Amended in Assembly April 27, 2016

Amended in Assembly April 6, 2016

Amended in Assembly March 18, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 1764

Introduced by Assembly Member Waldron

February 3, 2016

An act to amend Section 127660 of the Health and Safety Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 1764, as amended, Waldron. California Health Benefit Review Program: financial impacts.

Existing law, until July 1, 2017, requests the University of California to establish the California Health Benefit Review Program to assess, among other things, legislation that proposes to mandate or repeal a mandated benefit or service, as defined. Existing law requests the University of California to prepare a written analysis with relevant data on public health, medical, financial, and other impacts of that legislation, as specified.

Existing law requests the University of California to provide the analysis to the appropriate policy and fiscal committees of the Legislature, as specified, and to submit a report to the Governor and the Legislature regarding the implementation of these provisions by January 1, 2017. Existing law establishes the Health Care Benefits Fund in the State Treasury to effectively support the University of California and its work in implementing these provisions. begin insert The California Health Benefit Review Program has been reauthorized since its predecessor was established in 2002. end insert

This bill would additionally request the University of begin delete California end delete begin insert California, commencing July 1, 2017, end insert to include in its analysis, as part of the financial impacts of the above legislation, relevant data on the impact of coverage or repeal of coverage of the benefit or service on anticipated costs or savings estimated upon implementation for the 2 subsequent state fiscal years and, if applicable, for the 5 subsequent state fiscal years, as specified.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 127660 of the Health and Safety Code
is amended to read:

127660.  

(a) The Legislature hereby requests the University of
California to establish the California Health Benefit Review
Program to assess legislation proposing to mandate a benefit or
service, as defined in subdivision (d), and legislation proposing to
repeal a mandated benefit or service, as defined in subdivision (e),
and to prepare a written analysis with relevant data on the
following:

(1) Public health impacts, including, but not limited to, all of
the following:

(A) The impact on the health of the community, including the
reduction of communicable disease and the benefits of prevention
such as those provided by childhood immunizations and prenatal
care.

(B) The impact on the health of the community, including
diseases and conditions where disparities in outcomes associated
with the social determinants of health as well as gender, race,
sexual orientation, or gender identity are established in
peer-reviewed scientific and medical literature.

(C) The extent to which the benefit or service reduces premature
death and the economic loss associated with disease.

(2) Medical impacts, including, but not limited to, all of the
following:

(A) The extent to which the benefit or service is generally
recognized by the medical community as being effective in the
screening, diagnosis, or treatment of a condition or disease, as
demonstrated by a review of scientific and peer-reviewed medical
literature.

(B) The extent to which the benefit or service is generally
available and utilized by treating physicians.

(C) The contribution of the benefit or service to the health status
of the population, including the results of any research
demonstrating the efficacy of the benefit or service compared to
alternatives, including not providing the benefit or service.

(D) The extent to which mandating or repealing the benefits or
services would not diminish or eliminate access to currently
available health care benefits or services.

(3) Financial impacts, including, but not limited to, all of the
following:

(A) The extent to which the coverage or repeal of coverage will
increase or decrease the benefit or cost of the benefit or service.

(B) The extent to which the coverage or repeal of coverage will
increase the utilization of the benefit or service, or will be a
substitute for, or affect the cost of, alternative benefits or services.

(C) The extent to which the coverage or repeal of coverage will
increase or decrease the administrative expenses of health care
service plans and health insurers and the premium and expenses
of subscribers, enrollees, and policyholders.

(D) The impact of this coverage or repeal of coverage on the
total cost of health care.

(E)  begin delete The end delete begin insert Commencing July 1, 2017, the end insert impact of this coverage
or repeal of coverage on anticipated costs or savings estimated
upon implementation for the following periods:

(i) The two subsequent state fiscal years.

(ii) If applicable, the five subsequent state fiscal years through
a longer-range estimate.

(F) The potential cost or savings to the private sector, including
the impact on small employers as defined in paragraph (1) of
subdivision (l) of Section 1357, the Public Employees’ Retirement
System, other retirement systems funded by the state or by a local
government, individuals purchasing individual health insurance,
and publicly funded state health insurance programs, including
the Medi-Cal program and the Healthy Families Program.

(G) The extent to which costs resulting from lack of coverage
or repeal of coverage are or would be shifted to other payers,
including both public and private entities.

(H) The extent to which mandating or repealing the proposed
benefit or service would not diminish or eliminate access to
currently available health care benefits or services.

(I) The extent to which the benefit or service is generally utilized
by a significant portion of the population.

(J) The extent to which health care coverage for the benefit or
service is already generally available.

(K) The level of public demand for health care coverage for the
benefit or service, including the level of interest of collective
bargaining agents in negotiating privately for inclusion of this
coverage in group contracts, and the extent to which the mandated
benefit or service is covered by self-funded employer groups.

(L) In assessing and preparing a written analysis of the financial
impact of legislation proposing to mandate a benefit or service and
legislation proposing to repeal a mandated benefit or service
pursuant to this paragraph, the Legislature requests the University
of California to use a certified actuary or other person with relevant
knowledge and expertise to determine the financial impact.

(4) The impact on essential health benefits, as defined in Section
1367.005 of this code and Section 10112.27 of the Insurance Code,
and the impact on the California Health Benefit Exchange.

(b) The Legislature further requests that the California Health
Benefit Review Program assess legislation that impacts health
insurance benefit design, cost sharing, premiums, and other health
insurance topics.

(c) The Legislature requests that the University of California
provide every analysis to the appropriate policy and fiscal
committees of the Legislature not later than 60 days, or in a manner
and pursuant to a timeline agreed to by the Legislature and the
California Health Benefit Review Program, after receiving a request
made pursuant to Section 127661. In addition, the Legislature
requests that the university post every analysis on the Internet and
make every analysis available to the public upon request.

(d) As used in this section, “legislation proposing to mandate a
benefit or service” means a proposed statute that requires a health
care service plan or a health insurer, or both, to do any of the
following:

(1) Permit a person insured or covered under the policy or
contract to obtain health care treatment or services from a particular
type of health care provider.

(2) Offer or provide coverage for the screening, diagnosis, or
treatment of a particular disease or condition.

(3) Offer or provide coverage of a particular type of health care
treatment or service, or of medical equipment, medical supplies,
or drugs used in connection with a health care treatment or service.

(e) As used in this section, “legislation proposing to repeal a
mandated benefit or service” means a proposed statute that, if
enacted, would become operative on or after January 1, 2008, and
would repeal an existing requirement that a health care service
plan or a health insurer, or both, do any of the following:

(1) Permit a person insured or covered under the policy or
contract to obtain health care treatment or services from a particular
type of health care provider.

(2) Offer or provide coverage for the screening, diagnosis, or
treatment of a particular disease or condition.

(3) Offer or provide coverage of a particular type of health care
treatment or service, or of medical equipment, medical supplies,
or drugs used in connection with a health care treatment or service.