BILL ANALYSIS Ó
AB 369
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Date of Hearing: January 23, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 369 (Pan) - As Amended: January 16, 2014
Policy Committee: HealthVote:16-0
Urgency: Yes State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill expands the rights of people in the individual health
insurance market whose plans were terminated between December 1,
2013 and March 31, 2014 to receive so-called "continuity of
care" health care services, services delivered by providers who
have a treatment relationship with an individual but lack a
contractual relationship with that individual's current insurer/
health care service plan.
FISCAL EFFECT
Costs to the Department of Managed Health Care (DMHC) and the
California Department of Insurance (CDI) to enforce this bill's
provisions are likely to be minor. Even if a complaint related
to these provisions results in a trial, for example, enforcement
costs would likely be less than $100,000 (Managed Care Fund or
Insurance Fund).
COMMENTS
1)Purpose . According to the author, this bill protects
continuity of care for people who lose plans and policies of
health insurance coverage in the individual market, including
people whose policies have been cancelled because the policies
were not compliant with the Patient Protection and Affordable
Care Act (ACA).
2)Background . For individuals in the large-group market,
existing law requires plans and insurers to reimburse
providers with whom they otherwise lack a contractual
relationship, if the individual is undergoing treatment with
that provider when she enrolls into the plan for a condition
AB 369
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specified in statute (such as pregnancy or a scheduled
surgery). This bill extends the same reimbursement
requirements to plans and policies serving certain people in
the individual market who are transitioning to new coverage,
largely as a result of the ACA.
3)Urgency . This bill contains an urgency clause, explained as
follows: "Many health care service plans terminated health
plans between December 1, 2013 and March 31, 2014 in
anticipation of compliance with the federal Patient Protection
and Affordable Care Act. In order to allow than individual
enrolled in such a plan who was receiving covered treatment
under the plan from a provider for a certain condition to
continue to receive services from that provider for the
condition, it is necessary that this act take effect
immediately."
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081