BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1954| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 1954 Author: Burke (D) Amended: 6/27/16 in Senate Vote: 21 SENATE HEALTH COMMITTEE: 7-2, 6/22/16 AYES: Hernandez, Hall, Mitchell, Monning, Pan, Roth, Wolk NOES: Nguyen, Nielsen SENATE APPROPRIATIONS COMMITTEE: 5-2, 8/11/16 AYES: Lara, Beall, Hill, McGuire, Mendoza NOES: Bates, Nielsen ASSEMBLY FLOOR: 53-23, 5/23/16 - See last page for vote SUBJECT: Health care coverage: reproductive health care services SOURCE: Author California Family Health Council California Latinas for Reproductive Justice NARAL Pro-Choice California DIGEST: This bill establishes the Direct Access to Reproductive Health Care Act, which prohibits health plans and health insurers from requiring an enrollee to receive a referral prior to obtaining reproductive and sexual health care services. ANALYSIS: Existing law: AB 1954 Page 2 1)Establishes the Department of Managed Health Care (DMHC), which regulates health care service plans (health plans), and the California Department of Insurance (CDI), which regulates insurers. 2)Requires a health plan contract, or group or individual disability insurance policy, except as specified, that is issued, amended, renewed, or delivered on or after January 1, 2016, to provide coverage for specified services and contraceptive methods for women. 3)Requires every health plan contract, as specified, to allow an enrollee the option to seek obstetrical and gynecological physician services directly from a participating obstetrician and gynecologist (OB-GYN) or directly from a participating family practice physician and surgeon designated by the plan as providing those services. 4)Permits a health plan or insurer to establish reasonable provisions governing utilization protocols and the use of OB-GYN, or family practice physicians and surgeons participating in the plan network, medical group, or independent practice association, consistent with the law, those customarily applied to other physicians and surgeons, such as primary care physicians and surgeons, to whom the enrollee has direct access, and not more restrictive for the provision of obstetrical and gynecological physician services. Prohibits an enrollee from being required to obtain prior approval from another physician, another provider, or the health plan prior to obtaining direct access to obstetrical and gynecological physician services. Permits the plan to establish reasonable requirements for the participating OB-GYN or family practice physician and surgeon to communicate with the enrollee's primary care physician and surgeon regarding the enrollee's condition, treatment, and any need for follow-up care. This bill: 1)Requires every health plan contract or health insurance policy AB 1954 Page 3 issued, amended, renewed, or delivered on or after January 1, 2017, to be prohibited from requiring an enrollee to receive a referral prior to obtaining reproductive and sexual health care services. 2)Defines "reproductive and sexual health care services" as the prevention or treatment of pregnancy, including birth control, emergency contraceptive services, pregnancy tests, prenatal care, abortion, and abortion-related procedures; the screening, prevention, testing, diagnosis, and treatment of sexually transmitted infections and sexually transmitted diseases; the diagnosis and treatment of sexual assault or rape, including the collection of medical evidence with regard to the alleged rape or sexual assault; and the screening, prevention, testing, diagnosis, and treatment of the human immunodeficiency virus (HIV). 3)Permits a health plan or health insurer to establish reasonable provisions governing utilization protocols for obtaining reproductive and sexual health care services from health care providers participating in, or contracting with, the plan network, medical group, or independent practice association, provided that these provisions are consistent with the intent of this bill and those customarily applied to other health care providers, such as primary care physicians and surgeons, to whom the enrollee has direct access, and not more restrictive for the provision of reproductive and sexual health care services. 4)Prohibits an enrollee or insured from being required to obtain prior approval from another physician, another provider, the health plan or health insurer prior to obtaining direct access to reproductive and sexual health care services. Permits a plan or insurer to establish provisions governing communication with the enrollee's primary care physician and surgeon regarding the enrollee's or insured's condition, treatment, and any need for follow-up care. 5)Prohibits a health plan or health insurer from imposing utilization protocols related to contraceptive drugs, supplies, and devices, as specified. 6)Exempts specialized health plans, specialized health insurance, health plans governed by Medi-Cal, Medicare AB 1954 Page 4 supplement insurance, short-term limited duration health insurance, CHAMPUS supplement insurance, or TRICARE supplement insurance, or to hospital indemnity, accident-only, and specified disease insurance; and a health plan or insurance policy that does not require insureds to obtain a referral prior to seeking covered services from a specialist. 7)States legislative intent that there are wide variances in health benefit plans regarding referral requirements for reproductive and sexual health care services, and women across the state are obtaining these vital services from other licensed provider types, including family practice physicians, nurse practitioners, physician assistants, and certified nurse-midwives; and this bill is intended to increase timely, equal, and direct access to time-sensitive and comprehensive reproductive and sexual health care services. Comments 1)Author's statement. According to the author, for many women, reproductive health care is primary care. Nearly three-quarters of women of reproductive age in the nation receive at least one sexual or reproductive health service each year. While we've taken some steps to improve access to care, including the allowance through the Affordable Care Act which enables women to access OB-GYN care without a referral, there is still more to be done to ensure that Californians have timely access to the care they need without unnecessary barriers. AB 1954 eliminates the patchwork of referral policies for in-network providers for enrollees seeking reproductive and sexual health care services. By removing the unnecessary administrative burdens that cause delays in care, this bill levels the playing field across plans, creating more equitable access to care for all enrollees. 2)Use and access to services. The California Health Benefits Review Program (CHBRP) reviewed an earlier version of AB 1954 which mandated coverage for out-of-network reproductive and sexual health care. CHBRP resulted from the passage of AB 1996 (Thomson, Chapter 795, Statutes of 2002), which requested the University of California to assess legislation proposing a mandated benefit or service and prepare a written analysis with relevant data on the medical, economic, and public health AB 1954 Page 5 impacts of proposed health plan and health insurance benefit mandate legislation. Although the CHBRP analysis is not entirely relevant based on the current version of AB 1954, the CHBRP report provides some helpful background information. For example, according to CHBRB, it is estimated that among the insured population in California aged 12 and older, 21% get tested for an STD each year. Access to timely screening and treatment for STDs and HIV testing is critical to preventing further spread of these diseases and limiting the health impacts of infected individuals. Timely access to care has been cited by patients of specialized STD testing and reproductive health clinics as a major reason for seeking services there instead of at their usual places of care, even among those patients who have health insurance (Hoover et al., 2015). Unmet need for prevention and treatment of pregnancy services among the insured population may be underestimated due to their use of specialized publicly-funded family planning clinics. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: Yes According to the Senate Committee of Appropriations: 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. 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 AB 1954 Page 6 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. SUPPORT: (Verified8/9/16) California Family Health Council (co-source) California Latinas for Reproductive Justice (co-source) NARAL Pro-Choice California (co-source) ACT for Women American Congress of Obstetricians and Gynecologists District IX Anti-Defamation League Bayer Black Women for Wellness California Academy of Family Physicians California Health+Advocates California National Organization for Women California Primary Care Association Community Clinic Association of Los Angeles County Community Clinic Consortium Forward Together HIVE Latino Coalition for a Healthy California Law Students for Reproductive Justice Los Angeles LGBT Center AB 1954 Page 7 Maternal and Child Health Access NARAL Pro-Choice California National Association of Social Workers National Health Law Program Nevada County Citizens for Choice Northeast Valley Health Corporation Physicians for Reproductive Health Planned Parenthood Affiliates of California Secular Coalition for California URGE: Unite for Reproductive & Gender Equity Women's Community Clinic Women's Health Specialists of California OPPOSITION: (Verified8/9/16) California Catholic Conference California Right to Life Committee, INC ARGUMENTS IN SUPPORT: The California Family Health Council writes that nearly three-quarters of women of reproductive age in the nation receive at least one sexual or reproductive health service each year. Commercial health plans operating in California currently widely vary in terms of referral policies. Variances in these policies have created a patchwork of coverage and access to time sensitive-reproductive health services. NARAL Pro-Choice California indicates that requiring referrals also triggers potential confidentiality concerns that lead to further delays in obtaining care. ACT for Women writes that this bill would remove unnecessary administrative burdens that cause delays in care, and level the playing field to create greater, more equitable access to sexual and reproductive health care services by allowing access without referrals. The American Congress of Obstetricians and Gynecologists District IX writes that this bill builds on the Affordable Care Act by allowing patients in commercial health plans to obtain family planning and sexual health services without referrals from other providers including advanced practice clinicians, like nurse practitioners and certified nurse midwives. ARGUMENTS IN OPPOSITION: The California Catholic Conference, AB 1954 Page 8 Inc., believes this bill reduces the standard of care for women and girls because it would bypass the referral process in our health care system. AB 1954 would not be in the best interest of women, nonetheless young girls who are generally much less informed about their own reproductive and sexual health care. The California Right to Life Committee, INC, finds this bill to be detrimental to women's and children's health, irresponsible spending of health care dollars and an actual barrier to betterment of lives in general. ASSEMBLY FLOOR: 53-23, 5/23/16 AYES: Alejo, Atkins, Baker, Bloom, Bonilla, Bonta, Brown, Burke, Calderon, Campos, Chang, Chau, Chiu, Chu, Cooper, Dababneh, Daly, Dodd, Frazier, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Hadley, Roger Hernández, Holden, Irwin, Jones-Sawyer, Levine, Lopez, Low, Maienschein, McCarty, Medina, Mullin, Nazarian, O'Donnell, Olsen, Quirk, Ridley-Thomas, Rodriguez, Santiago, Mark Stone, Thurmond, Ting, Weber, Williams, Wood, Rendon NOES: Achadjian, Travis Allen, Bigelow, Brough, Chávez, Dahle, Beth Gaines, Gallagher, Grove, Harper, Jones, Kim, Lackey, Linder, Mathis, Mayes, Melendez, Obernolte, Salas, Steinorth, Wagner, Waldron, Wilk NO VOTE RECORDED: Arambula, Cooley, Eggman, Patterson Prepared by:Teri Boughton / HEALTH / (916) 651-4111 8/15/16 19:36:12 **** END ****