BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 1034 (Mitchell) - Health care coverage: autism
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|Version: April 26, 2016 |Policy Vote: HEALTH 6 - 0 |
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|Urgency: No |Mandate: Yes |
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|Hearing Date: May 27, 2016 |Consultant: Brendan McCarthy |
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Bill
Summary: SB 1034 would delete the existing statutory sunset on
the mandate to provide health care coverage for behavioral
health treatment for autism and related disorders. The bill
would also revise the existing benefit mandate and apply the
benefit mandate to health care coverage provided by CalPERS.
*********** ANALYSIS ADDENDUM - SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on May 27, 2016
Fiscal
Impact:
One-time costs of about $50,000 and ongoing costs of $15,000
per year to review health plan filings for compliance with the
requirements of the bill and to undertake any necessary
enforcement actions by the Department of Managed Health Care
(Managed Care Fund).
SB 1034 (Mitchell) Page 1 of
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Likely costs of less than $100,000 per year for review of
health insurance plan filings and enforcement actions by the
Department of Insurance (Insurance Fund).
No state costs are anticipated due to the elimination of the
existing sunset on the benefit mandate or the extension of the
existing benefit mandate to CalPERS coverage. While existing
law specifically mandates coverage for behavioral health
treatment, separate federal and state mental health parity
requirements and requirements for the provision of essential
health benefits implicitly require coverage for behavioral
health treatment for autism and related disorders. Therefore,
elimination of the statutory sunset and extension of the
mandate to CalPERS health coverage will not increase state
costs, because CalPERS plans would have to provide coverage
for these services even without a specific benefit mandate.
Nor will eliminating the sunset require the state to pay for
the costs to subsidize coverage for behavioral health
treatment coverage for subsidized Covered California plans.
Ongoing costs of about $300,000 per year due to a minor
increase in health care premiums to CalPERS due to the
expansion of the existing benefit mandate to require coverage
to "keep" the functioning of eligible individuals (General
Fund, special funds, and local funds). About half of the above
costs would accrue to the state and half to local governments.
See below.
Uncertain impact on CalPERS health care costs from other
changes to the existing benefit mandate in the bill (General
Fund, special funds, and local funds). According to the
California Health Benefits Review Program, there are several
changes to the existing benefit mandate that could increase
utilization of services, but that the Program was unable to
quantify. To the extent that those factors do increase
utilization, premium costs to CalPERS would increase.
No increased costs for the Medi-Cal program are anticipated
due to the bill. Current law exempts Medi-Cal managed care
plans from the existing benefit mandate. (However, federal
guidance requires coverage for behavioral health treatment for
Medi-Cal enrollees with autism or related disorders. The state
has just begun providing this benefit in Medi-Cal and is in
the process of transitioning Medi-Cal enrollee previously
SB 1034 (Mitchell) Page 2 of
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served by regional centers to having coverage provided by
Medi-Cal.) This bill does not eliminate the existing Medi-Cal
exemption.
Committee
Amendments: specify that the bill would not require coverage
for services required under a student's Individualized
Educational Program.
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