BILL ANALYSIS
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UNFINISHED BUSINESS
Bill No: SB 220
Author: Yee (D), et al
Amended: 8/24/09
Vote: 21
PRIOR VOTES NOT RELEVANT
SENATE HEALTH COMMITTEE : 8-0, 8/31/10
AYES: Alquist, Strickland, Aanestad, Cedillo, Leno,
Negrete McLeod, Pavley, Romero
ASSEMBLY FLOOR : 54-24, 8/30/10 - See last page for vote
SUBJECT : Heath care coverage: preventive health
services: tobacco
cessation
SOURCE : American Cancer Society
American Heart Association
American Lung Association
DIGEST : This bill 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
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requirements of this bill will result in additional costs
to the state.
Assembly Amendments delete the version of the bill that
passed the Senate regarding broadband communications and
now addresses the issue of health care coverage and tobacco
cessation.
ANALYSIS :
Existing state law :
1. Provides for regulation of health 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,
co-pays, 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.
This bill:
1. Makes specified findings and declarations regarding the
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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 nothing in this bill shall preclude a
health plan from allowing enrollees to access tobacco
cessation services on a self-referral basis.
5. States that "course of treatment" shall be defined to
consist of the following:
A. As applied to "counseling," at least four sessions
of counseling, this may be telephone, group, or
individual counseling with each session lasting at
least 10 minutes.
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.
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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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
This bill as amended has not been analyzed by an Assembly
fiscal committee.
SUPPORT : (Verified 8/27/10)
American Cancer Society (co-source)
American Heart Association (co-source)
American Lung Association (co-source)
OPPOSITION : (Verified 8/27/10)
Association of California Life and Health Insurance
Companies
ARGUMENTS IN SUPPORT : This bill is jointly sponsored by
the American Lung Association, the American Cancer Society,
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and the American Heart Association who states 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 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.
ARGUMENTS IN 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.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Arambula, Bass, Beall, Block,
Blumenfield, Bradford, Brownley, Buchanan, Caballero,
Charles Calderon, Carter, Chesbro, Coto, Davis, De La
Torre, De Leon, Eng, Evans, Feuer, Fletcher, Fong,
Fuentes, Furutani, Galgiani, Gatto, Hall, Harkey,
Hayashi, Hernandez, Hill, Huffman, Jones, Lieu, Bonnie
Lowenthal, Ma, Mendoza, Monning, Nava, Nestande, V.
Manuel Perez, Portantino, Ruskin, Salas, Saldana,
Skinner, Solorio, Swanson, Torlakson, Torres, Torrico,
Yamada, John A. Perez
NOES: Anderson, Bill Berryhill, Tom Berryhill, Conway,
Cook, DeVore, Fuller, Gaines, Garrick, Gilmore, Hagman,
Huber, Jeffries, Knight, Logue, Miller, Niello, Nielsen,
Norby, Silva, Smyth, Audra Strickland, Tran, Villines
NO VOTE RECORDED: Vacancy, Vacancy
CTW:do 8/31/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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