OF FIGURE OUT
STREET WHERE WE NOW HAVE OPEN
AIR, PROSTITUTION, SEX TRADE AND
BECAUSE OF YOUR BILLS, SENATOR
WEINER S 3 67 LAST YEAR EVEN
ALLOWED IT TO HAPPEN, AND
THERE'S A LOT OF MENTAL HEALTH
CRISIS HAPPENING WITH CHILDREN
DOWN THERE THAT ARE HAVING TO
WITNESS HAPTIC AND WOMEN OUT
THERE BEING TRAFFICKED. NOT ONLY
THE MENTAL ILLNESS FOR THEM, BUT
THE ACTUAL TRAFFICKING OF THOSE
THOSE WOMEN AND THEY'RE HAVING
TO DEAL WITH THAT. NOW IT'S
UNFORTUNATE ENOUGH TO GET CAUGHT
UP IN THE LEGAL SYSTEM. AND YOU
PUT IN THE PENITENTIARY SYSTEM
BECAUSE YOU'RE THE 1 32. YOU'RE
GOING TO HAVE THEM HELPS WITH
MEN, NOT TRANS WOMEN, BUT
MADNESS. WHAT IS HAPPENING RIGHT
NOW AND FROM MY UNDERSTANDING OF
THE WOMEN THAT ARE LOCKED UP IN
THERE RIGHT NOW THAT THESE MEN
ARE ALLOWED TO HARASS THEM AND
INTIMIDATE THEM, AND AS I SAID,
IT'S NOT THE WAY YOU READ IT,
YOU KNOW FOR MEN TO GO IN WITH
WOMEN'S PREFERENCE. SO THOSE MEN
THAT ARE TRANSITIONING THE WHOLE
ANOTHER STORY AND OF COURSE,
THEY'RE NOT THERE TO HARASS ANY
WOMEN. BUT MEN ARE TAKING
ADVANTAGE OF THIS. SO IT IS
IRONIC THAT YOU'RE CHANGING A
COMMITTEE ON MENTAL HEALTH
LEGISLATION THAT YOU'RE PASSING.
IT'S CREATING MORE MENTAL HEALTH
ISSUES FOR THE PEOPLE OF
CALIFORNIA. THANK YOU FOR TAKING
THE TITLE OF DATA CENTER OR
SHABIHA. HERE. WE HAVE NO ONE
ELSE IN QUÊ WISHING TO SPEAK AT
THIS TIME. OKAY I WANT TO THANK
EVERYONE FOR BEING HERE TODAY
AND PARTICULARLY ALL THE
PANELISTS VERY, VERY
APPRECIATIVE. WE'VE DONE A LOT
OF IMPORTANT WORK, UM AROUND
MENTAL HEALTH TREATMENT ACCESS,