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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|ASSEMBLY: |53-23 |(May 23, 2016) |SENATE: |28-11 |(August 22, |
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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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