BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1135|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
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UNFINISHED BUSINESS
Bill No: SB 1135
Author: Monning (D)
Amended: 8/15/16
Vote: 21
SENATE HEALTH COMMITTEE: 8-1, 4/6/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Pan, Roth,
Wolk
NOES: Nielsen
SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/27/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Bates, Nielsen
SENATE FLOOR: 29-10, 6/2/16
AYES: Allen, Beall, Block, Cannella, De León, Galgiani,
Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso,
Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell,
Monning, Nguyen, Pan, Pavley, Roth, Vidak, Wieckowski, Wolk
NOES: Anderson, Bates, Berryhill, Fuller, Gaines, Huff,
Moorlach, Morrell, Nielsen, Stone
NO VOTE RECORDED: Runner
ASSEMBLY FLOOR: 58-19, 8/18/16 - See last page for vote
SUBJECT: Health care coverage: notice of timely access to
care
SOURCE: Health Access California
DIGEST: This bill requires health plans, health insurers and
Medi-Cal managed care plans to notify enrollees and contracted
providers about information on timely access to care standards
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and information about interpreter services, at least annually.
Assembly Amendments change the effective date to contracts or
policies issued, renewed, or amended after July 1, 2017 (from
January); permit a health care plan or insurer to include the
information with other materials sent to the enrollee or
insured; delete a requirement that the information be provided
where language assistance notifications are required; require at
least annually, in or with newsletters, outreach, or other
materials that are routinely disseminated to the plan's
enrollees; require the information in the provider directory
commencing January 1, 2018; and delete the specific notice
language and instead indicate information that a plan or insurer
must provide to a contracting provider, and permit the
information to be provided with an existing communication with a
contracting provider.
ANALYSIS:
Existing law:
1)Establishes the Department of Managed Health Care (DMHC) to
regulate health plans, the California Department of Insurance
(CDI) to regulate insurers, including health insurers, and the
Department of Health Care Services (DHCS) to administer the
Medi-Cal program.
2)Requires DMHC to develop and adopt regulations to ensure that
enrollees have access to needed health care services in a
timely manner and consider specified indicators of timeliness
of access to care, such as waiting times for appointments and
referrals.
3)Requires, pursuant to CDI regulations, insurers to disclose
annually, in insurer newsletters or comparable communications
to covered persons, CDI's standards for timely access, the
insurer's process for ensuring timely access, and what steps a
covered person should take when experiencing access problems
inconsistent with timely access standards, including when and
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how to access applicable CDI and insurer helplines.
This bill:
1)Requires a health plan contract or health insurance policy
issued, renewed, or amended on or after July 1, 2017, to
provide information to an enrollee or insured regarding the
standards for timely access to care, as specified, including
information related to receipt of interpreter services in a
timely manner, no less than annually.
2)Requires information about appointment wait times for urgent
care, nonurgent primary care, nonurgent specialty care, and
telephone screening to enrollees, insureds and contracted
providers. Specifies the information that must be provided no
less than annually to contracted providers.
3)Requires the information to be provided to consumers upon
initial enrollment, annually upon renewal, and to contracting
providers no less than on an annual basis. Permits the
information to be included with other materials. Requires the
information to be provided at least annually, in or with
newsletters, outreach, or other materials that are routinely
disseminated to enrollees or insureds.
4)Requires, commencing January 1, 2018, the information to be
provided in a separate section of the provider directory
titled "Timely Access to Care." Requires the information to
be provided on the plan or insurer's Internet Web site.
5)Applies the provisions of this bill as described above, to
plans with Medi-Cal managed care plan contracts with DHCS, as
specified.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to the Assembly Appropriations Committee,
administrative costs to the CDI of $65,000 in 2016-17 and
$79,000 in 2017-18 (Insurance Fund) and minor and absorbable
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costs to DMHC (DMHC Managed Care Fund) to verify plans and
insurers comply with this requirement.
SUPPORT: (Verified 8/16/16)
Health Access California (source)
AARP
ALS Association Golden West Chapter
American for Democratic Action, Southern California
Asian Law Alliance
Autism Speaks
California Academy of Family Physicians
California Chapter of the American College of Emergency
Physicians
California Catholic Conference
CaliforniaHealth+ Advocates
California Labor Federation
California Pan-Ethnic Health Network
California School Employees Association
California State Council of the Service Employees International
Union
California Teachers Association
CALPIRG
Center for Autism and Related Disorders
Coalition of California Welfare Rights Organizations, Inc.
Congress of California Seniors
Consumers Union
Doctors for America, California
Los Angeles Professional Peace Officers Association
Mental Health America of California
Mexican American Legal Defense and Education Fund
National Alliance of Mental Illness
National Health Law Program
National Multiple Sclerosis Society - CA Action Network
National Union of Healthcare Workers
Organization of SMUD Employees
Planned Parenthood Affiliates of California
San Diego County Court Employees Association
San Francisco Bay Area Physicians for Social Responsibility
San Luis Obispo County Employees Association
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Western Center on Law and Poverty
OPPOSITION: (Verified8/16/16)
None received
ARGUMENTS IN SUPPORT: Health Access California, the sponsor
of this bill, writes that very few consumers know these timely
access consumer protections exist or where to complain to state
regulators if they do not get timely access to care or care in
the language they speak. Consumers Union writes that California
stands out among the states for its strong, quantified standards
for how quickly enrollees are entitled to get care, from primary
care check-ups to urgent care. Yet, many consumers do not
realize they have these important rights to prompt care, as well
as to interpreter services to ensure clear communication with
their health care provider. This bill ensures that enrollees
get this important information. The Los Angeles Professional
Peace Officers Association states that consumers do not know
where to complain when they need help getting the care they need
when they need it. Western Center on Law and Poverty writes
that over 10 million Californians are enrolled in Medi-Cal
managed care plans but these individuals make up a small
fraction of individuals who file complaints with DMHC despite
representing a third of lives in health plans DMHC regulates.
The National Union of Healthcare Workers (NUHW) writes that in
recent years they have filed a successful complaint with DMHC
regarding a plan's failure to provide timely access to thousands
of California consumers seeking mental health services. As a
result of NUHW's work with consumers, they learned that many
consumers are unaware of their right to receive timely care.
The California Chapter of the American College of Emergency
Physicians writes that emergency physicians see the effects of
inadequate access to care on the patients they treat. Many
patients present to the emergency department seeking care for
health conditions that have significantly deteriorated because
care was delayed due to inability to access primary and
specialty providers. Similarly, emergency physician routinely
treat an emergency condition that requires follow up care, but
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even with the help of emergency department staff, the patient is
unable to book the needed follow-up appointment because of
inadequate networks.
ASSEMBLY FLOOR: 58-19, 8/18/16
AYES: Alejo, Arambula, Atkins, Baker, Bloom, Bonilla, Bonta,
Brown, Burke, Calderon, Campos, Chang, Chau, Chiu, Chu,
Cooley, Cooper, Dababneh, Daly, Dodd, Eggman, Frazier,
Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez,
Gonzalez, Gordon, Gray, Hadley, Holden, Irwin, Jones-Sawyer,
Lackey, Levine, Linder, Lopez, Low, Maienschein, McCarty,
Medina, Mullin, Nazarian, O'Donnell, Quirk, Ridley-Thomas,
Rodriguez, Salas, Santiago, Mark Stone, Thurmond, Ting,
Waldron, Weber, Williams, Wood, Rendon
NOES: Achadjian, Travis Allen, Bigelow, Brough, Chávez, Dahle,
Beth Gaines, Gallagher, Grove, Harper, Jones, Kim, Mathis,
Mayes, Melendez, Obernolte, Patterson, Wagner, Wilk
NO VOTE RECORDED: Roger Hernández, Olsen, Steinorth
Prepared by:Teri Boughton / HEALTH / (916) 651-4111
8/19/16 19:37:26
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