BILL ANALYSIS Ó
SB 126
Page 1
Date of Hearing: August 14, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
SB 126 (Steinberg) - As Amended: August 8, 2013
Policy Committee: HealthVote:18-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill extends the sunset from July 1, 2014 to January 1,
2017, on statutes implementing requirements on health plans and
insurers to provide coverage for behavioral health treatment
(BHT) for pervasive developmental disorder or autism (PDD/A).
FISCAL EFFECT
The California Health Benefits Review Program (CHBRP) estimated
no impact on cost or on public health from this bill, given that
state mental health parity laws already require coverage for
this treatment.
However, in recent history there have been enforcement actions
based upon consumer claims that they were not able to access BHT
benefits for PDD/A despite existing law requirements. Thus, to
the extent the clarity provided in this bill causes more BHT to
be provided through health benefits, this bill may result in
continued GF savings to school districts and the state
Department of Developmental Services (DDS), to the extent BHT
services provided as health benefits reduce the demand from
these other primary payers.
There is not likely to be an additional impact on private
insurance costs, as the costs associated with ABA services are
already built in to premiums.
COMMENTS
1)Rationale . According to the author, SB 946 (Steinberg),
Chapter 650, Statutes of 2011, which mandated coverage for BHT
for PDD/A, has resulted in significant benefits that include
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expanded access to BHT services for PDD/A and lower
cost-sharing for services. The author also indicates SB 946
has resulted in significant GF savings. The author believes
extending the provisions of the current mandate will enable
evaluation of recommendations that have been provided by a
DMHC task force pursuant to SB 946, consideration of a "path
to licensure" for BHT providers and paraprofessionals,
coordination and synchronization with ACA, and assessment of
future federal guidelines.
2)Behavioral Health Treatment for PDD/A . The most common BHT for
PDD/A is Applied Behavioral Analysis (ABA). ABA is the
process of systematically applying interventions based upon
the principles of learning theory to improve socially
significant behaviors to a meaningful degree. Socially
significant behaviors include reading, academics, social
skills, communication, and adaptive living skills like motor
skills, eating and food preparation, personal self-care,
domestic skills, home and community orientation, and work
skills. ABA requires intensive treatments of more than 25
hours each week and costs about $50,000 each year.
3)Mandate Triggered Off if Found to Exceed EHBs. 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 (EHBs). Under federal law, individuals
purchasing coverage through exchanges will be eligible for
subsidies, based on income, paid by the federal government.
However, pursuant to ACA, if a state imposes a benefit mandate
that EHBs, the state is responsible for providing subsidies
equal to the marginal costs for coverage of that mandated
benefit.
For 2014 and 2015, the federal Health and Human Services
Agency has deferred to states to define and enforce an EHB
standard using such a benchmark approach. Pursuant to state
law, all plans and policies in the individual and small group
markets will have to cover all benefits currently covered by a
specific Kaiser Permanente small-group HMO plan, including BHT
for PDD/A, in those years.
The state could incur a cost associated with mandates that
exceed EHBs beginning in 2016, pursuant to federal guidance
that will be forthcoming in future years. A mandate may have
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unknown future state costs beginning in 2016 if the federal
government defines EHBs in a new way (for example, using a
nationwide standard) and finds that the mandate exceeds the
to-be-defined EHB standards. However, to mitigate potential
fiscal concerns, SB 946 states it does not mandate benefits
beyond those defined as EHBs. Thus, it is unlikely that there
would be an additional fiscal liability to the state as a
result of this BHT mandate for health plans offered in the
Exchange, because the mandate would be triggered off if EHBs
do not require BHT to be covered.
4)Related Budget Action . The Senate Subcommittee No. 3 on Health
and Human Services augmented the Medi-Cal budget by $100
million ($50 million GF) and adopted placeholder trailer bill
language to add ABA services to Medi-Cal managed care for
children ineligible for regional center services. This action
was discussed in the Budget Conference Committee but not
adopted in the final budget package.
5)Related Legislation . AB 1372 (Bonilla) is similar to this
bill. It extends the operative dates of the BHT mandate from
July 1, 2014 to July 1, 2017. AB 1372 is currently pending in
Assembly Health Committee.
Among numerous other provisions related to the expansion of
Medi-Cal, SB 1 X1 (Hernandez and Steinberg), Chapter 4,
Statutes of 2013 First Extraordinary Session adds mental
health services in the EHB package, excluding BHT, as covered
Medi-Cal benefits.
6)Previous Legislation . AB 1453 (Monning), Chapter 854, Statutes
of 2012, and SB 951 (Ed Hernandez), Chapter 866, Statutes of
2012, establish California's EHBs.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081