BILL ANALYSIS
SB 1169
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Date of Hearing: June 30, 2010
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
SB 1169 (Lowenthal) - As Amended: May 28, 2010
Policy Committee: Health Vote:12-5
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill requires health plans and health insurers (carriers)
to assign tracking numbers to provider claims and to submit
related documentation. Specifically, this bill:
1)Requires carriers to provide acknowledgement of receipt of a
claim submission, including the tracking number, by email or
in writing if a provider has opted out of electronic
communication.
2)Requires carriers to provide acknowledgement of a receipt of
additional information, including the tracking number, for
claims previously submitted and deemed incomplete. Requires
notification by email or in writing.
3)Specifies carriers must provide mental health parity, pursuant
to current law requirements, without any form of treatment
limitation or limitation of receipt of benefits.
FISCAL EFFECT
1)Unknown, likely absorbable workload to the California
Department of Managed Health Care (DMHC) to continue oversight
of health plan reimbursement practices. Minor absorbable
workload to the California Department of Insurance (CDI) to
continue oversight of health insurers.
2)Federal health reform, the Patient Protection and Affordable
Care Act (PL-111-148) includes provisions which may reduce the
impact of the requirements of this bill over the next several
years. The federal reform changes include several provisions
related to administrative streamlining and standardization.
SB 1169
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COMMENTS
1)Rationale . This bill is co-sponsored by four organizations:
the American Association of Marriage and Family Therapists,
California Division, the California Coalition for Mental
Health, the California Psychiatric Association, and the Mental
Health Association in California. According to the author and
sponsor, providers of mental health services are frequently
told by health plans and insurers that claims and requests for
prior authorization have not been received. This bill
establishes a requirement for tracking numbers to be assigned
to claims and requests and for carriers to provide
documentation to providers according to specified timelines.
2)Mental Health Parity . AB 88 (Thompson), Chapter 524, Statutes
of 1999 established partial mental health parity in
California. AB 88 requires treatment parity for "serious
mental illness" (SMI) such as schizophrenia, autism, and
anorexia nervosa. Under current law, less serious mental
health issues are subject to utilization controls such as
annual caps on number of visits and patient co-payments that
exceed co-payments for other medical treatment. AB 1600
(Beall), pending in the Senate, expands parity to other mental
illnesses specified in the Diagnostic and Statistical Manual
of Mental Disorders (DSM)-IV to include less serious mental
illness such as low-grade depression and anxiety.
3)Concerns . This bill is opposed by the California Association
of Health Plans (CAHP), the Association of California Life and
Health Insurance Companies (ACLHIC), and several specific
health insurance companies. CAHP indicates this bill imposes
unnecessary administrative costs and creates complicated
notifications at a time when increased health care costs are
leading to reduced health coverage.
ACLHIC asserts this bill will duplicate many existing
communication practices and add unnecessary administrative
costs to claims processes. According to carriers, current law
already requires acknowledge of a receipt of a claim within 15
days and requires processing of claims within 30 days or face
accrual of 10% interest accrual.
SB 1169
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Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081