BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 244|
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THIRD READING
Bill No: AB 244
Author: Beall (D), et al
Amended: 9/1/09 in Assembly
Vote: 21
SENATE HEALTH COMMITTEE : 6-3, 7/15/09
AYES: Alquist, Cedillo, DeSaulnier, Leno, Pavley, Wolk
NOES: Strickland, Aanestad, Cox
NO VOTE RECORDED: Maldonado, Negrete McLeod
SENATE APPROPRIATIONS COMMITTEE : 8-4, 8/17/09
AYES: Kehoe, Corbett, Hancock, Leno, Oropeza, Price, Wolk,
Yee
NOES: Cox, Denham, Walters, Wyland
NO VOTE RECORDED: Runner
ASSEMBLY FLOOR : 50-29, 6/1/09 - See last page for vote
SUBJECT : Health care coverage: mental health services
SOURCE : Author
DIGEST : This bill requires health plans and insurers to
cover the diagnosis and medically necessary treatment of a
mental illness of a person of any age under the same terms
and conditions applied to other medical conditions.
Senate Floor Amendments of 9/1/09 clarify that specified
health plans or insurers that are exempt from the bill
include Medicare supplement insurance policies, or
CONTINUED
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specialized health insurance policies, except behavioral
health-only insurance policies.
ANALYSIS : Existing law provides for the regulation of
health care service plans and health insurers by the
Department of Managed Health Care (DMHC) and the Department
of Insurance (DOI), respectively. Existing law establishes
the Healthy Families Program (HFP), California's version of
the federal Children's Health Insurance Program (CHIP).
This bill requires every health care service plan contract
and health insurance policy issued, amended, or renewed on
or after January 1, 2010, that provides hospital, medical
or surgical coverage to provide coverage for the diagnosis
and medically necessary treatment of a mental illness of a
person of any age, including a child, under the same terms
and conditions applied to other medical conditions in its
entire service area and in emergency situations. This is
what is commonly referred to as mental health parity.
This bill provides that a health plan or insurer may
provide coverage for all or part of the required mental
health services through a separate specialized health care
service or mental health plan. This bill exempts Medicare
supplement insurance policies or specialized health
insurance policies, except behavioral health-only or
insurers contracted with the Board of Administration of the
California Public Employees' Retirement System (CalPERS),
and accident-only, specified disease, hospital indemnity,
Medicare supplement, dental-only, or vision-only health
plan contracts or insurance policies.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee, costs to
DMHC and CDI to oversee these new filings would be minor
and absorbable. A 2009 California Health Benefits Review
Program (CHBRP) report on this bill identified $104,000 in
costs to the Healthy Families Program (HFP). HFP benefits
are reimbursed 35 percent General Fund and 65 percent
federal funds. CHBRP anticipates no change in California's
uninsured population. AB 1887 (Beall) of 2008 and AB 423
(Beall) of 2007 were similar bills to this and were vetoed
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due to the costs of health mandates.
SUPPORT : (Verified 9/2/09)
Alliance of California Autism Organizations
American Federation of State, County and Municipal
Employees, AFL-CIO
Board of Behavioral Sciences
California Academy of Child and Adolescent Psychiatry
(8/26/09)
California Academy of Family Physicians
California Alliance for Retired Americans
California Association of Alcohol and Drug Program
Executives, Inc.
California Association of Marriage and Family Therapists
California Coalition for Mental Health
California Council of Community Mental Health Agencies
California Medical Association
California Mental Health Directors Association
California Psychological Association
California Society for Clinical Social Work
California Society of Addiction Medicine
California State Association of Counties
Congress of California Seniors
County Alcohol and Drug Program Administrators of
California
Disability Rights California
Drug Policy Alliance
Health Access California
Mental Health Association in California
National Alliance on Mental Illness, California Affiliate
National Association of Social Workers, California Chapter
Psychiatric Solutions, Inc.
The Developmental Disabilities Area Board 10 (if amended)
OPPOSITION : (Verified 9/2/09)
Anthem Blue Cross
Association of California Life and Health Insurance
Companies
California Association of Health Plans
California Association of Health Underwriters
California Association of Joint Powers Authority
California Chamber of Commerce
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Citizens Commission on Human Rights, Sacramento Chapter
CSAC Express Insurance Authority
Department of Managed Health Care
Health Net
Office of the Insurance Advisor
Right of Family
ARGUMENTS IN SUPPORT : According to the author's office,
this bill is intended to end discrimination against
patients with mental disorders and substance abuse
addictions, by requiring treatment and coverage of these
illnesses that is equivalent to coverage provided for other
medical illnesses. The author's office states that
inadequate access to mental health services forces law
enforcement officers to serve as the mental health
providers of last resort; the lack of access to appropriate
care result for mentally ill persons often results in
incarceration, and this misuse of the corrections system
costs state taxpayers roughly $1.8 billion per year. The
author's office argues that the practice by the private
insurance market of excluding or limiting coverage of
mental health services benefits the private insurance
market, and shifts that financial burden to the state and
to counties. The author's office adds that mentally ill
persons who lack access to appropriate care often end up in
emergency rooms and receive mental health services from
county programs. The author's office argues that almost
all plans discriminate against patients with biological
brain disorders such as schizophrenia, depression and manic
depression, as well as posttraumatic stress disorders
suffered by victims of crime, abuse or disaster. The
author's office contends that this bill corrects a serious
problem that bankrupts families and causes enormous
taxpayer expense.
The California State Association of Counties (CSAC) states
that numerous studies have shown that mental illness is
treatable, and that appropriate and timely treatment of
mental health conditions and disorders reduces costly
hospitalizations, incarcerations, homelessness, and human
suffering. CSAC argues that a growing body of evidence
suggests that mental health parity outweighs the societal
costs and risks associated with untreated illness. CSAC
contends that this bill helps ensure that private health
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plans treat individuals with mental health, substance
abuse, or co-occurring disorders in a comprehensive way.
The California Council of Community Mental Health Agencies
(CCCMHA) and the California Coalition for Mental Health
(CCMH) state that, as a result of the federal mental health
parity law that goes into effect on October 3, 2009,
California needs to update its statute to be in full
compliance, and to fill in the gaps in service that will be
left uncovered by the federal bill. CCCMHA and CCMH argue
that, California was a national leader in passing a
landmark mental health parity law a decade ago, but will
fall behind other states if it fails to pass this bill.
The Drug Policy Alliance (DPA) states that, addiction and
mental illness, which are often co-occurring, are the only
conditions which, left untreated, often lead to the
incarceration of the sufferer. There are over 30,000 drug
violators in prisons today at a cost of $49,000 per
offender. DPA contends that this bill reduces costs to the
criminal justice system.
The Board of Behavioral Sciences (BBS) argues that any
costs associated with this bill will be more than offset by
increased productivity of workers, overall reduction of
medical costs, crime, and homelessness.
ARGUMENTS IN OPPOSITION : The Office of the Insurance
Advisor states that California currently has 44 mandates on
health insurance policies and adding a new mandate, such as
that in this bill, increases health costs and simply shift
costs without fully addressing affordability, cost
containment, and shared responsibilities.
The Department of Managed Health Care states that, although
the intent of this bill has merit, health plans would
likely increase the monthly premiums of enrollees, which
may lead more individuals to drop existing coverage,
further increasing the uninsured population. DMHC further
states that, due to its nature as a mandate, this bill will
further elevate already high health care costs in
California.
The California Association of Health Plans argues that this
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bill goes much further than federal legislation that will
go into effect in October, 2009, by expanding state level
coverage requirements to include all 400 identified DSM IV
disorders, and that expanding current mandates in this
manner increases costs for private employers and
individuals purchasing insurance in the private market.
ASSEMBLY FLOOR :
AYES: Ammiano, Arambula, Beall, Blumenfield, Brownley,
Buchanan, Caballero, Charles Calderon, Carter, Chesbro,
Cook, Coto, Davis, De La Torre, De Leon, Eng, Evans,
Feuer, Fong, Fuentes, Furutani, Galgiani, Hall, Hayashi,
Hernandez, Hill, Huffman, Jones, Krekorian, Lieu, Bonnie
Lowenthal, Ma, Mendoza, Monning, Nava, John A. Perez, V.
Manuel Perez, Portantino, Price, Ruskin, Salas, Saldana,
Skinner, Solorio, Swanson, Torlakson, Torres, Torrico,
Yamada, Bass
NOES: Adams, Anderson, Bill Berryhill, Tom Berryhill,
Blakeslee, Conway, DeVore, Duvall, Emmerson, Fletcher,
Fuller, Gaines, Garrick, Gilmore, Hagman, Harkey, Huber,
Jeffries, Knight, Logue, Miller, Nestande, Niello,
Nielsen, Silva, Smyth, Audra Strickland, Tran, Villines
NO VOTE RECORDED: Block
DLW:RJG:do 9/2/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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