BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
2093 (M. Perez)
Hearing Date: 8/2/2010 Amended: 7/15/2010
Consultant: Katie Johnson Policy Vote: Health 7-1
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BILL SUMMARY: AB 2093 would prohibit health plan and insurer
contracts and policies issued, amended, or renewed on or after
January 1, 2011, that provides coverage for childhood and
adolescent immunizations from imposing cost-sharing mechanisms
on immunizations. The bill would further prohibit health plans
and insurers that provide coverage for childhood and adolescent
immunizations from requiring physicians and physician groups to
bear the financial risk for the administration costs, in
addition to the acquisition costs, of required immunizations for
children, as a condition of accepting a contract issued,
amended, or renewed on or after January 1, 2011.
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Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
DMHC filings modification $60 ongoing minor and
absorbableSpecial*
*Managed Care Fund
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STAFF COMMENTS:
Costs to the Department of Managed Health Care (DMHC) would be
approximately $60,000 in FY 2010-2011 and minor and absorbable
thereafter, to review modified health plan filings associated
with this bill. Any fiscal impact on the California Department
of Insurance (CDI) would be minor and absorbable.
This bill would prohibit health plan and insurer contracts and
policies issued, amended, or renewed on or after January 1,
2011, that provides coverage for childhood and adolescent
immunizations from imposing cost-sharing mechanisms, such as a
deductible or copayment, or dollar limits on immunizations.
Health plans and insurers would be prohibited from requiring
physicians and physician groups to bear the financial risk for
the administration costs of administering required vaccinations
for children as a condition of accepting the contract for
contracts issued, amended, or renewed on or after January 1,
2011. Currently, physicians and physician groups may not be
required to assume financial risk for the acquisition costs of
vaccines as a condition of the contract. This bill would permit
the cost of administering the vaccine, in addition to the
acquisition costs, to be part of the contract negotiation
between a physician or physician group and a plan or insurer.
This bill would require that health plans and insurers include
the cost of administration of a vaccine in its reimbursement of
a physician or physician group for that service. Administration
would be defined to include physician, clinical staff, and
office staff time
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AB 2093 (M. Perez)
as well as the costs of storage, insurance, supplies, and
medical equipment, and would be required to be an amount not
less than that specified in the most current annual Medicare
physician fee schedule. Health plans and insurers would be
prohibited from including the cost of the administration of
vaccines in the capitation rate of a physician who is
individually capitated. However, physician groups may assume
such risk, as specified.
Medi-Cal and the Healthy Families Program would be exempt from
these provisions. The California Public Employees Retirement
System (CalPERS) would be exempt from including a reimbursement
for the administration cost of the vaccine in its reimbursement
of physicians. However, CalPERS would be prohibited from
imposing cost sharing requirements on immunizations. There would
be no cost to implement this provision since CalPERS currently
complies with it. Any cost increases to the Major Risk Medical
Insurance Program (MRMIP) would be minor and absorbable.