BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular Session AB 1954 (Burke) - Health care coverage: reproductive health care services ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: June 27, 2016 |Policy Vote: HEALTH 7 - 2 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: Yes | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: August 1, 2016 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- This bill meets the criteria for referral to the Suspense File. Bill Summary: AB 1954 would prohibit health insurers and health plans from requiring an enrollee to receive a referral before accessing services for reproductive and sexual health care. Fiscal Impact: One-time costs of $150,000 and ongoing costs of $20,000 per year for the adoption of regulations and the review of plan filings by the Department of Managed Health Care (Managed Care Fund). Ongoing costs of about $10,000 per year for review of health insurer filings by the Department of Insurance (Insurance Fund). No impact to the Medi-Cal program is anticipated, as the bill specifically excludes health plans that contract with the Medi-Cal program from the requirements in the bill. AB 1954 (Burke) Page 1 of ? No significant cost impact is anticipated for health care coverage paid for by CalPERS. According to an analysis of a prior version of this bill (which would have also required health insurers and health plans to provide access to out-of-network providers of reproductive and sexual health care services), the California Health Benefits Review Program projected that there would not be a significant overall increase in utilization of services. Therefore, the Program projects that the bill will not result in an increase in health care premiums for CalPERS. No state cost to subsidize health care coverage through Covered California is anticipated. Under federal law, any new mandated health benefit that exceeds the benefits in the state's essential health benefits benchmark plan would be a state responsibility. In other words, to the extent that the state imposes a new benefit mandate that exceeds the essential health benefits benchmark, the state would be responsible for paying for the cost to subsidize that benefit for those individuals who are receiving subsidized coverage through Covered California. Because this bill does not mandate a new benefit, but only change the terms of an existing benefit (access to reproductive and sexual health care services), the bill is not expected to result in the state being responsible for subsidizing coverage. Background: Under current law, health insurers are regulated by the Department of Insurance and health plans are regulated by the Department of Managed Health Care. Under current law, reproductive and sexual health care services are covered benefits and must be provided by health insurers and health plans. Current law specifies that health insurers and health plans must provide coverage for approved contraceptive drugs and devices, voluntary sterilization, patient education relating to contraception, and follow up services. Current law requires health insurers and health plans to allow enrollees to seek obstetrical and gynecological services directly from providers in a health insurance or health plan network, without receiving a prior referral for those services. AB 1954 (Burke) Page 2 of ? Proposed Law: AB 1954 would prohibit health insurers and health plans from requiring an enrollee to receive a referral before accessing services for reproductive and sexual health care. Specific provisions of the bill would: Prohibit health insurance policies and health plans from requiring an enrollee to receive a referral prior to receiving coverage or services for reproductive and sexual health care; Define reproductive and sexual health care services by reference to existing law; Specify that the requirements of the bill apply to minors; Authorize health insurers and health plans to establish reasonable utilization protocols for providers in the health insurance or health plan network; Authorize health insurers and health plans to establish reasonable provisions governing communication with the enrollee's primary care physician; Prohibit health insurers and health plans from imposing utilization controls for contraceptive drugs or devices beyond what is currently authorized in law; Exempt specialized health plans, Medi-Cal managed care plans, Medicare plans, and several other specialty health insurance products. Staff Comments: According to an analysis of a prior version of this bill, there are some potential public health benefits associated with providing quicker access to reproductive and sexual health care services. For example, there is evidence that access to emergency contraception, sexually transmitted disease testing and treatment, and the collection of forensic evidence and/or emergency contraception following sexual assault or rape all have public health benefits when provided quickly. Whether or not this bill substantially increases access to those services in a timely way is unclear, therefore the Program was not able to quantify benefits to public health. The only costs that may be incurred by a local agency relate to crimes and infractions. Under the California Constitution, such costs are not reimbursable by the state. AB 1954 (Burke) Page 3 of ? -- END --