BILL ANALYSIS Ó AB 1954 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 1954 (Burke) As Amended August 17, 2016 Majority vote -------------------------------------------------------------------- |ASSEMBLY: |53-23 |(May 23, 2016) |SENATE: |28-11 |(August 22, | | | | | | |2016) | | | | | | | | | | | | | | | -------------------------------------------------------------------- Original Committee Reference: HEALTH SUMMARY: Establishes the Direct Access to Reproductive Health Care Act, which prohibits health care service plans (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. The Senate amendments: 1)Add intent language indicating 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. AB 1954 Page 2 2)Add language specifying that reproductive and sexual health care services do not include the services subject to a health plan's referral procedures as required by standing referral to specialist provisions in existing law. 3)Add language permitting a health plan and health insurer to establish reasonable provisions governing utilization protocols for obtaining reproductive and sexual health care services provided that these provisions are consistent with the intent of this bill; are customarily applied to other health care providers to whom the enrollee or insured has direct access; and, are not more restrictive. 4)Add language permitting a health plan and health insurer to establish provisions governing communication with the enrollee or insured's primary care physician and surgeon regarding the enrollee or insured's condition, treatment, and any need for follow-up care. 5)Add language prohibiting health plans and health insurers from imposing utilization protocols related to contraceptive drugs, supplies, and devices beyond the provisions in existing law. 6)Add language specifying that this bill does not apply to a health plan contract or insurance policy that does not require enrollees or insureds to obtain a referral from their primary care physician prior to seeking covered health care services from a specialist. FISCAL EFFECT: According to the Senate Appropriations Committee, 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 (DMHC Managed AB 1954 Page 3 Care Fund). 2)Ongoing costs of about $10,000 per year for review of health insurer filings by the California Department of Insurance (CDI Insurance Fund). 3)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. 4)No significant cost impact is anticipated for health care coverage paid for by the California Public Employees' Retirement System (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 (CHBRP) projected that there would not be a significant overall increase in utilization of services. Therefore, CHBRP projects that this 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), this bill is not expected to result in the state being responsible for subsidizing coverage. AB 1954 Page 4 COMMENTS: 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 obstetrician-gynecologist (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. This bill 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 health plans, creating more equitable access to care for all enrollees. CHBRP analysis. AB 1996 (Thomson), Chapter 795, Statutes of 2002, requests 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. CHBRP was created in response to AB 1996. CHBRP reviewed an earlier version of this bill which mandated coverage for out-of-network reproductive and sexual health care. Although the CHBRP analysis is not entirely relevant based on the current version of this bill, the CHBRP report provides 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 a sexually transmitted disease (STD) each year. Access to timely screening and treatment for STDs and human immunodeficiency virus (HIV) testing is critical to preventing further spread of these diseases and limiting the health impacts of infected individuals. Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097 FN: 0004544 AB 1954 Page 5