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
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|Version: June 27, 2016 |Policy Vote: HEALTH 7 - 2 |
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|Urgency: No |Mandate: Yes |
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|Hearing Date: August 1, 2016 |Consultant: Brendan McCarthy |
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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
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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
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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
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