BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    SB 1135


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          SENATE THIRD READING


          SB  
          1135 (Monning)


          As Amended  August 15, 2016


          Majority vote


          SENATE VOTE:  29-10


           -------------------------------------------------------------------- 
          |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, |                     |








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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        |
            |                                                  |            |
            |                                                  |            |
            |                                                  |            |
             --------------------------------------------------------------- 


            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