BILL ANALYSIS
SB 220
Page 1
SENATE THIRD READING
SB 220 (Yee)
As Amended August 20, 2010
Majority vote
SENATE VOTE : Not relevant
JUDICIARY APPROPRIATIONS
(vote not relevant) (vote not relevant)
SUMMARY : Requires a health care service plan (health plan)
contract or health insurance policy issued, amended, renewed or
delivered after January 1, 2011 to cover specified tobacco
cessation treatments, requests the California Health Benefits
Review Program (CHBRP) to prepare an analysis of the cost
savings as a result of the provisions of this bill and states
that this bill shall become inoperative on the date the
Exchange, as defined, determines that the requirements of this
bill will result in additional costs to the state.
Specifically, this bill :
1)Make specified findings and declarations regarding the costs
of tobacco use in California and the benefits of tobacco
cessation services.
2)Requires a health plan contract or health insurance policy
issued, amended, renewed, or delivered on or after January 1,
2011 to cover a minimum of two courses of treatment in a
12-month period for all smoking cessation treatments rated "A"
or "B" by the United States Preventive Services Task Force
(USPSTF), which shall include counseling and over-the-counter
medication and prescription pharmacotherapy approved by the
federal Food and Drug and Administration (FDA).
3)States that coverage provided pursuant to this bill shall only
be available upon the order of an authorized provider and that
nothing in this bill shall preclude a health plan from
allowing enrollees to access tobacco cessation services on a
self-referral basis.
4)For purposes of this bill, states that "course of treatment"
shall be defined to consist of the following:
a) As applied to "counseling," at least four sessions of
counseling, which may be telephone, group, or individual
SB 220
Page 2
counseling with each session lasting at least 10 minutes;
and,
b) As applied to "prescription" or "over-the-counter"
medication, the duration of treatment approved by the FDA
for that medication.
5)States that enrollees shall not be required to enter
counseling in order to receive tobacco cessation medications
after the patient's first course of treatment
6)Prohibits a health plan or health insurance policy from
imposing prior authorization or stepped-care requirements on
tobacco cessation treatments after the patient's first course
of treatment.
7)States that this bill shall not apply to Medicare supplement
plan contracts or to specialized health care service plan
contracts.
8)Defines "Exchange" as the American Health Benefit Exchange
established in California by the federal Patient Protection
and Affordable Care Act (PPACA) (Public Law 111-148).
9)Requests that the University of California, as part of CHBRP
prepare a report by December 31, 2013, evaluating the
requirements of this bill to determine the savings to the
health care system as a result of the requirements and
requests that the report be made available to the Legislature
and to the Exchange.
10)States that this bill shall become inoperative on the date
that the Exchange determines that the requirements of this
section will result in the state assuming additional costs
pursuant to specified requirements of the PPACA.
EXISTING LAW :
1)Provides for regulation of health care service plans by the
Department of Managed Health Care and health insurers by the
Department of Insurance.
2)Allows health insurers (but not health plans) to subject
treatment for nicotine use to separate deductibles, copays,
and overall cost limitations.
SB 220
Page 3
3)Requires, by regulation, health plans (but not health
insurers) to cover all medically necessary services,
applicable to basic health care services and also to
prescription drug benefits, if prescription drugs are covered.
4)Allows, by regulation, health plans covering prescription drug
benefits to require prior authorization and to establish
co-payments or deductibles that are found to be
non-objectionable.
5)Existing federal law requires each state, by January 1, 2014,
to establish an American Health Benefit Exchange that makes
qualified health plans available to qualified individuals and
qualified employers. Federal law establishes requirements for
the Exchange, for health plans participating in the Exchange,
and defines who is eligible to receive coverage in the
Exchange.
FISCAL EFFECT : This bill as amended has not been analyzed by an
Assembly fiscal committee.
COMMENTS : According to the author, smoking remains one of the
most difficult public health issues facing California, with
nearly four million smokers in our state and 32,000 youth
becoming smokers each year. Smoking costs California's economy
an estimated $18 billion in a year in the form of medical care,
lost productivity, and worker absenteeism. Studies show that
people who use tobacco cessation treatment such as counseling,
over-the-counter and prescription medications are more likely to
quit and stay tobacco free for a longer period of time.
Additionally, people with full coverage for medications and
counseling services for tobacco cessation are more likely to use
tobacco cessation medication than those who do not have
coverage. This bill will address these negative impacts by
requiring health plans and health insurance policies that
provide outpatient prescription drug benefits to include
coverage for comprehensive tobacco cessation services.
On March 23, 2010, President Obama signed the PPACA (Public Law
111-148), as amended by the Health Care and Education
Reconciliation Act of 2010 (Public Law 111-152). Among other
provisions, the new law makes statutory changes affecting the
regulation of and payment for certain types of private health
insurance. Each state is required to establish an American
SB 220
Page 4
Health Benefit Exchange and a Small Business Health Options
Program Exchange by 2014 for individuals and small employers
with 50 to 100 employees; after 2017, states have the option of
opening the small business exchange to employers with more than
100 employees. A key provision of PPACA, related to
preventative health, requires group health plans or individual
health insurance coverage, without imposing any cost-sharing
requirements, to provide for items or services that have an A or
B rating in current recommendations of the USPSTF, immunizations
recommended by the Advisory Committee on Immunization Practices
of the Centers for Disease Control and Prevention, and other
specified services. USPSTF provides A and B recommendations for
an array of preventative services such as tobacco use counseling
for pregnant women and non-pregnant adults, healthy diet
counseling, diabetes screening and numerous other services.
Analysis Prepared by : Martin Radosevich / HEALTH / (916)
319-2097
FN: 0006524