BILL ANALYSIS
SB 630
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Date of Hearing: August 19, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
SB 630 (Steinberg) - As Amended: June 22, 2009
Policy Committee: Health Vote:13-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill requires health plans and insurers to cover medically
necessary dental or orthodontic services related to cleft palate
procedures that are an integral part of reconstructive surgery,
as defined. This bill also adds a definition for cleft palate
for the purpose of inclusion in the current law reconstructive
surgery coverage mandate. Under current law, health plan and
insurer coverage for reconstructive surgery is required, but
does not specify dental or orthodontic services for cleft palate
procedures.
FISCAL EFFECT
1)Although this bill addresses a health mandate, this bill has
not been analyzed by the California Health Benefits Review
Program (CHBRP). Therefore specific CHBRP estimates on SB 630
have not been published.
2)Based on CHBRP analysis of a similar bill, SB 1634
(Steinberg), which was vetoed in 2008 due to cost concerns,
this bill has a likely fiscal impact of $600,000 in premium
costs in the private group and individual insurance markets.
These costs reflect a shift from out-of-pocket spending by
individuals and families to health insurance premium
expenditures.
3)Based on CHBRP analysis of SB 1634, costs of $40,000 to
CalPERS to comply with the mandated expansion of coverage
established by this bill.
4)The total cost impact, in both the private and public sectors
is relatively minor compared to other health mandates because
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fewer than 100 individuals statewide are expected to benefit
from this mandate.
COMMENTS
1)Rationale . This bill is sponsored by the California Society of
Plastic Surgeons to expand a current law reconstructive
surgery mandate established by AB 1621 (Figueroa), Chapter
788, Statutes of 1998. This bill adds specificity to the
reconstructive surgery mandate by requiring coverage for
dental and orthodontic services related to cleft palate
procedures. According to the author, children with cleft
palates often require reconstructive surgery completed over
the course of early childhood, but some children are not
covered for surgery unless they have separate dental
insurance. This bill requires health plans and insurers to
cover these surgeries as a part of other medical, not dental,
care.
2)Cleft palates are birth defects that occur when the roof of
the mouth does not close fully, leaving a gap in the roof of
the mouth and possibly through to the nasal cavity. Cleft
palates can result in trouble in speaking, hearing, and
eating.
3)Industry Cost Concerns . Opponents of this bill indicate
legislatively mandated health benefits increase costs and
limit insurer, employer, and individual choices with respect
to a variety of health benefits. Opponents indicate health
mandates can hinder compliance with evidence-based medical
standards that reflect new medical technology or other
advances in knowledge. When considered together, mandates may
also hinder the ability of insurers and employers to offer a
wide range of affordable products to consumers with a variety
of health care needs.
4)Related Legislation . There are more than two dozen current law
health mandates, established over the last two decades, to
provide coverage for specified services such as cancer
screenings and treatment. There are another handful of
mandates to offer coverage for a number of other health
services.
5)Other Health Mandates in the Current Session . There are nine
health mandates under legislative consideration this year,
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including SB 630. Other proposed health mandates include:
a) SB 161 (Wright): chemotherapy treatment- also being
heard in this committee today
b) AB 56 (Portantino): mammography notification- pending in
the Senate
c) AB 98 (De La Torre): maternity coverage- pending in the
Senate
d) AB 163 (Emmerson): amino acid-based elemental formulas-
held on the Suspense File of this Committee
e) AB 214 (Chesbro): durable medical equipment coverage-
held on the Suspense File of this Committee
f) AB 244 (Beall): mental health parity- pending in the
Senate
g) AB 259 (Skinner): access to nurse midwives- pending in
the Assembly Health Committee
h) AB 513 (De Leon): lactation consultant coverage- pending
in the Senate
Two other bills address specification of current law mandates
with respect to minimum coverage or loosening of current law
mandates. These two bills are:
a) AB 786 (Jones): standardization of individual market
products- pending in the Senate
b) SB 92 (Aanestad): out-of-state carrier coverage- failed
passage in the Senate Health Committee.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081