BILL ANALYSIS Ó
SB 1135
Page 1
SENATE THIRD READING
SB
1135 (Monning)
As Amended August 15, 2016
Majority vote
SENATE VOTE: 29-10
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+-----------------------+---------------------|
|Health |13-4 |Wood, Bonilla, Burke, |Maienschein, |
| | |Campos, Chiu, Gomez, |Patterson, |
| | |Roger Hernández, |Steinorth, Waldron |
| | |Lackey, Nazarian, | |
| | | | |
| | | | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |McCarty | |
| | | | |
|----------------+-----+-----------------------+---------------------|
|Appropriations |15-5 |Gonzalez, Bloom, |Bigelow, Gallagher, |
| | |Bonilla, Bonta, |Jones, Obernolte, |
| | |Calderon, Chang, Daly, |Wagner |
| | |Eggman, Eduardo | |
| | |Garcia, Holden, Quirk, | |
| | |Santiago, Weber, Wood, | |
SB 1135
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| | |Chau | |
| | | | |
| | | | |
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SUMMARY: Requires a health care service plan (health plan) or
health insurer to provide enrollees or insureds with information
regarding standards for timely access to care (timely access
standards) pursuant to existing law for health plan and insurer
contracts effective July 1, 2017. A health plan or health
insurer may include the timely access standard information with
other materials sent to the enrollee or insured and must be
provided in a separate section of the evidence of coverage; at
least annually in or with newsletters, outreach or other
materials; and beginning, January 1, 2018, in a separate section
of the health plan or health insurer's provider directory.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, administrative costs to the California Department of
Insurance (CDI) of $65,000 in 2016-17 and $79,000 in 2017-18
(Insurance Fund) and minor and absorbable costs to the
Department of Managed Health Care (DMHC Managed Care Fund) to
verify plans and insurers comply with this requirement.
COMMENTS: According to the author, very few California
consumers know that they are entitled to timely access to care
and in their preferred language. In addition, a recent survey
found that an overwhelming majority do not even know which state
regulator oversees their health plan or how to file a complaint
with the appropriate regulator should an issue arise. The goal
of this bill is to help inform consumers about their timely
access rights so consumers are better able to insure health plan
accountability in meeting timely access standards. In addition,
by informing consumers about their timely access rights, more
accurate data can be compiled for policymakers and regulators
and assist in determining network adequacy.
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Timely access requirements. Both the DMHC and CDI have similar
timely access regulations which require each health plan or
health insurer to contract with adequate numbers of physicians
and other health care providers in each geographic area to meet
clinical and time elapsed standards. For example, the DMHC
includes the following appointment wait times on its Web site:
---------------------------------------------------------------
|Urgent Appointments: |Wait Time |
| | |
|--------------------------------------------------+------------|
|for services that don't need prior approval |48 hours |
| | |
|--------------------------------------------------+------------|
|for services that do need prior approval |96 hours |
| | |
|--------------------------------------------------+------------|
|Non-Urgent Appointments |Wait Time |
| | |
|--------------------------------------------------+------------|
|Primary care appointment |10 business |
| | |
| |days |
| | |
|--------------------------------------------------+------------|
|Specialist appointment |15 business |
| | |
| |days |
| | |
|--------------------------------------------------+------------|
|Appointment with a mental health care provider |10 business |
| | |
|(who is not a physician) |days |
| | |
|--------------------------------------------------+------------|
|Appointment for other services to diagnose or |15 business |
| | |
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|treat a health condition |days |
| | |
| | |
| | |
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The applicable waiting time for an appointment may be shorter or
longer as clinically appropriate based on the opinion of a
qualified health care professional acting within the scope of
his or her practice consistent with professionally recognized
standards of practice.
Medi-Cal timely access requirements. According to Medi-Cal
managed care contract provisions, Medi-Cal managed care plans
are required to meet the same timely access standards as
established by DMHC. Excerpts from those contracts include the
following: Contractor shall establish acceptable accessibility
standards in accordance
Consumer complaints. In the Fall of 2014, Consumer
Representatives to the National Association of Insurance
Commissioners fielded a survey of all 50 state insurance
commissioners to assess their work on network adequacy and the
commissioners reported that consumer complaints are one of the
strongest resources state agencies have for monitoring network
adequacy issues. In the spring of 2015, the Consumer Reports
National Research Center conducted a survey of 825
privately-insured English speaking Californians to learn more
about their experience with surprise medical bills. One of the
most striking findings of the survey was that most California
consumers do not understand that they can complain to a state
agency about health insurance. Specifically, the results
indicate that 85% of privately insured Californians do not know
which state agency is tasked with handling complaints about
health insurance. And only a small percentage (11%) surveyed
believe that a state agency is responsible for resolving health
insurance billing issues. More than two-thirds of Californians
(71%) are unaware of their right to appeal to the state or an
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independent medical expert if a health plan refuses coverage for
medical services they think they need.
Health Access California, sponsor of this bill, states that this
bill will provide consumers with information about their
existing rights so that they can get the care they need, when
they need it, in a language they can understand.
Analysis Prepared by:
Kristene Mapile / HEALTH / (916) 319-2097 FN:
0004055