STATE SENATE BILL 999 (2024)
SB 999 will ensure that Californians suffering from mental health and substance use disorders (SUD) are able to receive the level of treatment necessary to safely recover from addiction. This bill establishes utilization review (UR) criteria for health plans and disability insurers that safeguard patient access to timely review decisions, ensures UR is conducted by a provider with experience in the relevant diagnosis, and reinforces patients’ rights to access a health plan’s basis for treatment denials.
STATE SENATE BILL 999 (2024): HISTORY
In 2011 the American Society of Addiction Medicine confirmed for the first time that addiction is a treatable chronic brain disease.
Since then, to limit the length and cost of substance use treatment, the insurance industry has adopted the practice of initially authorizing only a limited number of days. When the licensed addiction doctor requests additional days of treatment based on addiction industry criteria, the insurance companies regularly hire unqualified doctors who deny 90-100% of the time.
The result is that either the addiction patient is discharged before he/she has the skills to maintain long term sobriety, the patient self-pays for the denied days, or the facility keeps the patient in treatment and fights to hopefully have the denial turned around.
Frequently the companies hired by the insurance carriers to provide these unqualified doctors refuse to reveal to the addiction treatment team the full names of the doctors, the state in which they are licensed, their license number or specialty. The doctors themselves often also refuse to reveal their identities.
This is unacceptable because several years ago the California Workers Comp industry discovered that some the doctors being assigned by insurance carriers to do “peer-to-peer” evaluations on industrial accidents had suspended medical licenses or were renting the “gig” from another doctor.
The unqualified doctors, often child psychiatrists or MD who do not specialize, rarely spend more than 5–7-minutes on the phone meeting with the qualified addiction professional who has determined the appropriate length of treatment and level of treatment based on criteria of the American Society of Addiction Medicine (ASAM)
which became the official and exclusive California State guideline on January 1, 2021. It mandates that in California length of stay, and level of care of a patient being treated for substance abuse could only be based on the criteria of the ASAM criteria.
In 2022 Summit Estate Recovery Center, together with Hansei Solutions and Billing Solutions, decided to act. We brought the dire situation to the attention of Summit’s State Senator Dave Cortese. He agreed to sponsor a bill aimed at stopping unqualified doctors from begin paid to deny necessary treatment, and to publicly disclose their denial rates. SB 999 has already passed through both State Senate committees (Heath and Appropriations) and a vote of the entire State Senate, both Assembly committees Health (Heath and Appropriations). To our great surprise when SB 999 got to the desk of Governor Gavin Newsom, he veto-ed it.
Governor wrote: “I share the author's goal of ensuring that patients are able to receive the behavioral health care they need, when they need it. Two years ago, I signed SB 855 (Wiener, Chapter 151, Statutes of 2020), a landmark update to California's mental health parity statutes. SB 855 and forthcoming regulations implementing the law seek to address the issues targeted by this bill”.
Fortunately, the Department of Insurance toughened their regulations. The Department of Managed Health Care did not. The denials continued apace, even though the majority of those submitted to an Independent Medical Review panel were overturned. After an oversight hearing on October 18, 2023 Senator Cortese decided to bring SB 999 again, this time sponsored by Summit Estate Recovery Center and The Kennedy Forum and The Steinberg Institute.
Click here to read Summit Estate Recovery Center Executive Director Joan Borsten's October 18th hearing testimony and exchanges during the hearing between Senator Cortese and the chair of the Department of Healthcare Services.
California Score Board
click here to see if you know any of the doctors who have shocking denial rates
Meet the Team
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Dave Cortese
State Senator
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Contact
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Email
SB999Friends@gmail.com