BILL ANALYSIS Ó
AB 845
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Date of Hearing: April 29, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
845 (Cooley) - As Amended April 21, 2015
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill authorizes the board of the Exchange, referred to as
Covered California, to construct, manage, and maintain a
separate website to provide standardized information about
vision plans available for consumers to purchase. It also:
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1)Authorizes the board to receive funds from providers of
ancillary vision care products and any other nongovernmental
source for the purpose of the website.
2)Prohibits federal funds, user fees, and other assessments
imposed for the purposes of the Exchange from being used for
the purpose of the website, and prohibits other federal and
state funds from being comingled with funds made available for
the website.
3)Requires the website to facilitate an option for consumers to
obtain more information about, and enrollment in, a vision
plan through a licensed agent.
FISCAL EFFECT:
1)One-time cost pressure of in the hundreds of thousands to low
millions to Covered California to construct, design, and test
a website that meets the criteria of the bill. Costs depend on
the functionality of the site. Although the bill authorizes,
and does not require, Covered California to create the
website, codifying such a directive places clear cost pressure
on the state to create it. The bill authorizes Covered
California to receive private funds for the purpose and does
not allow the use of their other funding sources for the
purpose. It is unclear whether resources would be available.
2)Ongoing costs to maintain the website in the low hundreds of
thousands of dollars. If the website is built with private
funds, there would be cost pressure to the state to maintain
the site even if private funds later dry up.
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COMMENTS:
1)Purpose. According to the author, this bill will provide
California consumers the opportunity to shop for adult,
individual vision care. The author states that Covered
California currently offers pediatric-only vision benefits,
and adult consumers do not have access to affordable vision
coverage when purchasing a health plan through Covered
California. The author states that vision is a critical part
of everyday life, with the added preventative benefit that
routine eye exams can disclose many serious underlying health
conditions.
2)Background. Federal law requires state Exchanges, including
Covered California, to facilitate enrollment in qualified
health plans that provide a set of 10 "essential health
benefits" (EHBs) including inpatient and outpatient care,
pharmacy, maternity services, and behavioral health care,
among others. In addition, pediatric oral and vision care is
included as an EHB.
In 2012, the Covered California board intended to pursue the
offering of supplemental insurance plans, including standalone
vision and dental plans for adults and families. However, on
March 29, 2013, the federal Center for Consumer Information
and Insurance Oversight (CCIIO), released guidance stating an
Exchange could not offer certain supplemental products,
including vision plans. However, Covered California would be
able to partner and share infrastructure with a separate
non-Exchange state program in order to offer supplemental
products such as vision plans, provided several conditions
were met. For example, the non-Exchange state program must be
supported by a separate funding stream and have a separate
legal status. The federal guidance allows such an entity to
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share infrastructure with the Exchange, provided that if an
Exchange resource is used for non-Exchange purposes, the cost
of using the resource must be paid by the other, non-Exchange
state program.
In a letter dated February 2, 2015, from the federal
Department of Health and Human Services to Congresswoman Doris
Matsui, the Centers for Medicare and Medicaid Services
Administrator, Marilyn Tavenner, clarified that a separate
state entity does not need to be created in order for the
Exchange to provide a Website link to a marketplace for adult
vision care. The website is, however, required to state
disclaimers that the plans are not QHPs and do not qualify for
tax credits and subsidies. This bill requires such
disclaimers.
3)Previous Legislation. AB 1877 (Cooley) would have created in
state government the California Vision Care Access Council,
modeled after the Exchange, to create a marketplace for the
purchase of vision plans by individuals and employers. This
bill was vetoed. In his veto message, the Governor stated
that, "Creating a new state bureaucracy to inform consumers
about vision plans isn't necessary, nor is it advisable to
divert Covered California's focus with a new scheme, the
governance of which may be impermissible under federal rules."
This bill partially addresses the veto message, in that it
does not create a new state bureaucracy. However, the issue
of diverting Covered California's focus from its core mission
appears to stand.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081
AB 845
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