BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1954|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: AB 1954
Author: Burke (D)
Amended: 8/17/16 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: 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 receiving coverage or services for reproductive and sexual
health care services.
Senate Floor Amendments of 8/17/16 clarify that for health
plans, 'reproductive and sexual health care services" do not
include the services subject to standing referral by a
specialist, as specified, and make other technical revisions.
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ANALYSIS:
Existing law:
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
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the enrollee's condition, treatment, and any need for
follow-up care.
This bill:
1)Requires every health plan contract or health insurance policy
issued, amended, renewed, or delivered on or after January 1,
2017, to be prohibited from requiring an enrollee to receive a
referral prior to receiving coverage or services for
reproductive and sexual health care services.
2)Defines "reproductive and sexual health care services" as all
reproductive and sexual health services described in existing
law related to minor consent for HIV testing, pregnancy
prevention, sexual transmitted disease (STD) treatment and
medical treatment after rape and sexual assault, as specified.
Indicates that this bill applies whether or not the patient
is a minor.
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,
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supplies, and devices, as specified.
6)Exempts specialized health plans, specialized health
insurance, health plans governed by Medi-Cal, Medicare
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
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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
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:
1)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).
2)Ongoing costs of about $10,000 per year for review of health
insurer filings by the Department of Insurance (Insurance
Fund).
3)No impact to the Medi-Cal program is anticipated, as the bill
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specifically excludes health plans that contract with the
Medi-Cal program from the requirements in the bill.
4)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.
5)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: (Verified8/17/16)
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
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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
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: (Verified8/17/16)
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
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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,
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
8/22/16 9:47:52
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