BILL NUMBER: AB 1453	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Monning

                        JANUARY 5, 2012

   An act to add Section 100509 to the Government Code, relating to
health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1453, as introduced, Monning. Essential health benefits.
   Commencing January 1, 2014, existing law, the federal Patient
Protection and Affordable Care Act (PPACA), requires a health
insurance issuer that offers coverage in the small group or
individual market to ensure that such coverage includes the essential
health benefits package, as defined. PPACA requires each state to,
by January 1, 2014, establish an American Health Benefit Exchange
that facilitates the purchase of qualified health plans by qualified
individuals and qualified small employers. PPACA defines a qualified
health plan as a plan that, among other requirements, provides the
essential health benefits package. Existing state law creates the
California Health Benefit Exchange to facilitate the purchase of
qualified health plans by qualified individuals and qualified small
employers by January 1, 2014.
   This bill would require the board of the California Health Benefit
Exchange to, by March 1, 2013, submit to the Assembly Committee on
Health and the Senate Committee on Health a recommendation for an
existing health plan to set the benchmark for items and services to
be included in the definition of essential health benefits as
contemplated under PPACA and a specified federal bulletin. In
developing this recommendation, the bill would require the board to
collaborate with the Department of Managed Health Care, the
Department of Insurance, and other interested stakeholders and to
take into consideration the benefits required to be covered by health
care service plans. The bill would require the board to compare and
contrast the options presented in a specified federal bulletin and
would authorize the board to convene an advisory council to aid in
its deliberations.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 100509 is added to the Government Code, to
read:
   100509.  (a) By March 1, 2013, the board shall submit to the
Assembly Committee on Health and the Senate Committee on Health a
recommendation for an existing health plan to set the benchmark for
items and services to be included in the definition of essential
health benefits, as contemplated under Section 1302 of the federal
Patient Protection and Affordable Care Act (42 U.S.C. Sec. 18022) and
the Essential Health Benefits Bulletin issued on December 16, 2011,
by the Center for Consumer Information and Insurance Oversight within
the federal Centers for Medicare and Medicaid Services.
   (b) (1) In developing the recommendation under subdivision (a),
the board shall collaborate with the Department of Managed Health
Care, the Department of Insurance, and other interested stakeholder
organizations. The board may convene an advisory council to aid in
its deliberations. The board shall compare and contrast the options
presented in the bulletin referred to in subdivision (a), including
use of any of the following as the benchmark plan:
   (A) One of the three largest small employer plans in the state.
   (B) One of the three largest state employee health plans.
   (C) One of the three largest federal employee health plan options.

   (D) The largest HMO plan offered in the state's commercial market.

   (2) In developing the recommendation under subdivision (a), the
board shall take into consideration all of the benefits required to
be covered by health care service plans under the Knox-Keene Health
Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section
1340) of Division 2 of the Health and Safety Code), including, but
not limited to, basic health care services, as defined in subdivision
(b) of Section 1345 of the Health and Safety Code and Section
1300.67 of Title 28 of the California Code of Regulations. The board
shall propose statutory amendments necessary to implement its
recommendation and other conforming amendments necessary to comply
with the requirements of the federal Patient Protection and
Affordable Care Act, and the rules and regulations issued thereunder,
relating to essential health benefits.