BILL ANALYSIS Ó SB 1135 Page 1 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, | | SB 1135 Page 2 | | |Chau | | | | | | | | | | | | -------------------------------------------------------------------- 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. SB 1135 Page 3 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 | | | | SB 1135 Page 4 |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 SB 1135 Page 5 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