Substance use disorder coverage.

Assembly Member Haney's substance use disorder treatment legislation establishes new parameters for insurance coverage review processes, aiming to ensure consistent access to care during critical treatment periods. Starting January 1, 2027, health plans and insurers must provide the first 28 days of in-network inpatient or residential substance use disorder treatment without concurrent or retrospective medical necessity reviews, though prior authorization may be required.

For treatment extending beyond 28 days, the bill permits concurrent reviews at maximum two-week intervals. When insurers determine continued care is not medically necessary, they must notify patients and physicians within 24 hours and provide an expedited appeals process. Patients cannot be discharged until all internal and external appeals are exhausted, unless they choose to leave. The legislation also prohibits facilities from billing patients beyond standard cost-sharing amounts.

For outpatient services at certified programs, the bill eliminates concurrent and retrospective medical necessity reviews. The first 28 days of intensive outpatient or partial hospitalization treatment face similar restrictions, with reviews permitted only after that initial period. All medical necessity determinations must utilize the American Society of Addiction Medicine's placement criteria. The provisions exclude Medi-Cal behavioral health delivery systems and managed care plans from these requirements.