BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
56 (Portantino)
Hearing Date: 8/27/2009 Amended: 7/8/2009
Consultant: Katie Johnson Policy Vote: Health 7-2
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BILL SUMMARY: AB 56 would require health care service plan
contracts and individual or group health care insurance policies
to provide coverage for mammography screening or diagnostic
purposes upon the referral of a participating physician
assistant and would require plans and insurers to provide
enrollees or insureds with information regarding recommended
timelines for screening for breast cancer.
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Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12 Fund
Increased number of $0 up to $375 up to
$375 General/
Medi-Cal, AIM, and Federal/
MRMIP mammographies Special
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STAFF COMMENTS: SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
Existing law provides for the regulation of health care service
plans and health insurance policies by the Department of Managed
Health Care (DMHC) and the California Department of Insurance
(CDI). Existing law requires that health plans and insurers
cover mammography for screening or diagnostic purposes upon
referral by a participating nurse practitioner, certified
nurse-midwife, or physician.
This bill would require health plan contracts and health
insurance policies issued, amended, delivered, or renewed on or
after July 1, 2010, to cover mammography for screening or
diagnostic purposes upon the referral of a participating
physician assistant, in addition to those providers under
current law.
This bill would, commencing July 1, 2010, require plans and
insurers to provide enrollees or insureds with information
regarding recommended timelines for an individual to undergo
tests for the screening or diagnosis of breast cancer, as
specified.
Any costs to CDI and DMHC as a result of implementing these
provisions would be minor and absorbable.
According to a 2009 analysis of this bill by the California
Health Benefits Review Program (CHBRP), this bill would cause
20,000 more women to receive mammographic screening and
diagnosis annually, which could impact health care programs
administered and funded by the state. Since the analysis'
publication, the requirement for health plans and insurers to
provide written notification to women the year that national
guidelines indicate they should start screening for breast
cancer has been
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AB 56 (Portantino)
deleted, so the 20,000 mammograms annually may no longer be
accurate. Instead, this bill would require health plans and
insurers to provide information to enrollees and insureds
regarding recommended timelines for the screening and diagnosis
of breast cancer in the form of a written letter, publication in
a newsletter, publication in evidence of coverage, a telephone
call, an email, and various other means. However, to the extent
that this bill increases the number of mammograms annually,
there would be costs to Medi-Cal, Access for Infants and Mothers
(AIM), and the Major Risk Medical Insurance Program (MRMIP).
This could result in up to approximately $375,000 in additional
costs, using the 20,000 additional mammograms as the high end
estimate of additional mammograms resulting from this bill's
provisions.
Medi-Cal costs are generally shared equally between the federal
government (FF) and state General Fund (GF). However, as a
result of the passage of the American Reinvestment and Recovery
Act (ARRA) in February of 2009, the Federal Medical Assistance
Percentage (FMAP) increased from 50 percent to 61.59 percent.
Thus, retroactively from October 1, 2008, through December 31,
2010, the federal government would pay for approximately 62
percent and the state General Fund would pay for 38 percent of
benefit-related Medi-Cal expenditures. After December 31, 2010,
the FMAP reduces to 50 percent FF, 50 percent GF.
The Access for Infants and Mothers (AIM) program and the Major
Risk Medical Insurance Program (MRMIP) are generally funded by
enrollee premiums and tobacco tax revenues. However, due to
recent budget cuts of $85 million of AIM's $149 million
appropriation, MRMIB indicates that AIM will close in January
2010.
There would also be minor and absorbable costs to the
state-payer portion of the California Public Employees
Retirement System (CalPERS) and no fiscal impact on the Healthy
Families Program.
The author's proposed amendments would make changes throughout
this bill to change "enrollee" to "subscriber" and "insured" to
"policyholder" and other minor technical changes.