Substance use disorder coverage.
The provisions of AB 669 will take effect on January 1, 2027, and include prohibitions against concurrent and retrospective reviews of medical necessity for the first 28 days of inpatient treatment for substance use disorders. This means that once a patient has been admitted for treatment, insurance providers will not be able to second-guess the necessity of care being provided during this initial period. Outpatient services are similarly protected, requiring that only determinations made by the treating physician will dictate the necessity of care, thereby potentially increasing the demand for these services and reducing delays for patients seeking treatment.
Assembly Bill 669, introduced by Assembly Member Haney, focuses on the coverage of substance use disorder treatments and aims to enhance access to necessary medical services. The bill proposes significant changes to the management of health care services, specifically relating to how insurance providers can assess and authorize treatments for individuals with substance use disorders. It underscores a commitment to treating these conditions with the same regard as other health issues by mandating that insurance contracts not impose prior authorization for specific treatments, thus easing access for patients in need.
The sentiment around AB 669 appears supportive, particularly among advocates for mental health who emphasize the need for comprehensive and accessible treatment for substance use disorders. There is, however, concern expressed by some stakeholders regarding the possible implications for insurance providers, particularly about cost controls and the long-term sustainability of these mandated changes. The bill is seen as a progressive step towards recognizing and normalizing substance use disorders as health conditions that warrant careful attention and appropriate care.
Notable points of contention may arise from the insurance industry, as the bill imposes restrictions on their ability to review the medical necessity of treatments they are required to cover. Critics may argue that such provisions could lead to increased costs for insurance companies and, by extension, subscribers, potentially altering how resources are allocated for health care services. Additionally, exempting certain delivery systems from these requirements raises questions about equity in treatment access across diverse patient populations, possibly prompting further debate about how best to deliver substance use disorder care.