BILL ANALYSIS �
AB 912
Page 1
ASSEMBLY THIRD READING
AB 912 (Quirk-Silva)
As Introduced February 22, 2013
Majority vote
HEALTH 13-6 APPROPRIATIONS 12-5
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|Ayes:|Pan, Ammiano, Atkins, |Ayes:|Gatto, Bocanegra, |
| |Bonilla, Bonta, Chesbro, | |Bradford, |
| |Gomez, | |Ian Calderon, Campos, |
| |Roger Hern�ndez, | |Eggman, Gomez, Hall, |
| |Lowenthal, Mitchell, | |Ammiano, Pan, Quirk, |
| |Nazarian, V. Manuel | |Weber |
| |P�rez, Wieckowski | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Logue, Maienschein, |Nays:|Harkey, Bigelow, |
| |Mansoor, Nestande, | |Donnelly, Linder, Wagner |
| |Wagner, Wilk | | |
| | | | |
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SUMMARY : Mandates that every group or individual health care
service plan contract and health insurance policy that is
issued, amended, or renewed, on and after January 1, 2014,
provide coverage for medically necessary expenses for standard
fertility preservation services when a necessary medical
treatment may cause iatrogenic infertility to an enrollee or
insured.
EXISTING LAW :
1)Establishes the Knox-Keene Health Care Service Plan Act of
1975 to regulate and license health plans and specialized
health plans by the Department of Managed Health Care (DMHC),
mandates coverage for basic health care services, and provides
for the regulation of health insurers by the California
Department of Insurance (CDI). Requires health plan contracts
and health insurance policies to offer group coverage for the
treatment of infertility, as defined.
2)Establishes as California's Essential Health Benefit (EHB)
benchmark plan the Kaiser Small Group Health Maintenance
Organization (HMO) plan along with the following 10 federal
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Patient Protection and Affordable Care Act (ACA) mandated
benefits:
a) Ambulatory patient services;
b) Emergency services;
c) Hospitalization;
d) Maternity and newborn care;
e) Mental health and substance use disorder services,
including behavioral health treatment;
f) Prescription drugs;
g) Rehabilitative and habilitative services and devices;
h) Laboratory services;
i) Preventive and wellness services and chronic disease
management; and,
j) Pediatric services, including oral and vision care.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, approximately $69,000 to the California Public
Employees' Retirement System for additional premiums. Unknown
costs, potentially greater than $100,000, to Covered California,
to the extent the fertility treatment preservation services
exceed the EHB requirement under the ACA.
COMMENTS : According to the author of this bill, a diagnosis of
cancer may bring with it an unexpected consequence: the
potential loss of fertility. The author maintains that
treatments that accompany this diagnosis may have long-term
implications for the ability of a survivor to build a family and
develop the kind of legacy many people take for granted. The
author asserts that treatments to preserve fertility in men and
women can be performed before chemotherapy and radiation starts
and used after the patient is given a clean bill of health.
However, the author argues, the cost to preserve fertility is
not a covered option for the majority of cancer patients, even
though fertility loss occurs as a consequence of their
treatment. The author further argues that as reconstructive
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coverage for breast cancer patients is required, similarly, the
option of fertility preservation for patients undergoing
chemotherapy and radiation should also be covered. The author
states that while the cost to preserve fertility is relatively
modest, most patients are unable to afford this unexpected
out-of-pocket expense, especially at a time when they are facing
other significant cost pressures surrounding treatment. The
author argues that the situation is further complicated by a
short timeframe between diagnosis and treatment that does not
allow time to seek appeal when insurance companies deny
fertility preservation coverage. According to the author, this
bill seeks to make this coverage available and accessible as
soon as the decision is made to undergo fertility preservation.
The Kaiser Small Group HMO 30 EHB benchmark plan for California
excludes coverage for the treatment of infertility; therefore
health insurance subject to EHB coverage requirements is not
required to cover treatment for infertility. This state
benefit mandate meets the definition of a benefit mandate that
could exceed EHBs as established by federal regulations on
EHBs, which states it must be specific to care, treatment
and/or services. Therefore, according to the California Health
Benefits Review Program (CHBRP), this mandate could trigger the
requirement that the state defray the costs of coverage for
enrollees in qualified health plans (QHPs) in Covered
California. QHP issuers are responsible for calculating the
marginal cost that must be defrayed based on "either a
statewide average or each issuer's actual cost." California
has not yet identified which option it will use. CHBRP is not
able to estimate the total number of enrollees in QHPs in 2014,
but is able to estimate the marginal change in the per member
per month (PMPM) premium that would result from requiring
coverage for fertility preservation services in 2014. These
estimates reflect a statewide average and not an issuer's
actual cost. The marginal change in the PMPM premium that CHBRP
estimates would result from this bill and that the state would
be responsible for defraying for each enrollee in a QHP in
Covered California is $0.01 in nongrandfathered small-group and
individual market DMHC-regulated plans; and $0.01 in
nongrandfathered small-group and individual market
CDI-regulated policies. So if there were three million QHP
enrollees, the state would be responsible for $360,000
associated with this mandate ($0.01 x 3 million x 12 months).
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The American Society for Reproductive Medicine, a cosponsor of
this bill, writes in support that with advances in medical
treatment, many diseases once thought fatal or chronic, can now
be treated and cured. However, the very treatment that saves
lives could also cost both men and women the potential of
biological children. Along with their affiliated organization,
the Society for Assisted Reproductive Technology, supporters
maintain that losing the chance to have children in the future
is a major fear for cancer patients. Supporters cite surveys
and anecdotal information from treating physicians which
suggests that one-third of patients, if not able to obtain
fertility preservation services, choose less effective medical
care in an attempt to preserve their fertility. Supporters
argue that this could result in worse outcomes, resulting in
more expensive treatment. Based on the 2011 CHBRP analysis,
supporters argue that the cost effect of this coverage is
projected to range from zero increase to $0.0373 PMPM, with
current efforts aimed at bringing this estimate down to the
point of near cost neutrality. Supporters argue that this bill
will potentially address certain issues of gender, racial, and
ethnic disparities in care and will bring other untold benefits
by providing cancer patients and others the opportunity for a
long life by allowing them to focus on the best medical care
for a cure and to maintain their dream of a biological family
after treatment while also lowering the cost of care.
The California Chamber of Commerce and America's Health
Insurance Plans both write in opposition that, while well
intentioned, this bill would further exacerbate the problem of
rising health care costs. The opposition maintains that this
bill cannot be viewed in isolation. With the state already
required to meet requirements designated by the ACA, the
opposition believes California should focus its attention on
meeting the EHBs required by the ACA rather than adding
additional mandated benefits. These mandates, according to the
opposition, have already reduced flexibility in benefit design,
increased health care costs and premium rates, leading to
reduced employers' and individuals' choice of benefit packages
from health insurers and HMOs. The opposition asserts that
benefit mandates that do not promote evidence-based medicine may
lead to lower quality of care, over-utilization, and high costs
for possible non-effective treatments.
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Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
FN: 0000899