BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 951|
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THIRD READING
Bill No: SB 951
Author: Hernandez (D)
Amended: 4/16/12
Vote: 21
SENATE HEALTH COMMITTEE : 6-3, 4/11/12
AYES: Hernandez, Alquist, De León, DeSaulnier, Rubio, Wolk
NOES: Harman, Anderson, Blakeslee
SENATE APPROPRIATIONS COMMITTEE : 5-2, 4/30/12
AYES: Kehoe, Alquist, Lieu, Price, Steinberg
NOES: Walters, Dutton
SUBJECT : Health care coverage: essential health
benefits
SOURCE : Author
DIGEST : This bill designates the Kaiser Small Group HMO
as Californias benchmark plan to serve as the essential
health benefit standard, as required by federal health care
reform.
ANALYSIS :
Existing federal law:
1. Requires, under the federal Patient Protection and
Affordable Care Act (ACA), health plans and health
insurers that offer coverage in the small group or
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individual market to ensure that coverage includes the
essential health benefit (EHB) package.
2. Requires each state, by January 1, 2014, to establish an
American Health Benefit Exchange that facilitates the
purchase of qualified health plans by qualified
individuals and qualified small employers.
Existing state law:
1. Establishes the Department of Managed Health Care (DMHC)
to license and regulate health care service plans
(health plans) and establishes the Department of
Insurance to provide for the regulation of health
insurers.
2. Requires health plan contracts and health insurance
policies to cover various benefits.
3. Establishes 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:
1. Requires individual and small group health plans and
health insurance policy contracts, both inside and
outside of the American Health Benefit Exchange, to
cover EHBs, as defined.
2. Defines EHBs as the benefits and services covered by
Kaiser Small Group HMO, including the categories
identified in the ACA.
3. Requires the services and benefits to be covered to the
extent they are medically necessary, and prohibits the
scope and duration limits from exceeding the scope and
duration limits imposed on those services by the plan
contract.
4. Requires habilitative services to be provided for the
same services as the plan contract provides for
rehabilitative services and under the same terms and
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conditions of the plan contract for rehabilitative
services.
5. Requires the same services and benefits for pediatric
oral care as provided by a specified federal plan to be
provided as an EHB.
6. Prohibits plans from indicating or implying a contract
or policy meets the EHB standard unless it covers EHBs,
as defined.
7. Exempts self-insured group health plans, large group
market health plans, or grandfathered health plans.
Background
Effective January 1, 2014, federal law requires Medicaid
benchmark and benchmark-equivalent plans, plans sold
through the American Health Benefit Exchange and the Basic
Health Program (if enacted), and health plans and health
insurers providing coverage to individuals and small
employers to ensure coverage of EHBs, as defined by the
Secretary of the Department of Health and Human Services
(HHS). HHS is required to ensure that the scope of EHBs is
equal to the scope of benefits provided under a typical
employer plan, as determined by the Secretary.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
No additional costs to subsidize the costs of state
benefit mandates for health plans sold in the Exchange.
One-time costs to the Department of Insurance of $120,000
in 2012-13 and $110,000 in 2013-14 for the review of
health insurance policy filings (Insurance Fund).
SUPPORT : (Verified 5/1/12)
California Academy of Child and Adolescent Psychiatry
California Association for Behavioral Analysis
California Psychiatric Association
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California Speech-Language Hearing Association
Council of Acupuncture and Oriental Medicine Associations
Planned Parenthood Affiliates of California
Western Center on Law & Poverty
ARGUMENTS IN SUPPORT : The California Psychiatric
Association supports the inclusion of all significant
diagnoses in the Diagnostic and Statistical Manual of the
American Psychiatric Association within the EHBs. The
California Association for Behavioral Analysis writes in
support of this bill stating that it makes clear,
consistent with the requirements of state and federal law,
that applied behavior analysis for autism is a covered
benefit in the benchmark benefit package. The California
Speech-Language Hearing Association writes in support of
the bill including speech therapy and other habilitative
services.
CTW:do 5/2/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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