BILL ANALYSIS                                                                                                                                                                                                    ”



                                                                  AB 210
                                                                  Page  1

          CONCURRENCE IN SENATE AMENDMENTS
          AB 210 (Roger HernŠndez)
          As Amended September 1, 2011
          Majority vote
           
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          |ASSEMBLY:  |     |                |SENATE: |25-11|(September 2,  |
          |           |     |                |        |     |2011)          |
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                    (vote not relevant)

          Original Committee Reference:    HEALTH  

           SUMMARY  :  Requires every group health insurance policy to 
          provide coverage for maternity services.  

           The Senate amendments  delete the Assembly approved version of 
          this bill and instead:

          1)Delete Assembly Member Solorio as the author.

          2)Make Assembly Member Roger HernŠndez the author.

          3)Add Assembly Members Alejo, Ammiano, Blumenfield, Carter, 
            Huffman, Bonnie Lowenthal, and Williams as coauthors.

          4)Require every group health insurance policy to provide 
            coverage for maternity services for all insureds covered under 
            the policy on or before July 1, 2012.

          5)Define "maternity services" to include prenatal care, 
            ambulatory care maternity services, involuntary complications 
            of pregnancy, neonatal care, and inpatient hospital maternity 
            care, including labor and delivery and postpartum care. 

          6)Require the definition of "maternity services" from 5) above 
            to remain in effect until federal regulations and guidance 
            issued according to the federal health reform law, the Patient 
            Protection and Affordable Care Act (PPACA), define the scope 
            of benefits to be provided under the maternity benefit 
            requirement and at that time the PPACA definition is to apply.

          7)Exempt from the provisions of this bill specialized health 
            insurance, Medicare supplement insurance, short-term limited 
            duration health insurance, Civilian Health and Medical Program 








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            of the Uniformed Services-supplement insurance, or TRI-CARE 
            supplemental insurance, or hospital indemnity, accident-only, 
            or specified disease insurance. 

          8)Make the following findings and declarations:

             a)   Health care service plans (health plans) are required by 
               the Knox-Keene Health Care Service Plan Act of 1975 
               (Knox-Keene) to provide maternity services as a basic 
               health care benefit;

             b)   Existing law does not require health insurers to provide 
               designated basic health care services and, therefore, they 
               are not required to provide coverage for maternity 
               services; and,

             c)   It is essential to clarify that all health coverage made 
               available to California consumers, whether issued by health 
               plans regulated by the Department of Managed Health Care 
               (DMHC) or disability insurers who sell health insurance 
               regulated by the Department of Insurance (CDI), must 
               include maternity services.

          9)Require that the provisions of this bill become inoperative 
            only if Senate Bill 222 (Evans and Alquist) of the 2011-12 
            Regular Session is also enacted and take effect.

          EXISTING FEDERAL LAW  :

          1)Requires employers, under the Federal Civil Rights Act, that 
            offer health insurance, and have 15 or more employees, to 
            cover maternity services benefits at the same level as other 
            health care benefits. 

          2)Defines, under PPACA, a list of "essential health benefits 
            package," including maternal and newborn care, which health 
            insurance coverage and group health plans must provide, 
            beginning in 2014.

           EXISTING STATE LAW :

          1)Provides for the regulation of health plans by DMHC under 
            Knox-Keene and for the regulation of health insurers by CDI 
            under the Insurance Code. 









                                                                  AB 210
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          2)Requires health plans under Knox-Keene to cover a number of 
            basic health care services and permits DMHC to define the 
            scope of the services and to exempt plans from the requirement 
            for good cause. 

          3)Provides, under Knox-Keene, that "basic health care services" 
            include:  a) physician services, including consultation and 
            referral; b) hospital inpatient services and ambulatory care 
            services; c) diagnostic laboratory and diagnostic and 
            therapeutic radiological services; d) home health services; e) 
            preventive health services; f) emergency health care services, 
            including ambulance and ambulance transport services and 
            out-of-area coverage; and, g) hospice care. 

          4)Requires, under Knox-Keene, health plans to provide all 
            medically necessary basic health care services, including 
            maternity services necessary to prevent serious deterioration 
            of the health of the enrollee or the enrollee's fetus, and 
            preventive health care services, specifically including 
            prenatal care. 

          5)Prohibits health plans and health insurers from issuing 
            contracts and policies that contain a copayment or deductible 
            for inpatient hospital or ambulatory care maternity services 
            that exceed the most common amount charged for the same type 
            of care and services provided for other covered medical 
            conditions. 

          6)Prohibits health plans and health insurers providing maternity 
            benefits for a person covered continuously from conception 
            from attaching any exclusions, reductions, or limitations to 
            coverage for involuntary complications of pregnancy unless 
            those provisions apply to all of the benefits paid by the plan 
            or insurer. 

           FISCAL EFFECT  :  According to the Assembly Appropriations 
          Committee analysis of AB 185 (Roger HernŠndez), which contained 
          similar provisions, this bill will result in the following 
          costs:

          1)According to the California Health Benefits Review Program, no 
            direct state fiscal impact for publicly supported health 
            coverage provided through Medi-Cal, California Public 
            Employees' Retirement System, or Healthy Families/Access for 
            Infants and Mothers.  








                                                                  AB 210
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          2)                           Increased premium costs in the 
            individual insurance market of approximately $110 million. 
            Increased premium costs are estimated to be offset by a 
            reduction in out-of-pocket costs for women who would otherwise 
            pay for a variety of services not covered by insurance in the 
            absence of this mandate. 

          3)Federal regulations implementing PPACA may reduce the fiscal 
            impact of this bill in future years. PPACA requires maternity 
            services to be covered as a basic benefit in state-run health 
            insurance exchanges that will provide health coverage to 
            millions of individuals. 

           AS PASSED BY THE ASSEMBLY  , this bill revised existing statute 
          relating to the role of city, county or fire districts with 
          regard to prehospital emergency medical services.  

           COMMENTS  :  According to the author, preterm birth is the leading 
          cause of newborn deaths in the United States (U.S.).  The author 
          cites the Centers for Disease Control and Prevention which 
          stated in 2008 that, 10.5% of all child births in California 
          were preterm births.  Moreover, 11% or 57,770 of all preterm 
          child births in the U.S. were in California.  In addition to a 
          high preterm birth rate, California has the highest number of 
          all babies born with low-birth weight; 37,598 out of 347,209 
          births.  The author argues that these birth complications are 
          exacerbated by the lack of proper prenatal and postnatal care 
          for expecting mothers.  The author maintains that low income 
          minority communities are especially impacted by the lack of 
          maternity care making this a significant pregnancy-related 
          health disparity.  

          The author argues that health plans under the Knox-Keene are 
          required to cover "basic health care services," including 
          maternity services, while insurers in the individual insurance 
          markets exclude maternity care within their basic plan benefits. 
           According to the author, this bill would ensure fair and 
          affordable access to quality maternity coverage in all health 
          insurance policies.

          Numerous studies have shown that prenatal care pays for itself 
          by helping to minimize the prevalence and severity of low- and 
          very low-birth weight babies.  A 2004 study in the Journal of 
          Perinatal and Neonatal Nursing evaluated the effects of 








                                                                  AB 210
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          augmented prenatal care on women at high risk for having a 
          low-birth weight baby who were enrolled in a special program 
          that provided basic prenatal care, prenatal education, and case 
          management.  The program saved about $13,962 per single 
          low-birth weight birth prevented, and, after program costs were 
          considered, the return on investment equaled 37%; for every 
          dollar invested in the program $1.37 was saved.  In addition, a 
          March of Dimes report indicated that hospital charges for 
          premature, low-birth weight infants totaled $37.7 billion 
          nationally in 2003.  The report stated that premature birth was 
          among the most common, serious, and costly problems facing 
          infants in the U.S. and is responsible for about half of all 
          infant hospitalizations.

           Recent significant amendments  .  The previous version of this 
          bill dealt with emergency medical services.  The September 1, 
          2011 amendments to this bill deleted the prior version of this 
          bill and inserted the above analyzed provisions.  The above 
          analyzed provisions have already been heard by an Assembly 
          policy committee.


           Analysis Prepared by :    Tanya Robinson-Taylor / HEALTH / (916) 
          319-2097 


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