BILL ANALYSIS
SB 220
Page 1
Date of Hearing: August 25, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 220 (Yee) - As Amended: August 24, 2010
SENATE VOTE : Not relevant
SUBJECT : Health care coverage: preventive health services:
tobacco cessation.
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 American
Health Benefit Exchange (Exchange), as defined, determines that
the requirements of this bill will result in additional costs to
the state. Specifically, this bill :
1)Makes specified findings and declarations regarding the costs
of tobacco use in California and the benefits of tobacco
cessation services.
2)Requires group or individual health plan contracts and health
insurance policies that are issued, amended, renewed, or
delivered on or after September 23, 2010 to comply with
specified requirements related to preventative health of the
federal Patient Protection and Affordable Care Act of 2010
(PPACA) (Public Law 111-148) and any subsequent rules or
regulations issued pursuant to those requirements.
3)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,
which shall include counseling and over-the-counter medication
and prescription pharmacotherapy approved by the federal Food
and Drug and Administration (FDA).
4)States that coverage provided pursuant to this bill shall only
be available upon the order of an authorized provider and that
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nothing in this bill shall preclude a health plan from
allowing enrollees to access tobacco cessation services on a
self-referral basis.
5)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
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.
6)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.
7)Prohibits a health plan contract or health insurance policy
from imposing prior authorization or stepped-care requirements
on tobacco cessation treatments after the patient's first
course of treatment.
8)States that this bill shall not apply to Medicare supplement
plan contracts or to specialized health plan contracts.
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 any state savings as a
result of the requirements and requests that the report be
made available to the Legislature and to the Department of
Insurance and the Department of Managed Health Care.
10)States that this bill shall become inoperative on the date
that the state determines that, taking into account any state
savings identified in 9) above, the requirements of this bill
will result in the state assuming additional costs pursuant to
specified requirements of the PPACA.
EXISTING STATE LAW :
1)Provides for regulation of health plans by the Department of
Managed Health Care and health insurers by the Department of
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Insurance.
2)Allows health insurers (but not health plans) to subject
treatment for nicotine use to separate deductibles, copays,
and overall cost limitations.
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.
EXISTING FEDERAL LAW :
1)Requires each state, by January 1, 2014, to establish an
Exchange that makes qualified health plans available to
qualified individuals and qualified employers.
2)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 :
1)PURPOSE OF THIS BILL . 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
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services for tobacco cessation are more likely to use tobacco
cessation medication than those who do not have coverage. The
author states 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.
2)BACKGROUND . Despite significant efforts to reduce smoking in
California, nicotine use remains prevalent, particularly among
ethnic communities. While, overall, 15% of Californians
smoke, Native Americans smoke at twice this rate and one in
five African Americans smoke. Nicotine is highly addictive
and difficult to quit. According to U.S. Department of Health
and Human Services, 70% of smokers attempt to quit each year,
but only 7% remain smoke free for one year after attempting.
Comprehensive tobacco cessation services include telephone,
group, or individual counseling, and all prescription and
over-the-counter medication approved by the FDA. Numerous
studies show that behavioral and pharmacological treatments
and combinations of the two significantly improve quit rates
and increase the likelihood of sustained abstinence from
smoking.
3)FEDERAL HEALTH REFORM . On March 23, 2010, the federal
government enacted PPACA, which was further amended by the
Health Care Education Reconciliation Act (H.R. 4872). Under
PPACA, Medicaid would now cover tobacco cessation counseling
and pharmacotherapy for pregnant women, including the removal
of cost-sharing between Medicaid and beneficiaries. While the
provisions of PPACA that go into effect on 2014 will change
California's health insurance market and regulatory framework,
PPACA would also require tobacco cessation treatments to be
provided by qualified health plans providing coverage in
small-group and individual markets through the state-based
insurance exchanges. Tobacco cessation will also be
considered part of the "essential health benefits package" to
be provided, effective in 2014.
4)SUPPORT . This bill is jointly sponsored by the American Lung
Association, the American Cancer Society, and the American
Heart Association who state that health plans have an
obligation to fully over smoking cessation services for their
members. The sponsors state that a person's chances of
successfully quitting more than doubles when an evidence-based
tobacco cessation service or treatment is used. Providing
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comprehensive tobacco cessation services and treatments not
only will improve the health of smokers and save lives, it
will provide economic benefits to insurers, employers,
government, taxpayers, and smokers themselves.
5)OPPOSITION . The Association of California Life and Health
Insurance Companies (ACLHIC) opposes this bill, as amended,
because it imposes a new benefit mandate and eliminates the
flexibility of an employer to pick benefits that best address
the needs of his/her employees in the future. ACLHIC states
that in an era of escalating medical costs, mandating
additional benefits into all health insurance policies, while
well-intended, is counterproductive to its efforts to make
health insurance more affordable and available to all
Californians.
REGISTERED SUPPORT / OPPOSITION :
Support
American Heart Association (cosponsor)
American Cancer Society (cosponsor)
American Lung Association (cosponsor)
(Previous Version)
American Academy of Pediatrics
American Bone Health
American Cancer Society, California Division
American Nurses Association/California
American Stroke Association
Association of Northern California Oncologists
Asthma and Allergy Foundation of America, California Chapter
Bienestar Human Services, Inc.
Breathe California
California Academy of Family Physicians
California Academy of Physician Assistants
California Academy of Preventative Medicine
California Association of Physician Groups
California Black Chamber of Commerce
California Hispanic Chamber of Commerce
California Medical Association
California State Firefighters' Association, Inc.
California Tobacco Control Alliance
City and County of San Francisco
Coalition of Lavender-Americans on Smoking and Health
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First 5 LA
Institute for Restorative Health
Korean American Medical Association of Southern California
Loma Linda University, School of Medicine, Division of
Cardiology
Loma Linda University, School of Public Health
Los Angeles Society of Allergy, Asthma and Clinical Immunology,
Inc.
Medical Oncology Association of Southern California, Inc.
Mental Health Association in California
Mental Health Systems, Inc.
Microsoft
National Kidney Foundation
Osteopathic Physicians and Surgeons of California
Pharmacists Planning Service, Inc.
San Francisco Fire Fighters, Local 798
Smoke Free Marin Coalition
State Building and Construction Trades Council
The Foundation for Osteoporosis Research and Education
Opposition
Association of California Life and Health Insurance Companies
California Association of Health Plans
Molina Healthcare
(Previous Version)
California Chamber of Commerce
Health Net
Analysis Prepared by : Martin Radosevich / HEALTH / (916)
319-2097