BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          SB 1135 (Monning) - Health care coverage:  notice of timely  
          access to care
          
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          |Version: March 30, 2016         |Policy Vote: HEALTH 8 - 1       |
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          |Urgency: No                     |Mandate: Yes                    |
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          |Hearing Date: April 25, 2016    |Consultant: Brendan McCarthy    |
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          This bill meets the criteria for referral to the Suspense File.


          Bill  
          Summary:  SB 1135 would require health plans and health insurers  
          (including Medi-Cal managed care plans) to notify enrollees and  
          contracted providers about existing requirements to provide  
          timely access to covered health care services. The bill would  
          require health plans and health insurers (including Medi-Cal  
          managed care plans) to include the appropriate regulatory  
          agency's phone number on an enrollee's proof of coverage card.


          Fiscal  
          Impact:  
           Likely costs in the tens of millions per year for the  
            Department of Managed Health Care to respond to questions and  
            complaints from health plan enrollees and take enforcement  
            action against health plans, when appropriate (Managed Care  
            Fund).  See staff comments below.

           Likely costs in the low millions for the Department of  
            Insurance to respond to questions and complaints from Health  







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            insurance enrollees and take enforcement action against health  
            insurers, when appropriate (Insurance Fund). See staff  
            comments below.

           Likely costs in the millions for the Medi-Cal Managed Care  
            Office of the Ombudsman to respond to questions and complaints  
            from enrollees in Medi-Cal managed care plans not regulated by  
            the Department of Managed Health Care (General Fund and  
            federal funds). See staff comments below.
            
           No significant increase in Medi-Cal utilization or costs are  
            anticipated under the bill. Medi-Cal managed care plans are  
            required to comply with existing timely access requirements  
            and are already required to notify enrollees of those  
            requirements. It is not anticipated that providing the  
            additional information under the bill will significantly  
            increase enrollee utilization of services.


          Background:  Under current law, health plans and health insurers are  
          required to meet timely access standards - under which they are  
          required to ensure that enrollees have access to covered  
          benefits in specified timeframes. Health plans and health  
          insurers are not required to provide specific notice of those  
          timely access rights to their enrollees, although some health  
          plans or health insurers may do so as part of the information  
          they provide to enrollees on covered benefits and health care  
          networks. Medi-Cal managed care plans are required to provide  
          such information to enrollees upon enrollment and ever year,  
          under the plans' contracts with the Department of Health Care  
          Services.


          Proposed Law:  
            SB 1135 would require health plans and health insurers  
          (including Medi-Cal managed care plans) to notify enrollees and  
          contracted providers about existing requirements to provide  
          timely access to covered health care services. The bill would  
          require health plans and health insurers (including Medi-Cal  
          managed care plans) to include the appropriate regulatory  
          agency's phone number on an enrollee's proof of coverage card.
          Specific provisions of the bill would:
           Require health plan contracts or health insurance contracts to  
            provide information on requirements for timely access to care  








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            for enrollees and enrollee rights to interpretation services;
           Require such disclosures to include specific information on  
            timely access requirements in law and regulation;
           Require the information to be provided upon enrollment and  
            annually thereafter;
           Require the information to be provided in specified ways,  
            including in the enrollee's evidence of coverage, in provider  
            directories, and on the health plan or health insurer's  
            website;
           Require the same information to be provided annually to  
            providers that contract with a health plan or health insurer;
           Apply these requirements to Medi-Cal managed care plans;
           Require health plans and health insurers to provide the  
            toll-free number and website for either the Department of  
            Managed Health Care or the Department of Insurance on the  
            enrollee's proof of coverage card;
           Require Medi-Cal managed care plans not regulated by the  
            Department of Managed Health Care to provide the toll-free  
            number for the Medi-Cal Managed Care Office of the Ombudsman  
            on the enrollee's proof of coverage card.


          Staff  
          Comments:  Under current law and practice, enrollees in health  
          plans and health insurance have proof of coverage cards which  
          include the health plan or health insurer's toll-free number for  
          enrollee questions or complaints about covered benefits, access  
          to services, and other issues. According to data collected by  
          the Department of Managed Health Care, about 7% of the state's  
          25 million health plan enrollees contact their health plan each  
          month. On the other hand, the Department gets about 100,000  
          calls per year from health plan enrollees. This indicates that a  
          relatively small number of enrollees either need to contact the  
          Department or are aware that they can contact the Department if  
          they are unhappy with their health plan's response.
          By putting the Department of Managed Health Care's toll-free  
          line on the enrollee's proof of coverage card, enrollee  
          awareness of the option to contact the Department will increase  
          dramatically. It is likely that the number of enrollees who  
          contact the Department (either instead of calling their health  
          plan or if they are not satisfied with the health plan's  
          response) will rise dramatically.  According to calculations by  
          the Department, if even 3% of the enrollees who contact their  
          plan each year call the Department for assistance, it will  








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          result in over 500,000 additional calls per year. At that call  
          volume, the cost to the Department to respond to calls and take  
          enforcement action when appropriate will be about $50 million  
          per year.


          Health insurance companies would also be required to provide the  
          toll-free number for the Department of Insurance. Medi-Cal  
          managed care plans not regulated by the Department of Managed  
          Health Care would be required to provide the toll-free number  
          for the Medi-Cal Office of the Ombudsman. It is likely that both  
          of those departments would receive a similar call volume in  
          proportion to their enrollments. The cost estimates above assume  
          that a similar proportion of their enrollees contact those  
          departments each year, at a similar cost per call to operate  
          their call centers.


          The only costs that may be incurred by a local agency relate to  
          crimes and infractions. Under the California Constitution, such  
          costs are not reimbursable by the state.




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