BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 1954


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          CONCURRENCE IN SENATE AMENDMENTS


          AB  
          1954 (Burke)


          As Amended  August 17, 2016


          Majority vote


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          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.









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          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  








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            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.










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          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










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