BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 1135| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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 SB 1135 Page 2 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 SB 1135 Page 3 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 SB 1135 Page 4 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 SB 1135 Page 5 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 SB 1135 Page 6 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 **** END ****