BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Kevin de León, Chair
SB 126 (Steinberg) - Health care coverage: pervasive development
disorder or autism.
Amended: As introduced Policy Vote: Health 9-0
Urgency: No Mandate: Yes
Hearing Date: May 13, 2013 Consultant: Brendan McCarthy
This bill does not meet the criteria for referral to the
Suspense File.
Bill Summary: SB 126 would extend the sunset, until January 1,
2019, of the state's existing health benefit mandate requiring
health plans and health insurers to provide coverage for
behavioral health therapy for pervasive development disorder or
autism.
Fiscal Impact:
Minor ongoing costs to the Department of Managed Health
Care (Managed Care Fund) and Department of Insurance
(Insurance Fund) for enforcement. See below.
No additional cost to the state to provide subsidies for
health coverage costs in the California Health Benefit
Exchange . See below.
Background: Current state law (SB 88, Thompson, Statutes of
1999) requires health plans and health insurers who provide
hospital, medical, or surgical coverage to provide coverage for
the diagnosis and treatment of severe mental illness (as
specified in statute). In addition, health plans and health
insurers are required to provide additional coverage for serious
emotional disturbances of a child. In both cases, coverage is
required to be provided under the same terms and conditions
applied to other medical conditions.
Under current federal law, health plans and health insurers that
offer coverage for mental health or substance abuse disorders
are required to provide that coverage under the same terms and
conditions as other covered benefits.
Collectively, these requirements are referred to as "mental
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health parity" requirements.
In addition, current state law (SB 946, Steinberg, Statutes of
2011) specifically requires health plans and health insurers to
cover behavioral health therapy for pervasive development
disorder or autism. SB 946 has a statutory sunset of July 1,
2014
Under the federal Patient Protection and Affordable Care Act,
health coverage provided in the small group or individual market
(including through health exchanges) must provide essential
health benefits. Under federal law, individuals purchasing
coverage through health benefit exchanges will be eligible for
subsidies, based on income, paid by the federal government.
However, if a state imposes a benefit mandate after January 1,
2012 that exceeds the benefits provided by the essential health
benefits benchmark plan, the state is responsible for providing
the subsidies for coverage of that mandated benefit.
Proposed Law: SB 126 would extend the sunset, until January 1,
2019, on the state's existing health benefit mandate requiring
health plans and health insurers to provide coverage for
behavioral health therapy for pervasive development disorder or
autism.
Related Legislation: SB 946 (Steinberg, Statutes of 2011)
requires health plans and health insurers to cover behavioral
health therapy for pervasive development disorder or autism.
Staff Comments: According to an analysis of this bill by the
California Health Benefits Review Program, health plans and
health insurers are already required to provide coverage for
behavioral health therapy (provided it is medically necessary)
under state and federal mental health parity requirements. Thus,
this bill does not create a new coverage mandate.
There is no expected additional enforcement cost to state
regulators, since they are already required to enforce existing
mental health parity requirements. Similarly, the state will not
be required to pay for the cost of subsidizing coverage in the
California Health Benefit Exchange, as this bill does not impose
a coverage mandate that goes beyond federal or state essential
health benefit requirements.
SB 126 (Steinberg)
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