BILL ANALYSIS Ó
SB 138
Page 1
SENATE THIRD READING
SB 138 (Ed Hernandez)
As Amended September 3, 2013
Majority vote
SENATE VOTE :26-11
JUDICIARY 7-3 HEALTH 13-5
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|Ayes:|Wieckowski, Alejo, Chau, |Ayes:|Pan, Ammiano, Atkins, |
| |Dickinson, Garcia, | |Bonilla, Bonta, Chesbro, |
| |Muratsuchi, Stone | |Gomez, |
| | | |Roger Hernández, |
| | | |Lowenthal, Mitchell, |
| | | |Nazarian, V. Manuel |
| | | |Pérez, Wieckowski |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Wagner, Gorell, |Nays:|Maienschein, Mansoor, |
| |Maienschein | |Nestande, Wagner, Wilk |
| | | | |
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APPROPRIATIONS 12-5
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|Ayes:|Gatto, Bocanegra, |
| |Bradford, |
| |Ian Calderon, Campos, |
| |Eggman, Gomez, Hall, |
| |Holden, Pan, Quirk, Weber |
| | |
| | |
|-----+--------------------------|
|Nays:|Harkey, Bigelow, |
| |Donnelly, Linder, Wagner |
| | |
| | |
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SUMMARY : Requires health care service plans (health plans) and
health insurers to take specified steps to protect the
confidentiality of an insured individual's medical information
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for purposes of sensitive services or if disclosure will
endanger an individual, as specified. Specifically, this bill :
1)Requires health plans and health insurers to take the
following steps to protect the confidentiality of a
subscriber's/enrollee's or insured's medical information on or
after January 1, 2015:
a) Permit a subscriber/enrollee or insured to request, and
must accommodate requests for, communication in the form
and format requested by the individual, if it is readily
producible in the requested form and format, or at
alternative locations, if the subscriber/enrollee or
insured clearly states either that the communication
discloses medical information or provider name and address
relating to receipt of sensitive services or that
disclosure of all or part of the medical information or
provider name and address could endanger him or her.
b) Authorizes health plans and health insurers to require
the subscriber/enrollee or insured to make a request for a
confidential communication specified in 1) a) above in
writing or by electronic transmission.
c) Authorizes health plans and health insurers to require
that confidential communications request contain a
statement that the request pertains to either medical
information related to the receipt of sensitive services or
that disclosure of all or part of the medical information
could endanger the subscriber/enrollee or insured.
Prohibits a health plan and health insurer from requiring
an explanation as to the basis for a
subscriber's/enrollee's or insured's statement that
disclosure could endanger the subscriber/enrollee or
insured.
d) Indicates that the confidential communications request
is valid until the subscriber/enrollee or insured submits a
revocation of the request, or a new confidential
communication request is submitted.
e) Specifies that a confidential communications request
must be implemented by the health plan and health insurer
within seven calendar days of the receipt of an electronic
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transmission or telephonic request within 14 calendar days
of receipt by first class mail. Requires the health plan
and health insurer to acknowledge receipt of the
confidential communications request and advise the
subscriber/enrollee or insured of the status of
implementation of the request if a subscriber/enrollee or
insured contacts the insurer.
2)Authorizes a provider of health care to make arrangements with
the subscriber/enrollee or insured for the payment of benefit
cost sharing and communicate that arrangement with the health
plan and health insurer.
3)Prohibits a health plan or health insurer from conditioning
enrollment or coverage on the waiver of rights, as specified.
4)Provides that to the extent that the Knox-Keene Health Care
Service Plan Act of 1975 and the provisions of the Insurance
Code that apply to health insurers conflicts with this bill's
provisions, this bill controls.
5)Defines the following terms, including:
a) Confidential communications request is a request by a
subscriber/enrollee or insured that health plan/health
insurance communications containing medical information be
communicated at specific mail or email address or specific
telephone number, as designated by the subscriber/enrollee
or insured.
b) Endanger means that the subscriber/enrollee or insured
fears that disclosure of his or her medical information
could subject the subscriber/enrollee or insured to
harassment or abuse.
c) Sensitive services means all health care services that
minors can consent to, including: mental health treatment
or counseling services; residential shelter services;
medical care related to the prevention or treatment of
pregnancy, as specified; diagnosis or treatment related to
infectious, contagious, or communicable disease; prevention
of sexually transmitted diseases, as specified; and human
immunodeficiency virus (HIV) services, obtained by a
patient at or above the minimum age specified for
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consenting to the service specified.
6)States that it is the intent of the Legislature to incorporate
Health Insurance Portability and Accountability Act (HIPAA)
standards into state law and to clarify the standards for
protecting the confidentiality of medical information in
insurance transactions.
7)Includes a definition of medical information in the Insurance
Code that conforms to a similar definition found in the Health
and Safety Code. Makes other technical, conforming, and
clarifying changes.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)One-time costs for initial review of health plan compliance in
the range of $500,0000 (Managed Care Fund) to the Department
of Managed Health Care (DMHC). Costs to the California
Department of Insurance (CDI) should be minor and absorbable,
as they appear to rely on insurance plan attestation of
compliance rather than reviewing privacy policies and plan
contracts for compliance.
2)Potential increase in ongoing enforcement costs to CDI and
DMHC, not likely to exceed $100,000 total annually (Insurance
Fund/Managed Care Fund).
COMMENTS : The California Family Health Council is the sponsor
of this bill. According to the author, when it comes to the
sharing of patient information for insured dependents, there is
a lack of clear definitions and clarity around requirements and
restrictions in existing state and federal law, there are
different regulations for different insurance products, there
are not standardized forms or processes, and there is an undue
burden on the insured dependent to opt-in to confidentiality
protections. This bill will bring clarity to the existing
patchwork of state and federal statutes and regulations related
to the sharing of patient information, and will protect patient
confidentiality for insured dependents accessing services
related to sexual and reproductive health, HIV/AIDS, substance
use and mental health care or any other health care service when
disclosure could cause harm.
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The California Family Health Council, the Privacy Rights
Clearinghouse, the American Civil Liberties Union of California,
all state that the inability to guarantee confidential access to
services can lead to harm. Some minors and adults may choose
not to seek care for sensitive services such as sexually
transmitted diseases, birth control, drug treatment, and mental
health services for fear a parent or partner will find out.
Survivors of domestic violence may choose not to seek medical or
mental health services knowing an abusive spouse may have access
to this information. In addition, there are concerns about
confidentiality protections, patients with private insurance may
choose to enroll in public programs in order to avoid possible
privacy breaches, and this unnecessarily shifts health care
costs to the state.
The Association of California Life and Health Insurance
Companies and the California Association of Health Plans
indicate that with the most recent amendments, they are removing
their opposition.
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097
FN: 0002164