BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 1200|
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THIRD READING
Bill No: SB 1200
Author: Leno (D)
Amended: 6/1/10
Vote: 21
SENATE HEALTH COMMITTEE : 5-0, 4/21/10
AYES: Alquist, Leno, Negrete McLeod, Pavley, Romero
NO VOTE RECORDED: Strickland, Aanestad, Cedillo, Cox
SENATE APPROPRIATIONS COMMITTEE : 7-3, 5/27/10
AYES: Kehoe, Alquist, Corbett, Leno, Price, Wolk, Yee
NOES: Denham, Walters, Wyland
NO VOTE RECORDED: Cox
SUBJECT : Health care coverage: timeliness of care
SOURCE : Author
DIGEST : This bill requires the Department of Managed
Health Care and the Department of Insurance in their timely
access regulations to consider timely access to care for
schoolage children who must receive medically necessary
services during school hours.
ANALYSIS :
Existing law:
1. Provides for the licensing and regulation of health care
service plans by the Department of Managed Health Care
CONTINUED
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(DMHC).
2. Provides for the regulation of health insurers by the
Commissioner of the Department of Insurance.
3. Requires DMHC and the Insurance Commissioner to develop
and adopt regulations to ensure that enrollees or
insureds of health care service plans and certain health
insurers have access to needed health care services in a
timely manner pursuant to specified indicators of
timeliness.
4. Requires DMHC to review and adopt standards, as needed,
concerning the availability of primary care physicians,
specialty physicians, hospital care, and other health
care so that consumers have timely access to care.
5. Requires DMHC to consider the nature of physician
practices and circumstances affecting the delivery of
care. If DMHC finds that health care service plans and
health care providers have difficulty meeting those
standards, existing law authorizes DMHC to make
recommendations to the Assembly Health Committee and the
Senate Insurance Committee on specified dates regarding
implementation.
This bill requires DMHC and the Department of Insurance in
their timely access regulations to consider timely access
to care for schoolage children who must receive medically
necessary services during school hours.
Background
In 2002, the Legislature passed AB 2179 (Cohn), Chapter
797, Statutes of 2002, which required DMHC to "develop and
adopt regulations to ensure that enrollees have access to
needed health care services in a timely manner." The
statute further required DMHC to develop indicators of
timeliness of access to care and specified three indicators
for DMHC to consider. The bill's author contended that the
law, at that time, permitted plans to set their own
standards for what constituted timely access to medical
care, and that neither the previous Department of
Corporations nor the current DMHC had set such standards.
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The purpose of the bill was to require DMHC to develop
these standards.
Timely access to care is one of the principal indicators
for health care quality, according to the Institute of
Medicine, and is linked to significant improvement in
morbidity, mortality, and cost savings, according to the
Agency for Healthcare Research and Quality. The
Legislature declared that timely access to health care is
essential to safe and appropriate health care; and that,
lack of timely access to health care may be an indicator of
other systemic problems such as lack of adequate provider
panels, fiscal distress of a health care service plan or a
health care provider, or shifts in the health needs of a
covered population.
DMHC regulations regarding timely access recently went into
effect
January 17, 2010, eight years after the original
legislation was passed. The regulations impact individual-
or employer-based health maintenance organizations (HMOs)
and the handful of preferred provider organization (PPO)
plans regulated by DMHC. Similar, though less extensive
regulations were promulgated by the Department of Insurance
in 2008 and apply to insurers and contracted PPOs and
independent physicians associations in the state.
Under DMHC regulations, each health plan must submit a
proposal to DMHC for complying with the required time
standards, receive approval, and begin using the standards
within one year of the effective date of the regulation.
While these regulations set time standards, they also
provide doctors flexibility in scheduling appointments, as
long as doing so would not adversely affect the patient's
condition. Health plans must ensure that their contracted
provider network has adequate capacity and availability of
licensed health care providers to offer enrollees
appointments that meet specified timeframes, including 48
hours for urgent care appointments that do not require
prior authorization, 10 business days for non-urgent
primary care appointments, and triage or screening by
telephone 24 hours a day, seven days a week.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
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Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
DMHC regulations $30-$60 $115-$175 $25
ongoing Special*
Potential increased PERS likely low millions of
dollars annually General**/
Medi-Cal, and Healthy commencing January 1, 2012,
upon Federal/
Families premiums completion of regulations Other
* Managed Care Fund
**PERS: 55 percent General Fund and 45 percent other funds
Medi-Cal: 50 percent General Fund and 50 percent federal
funds
Healthy Families: 65 percent General Fund and 35 percent
federal funds
SUPPORT : (Verified 6/1/10)
American Federation of State, County and Municipal
Employees
American Nurses Association
California State Employees Association
California School Nurses Association
California Teachers Association
Community Action to Fight Asthma
Health Access
OPPOSITION : (Verified 6/1/10)
Association of California Life and Health Insurance
Companies
California Association of Health Plans
Department of Finance
Health Net
ARGUMENTS IN SUPPORT : The California School Nurses
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Association supports the bill, and claims that the number
of children with chronic illnesses, specialized physical
health care needs, and medication needs attending our
schools is constantly rising. They claim that some of
these children are considered to be "special education" and
some have Individualized Educational Programs. Other
children in 504 plans, are in regular education, and some
just get sick at school. As more of these children need
access to care during the school day, as ordered by their
physicians, it becomes a financial burden to the school
district and can prevent or limit access to the multi
facets of the educational day for many children.
The California Teachers Association supports this bill, and
claims that providing timely access for students will
ensure that children are ready to learn. This bill will
assist in providing mechanisms to better assist children
with health access.
ARGUMENTS IN OPPOSITION : The Association of California
Life and Health Insurance Companies claims the bill will
require health insurers to contract with school districts
to reimburse for services provided by school nurses. They
believe that the Department of Insurance's "Provider
Network Access Standards" regulation already includes a
requirement on insurers to ensure that their network
providers are duly licensed and accredited, and that there
are a sufficient number to furnish health care services.
They believe this bill will result in an expensive cost
shift to health insurers and will be difficult to
administer.
The California Association of Health Plans mentions that
California's timely access law applies to enrollees of
every age and without regard to whether they are at home,
at work, at school, or in between. They claim that health
plans can only ensure timely access to providers who are
under contract, therefore, they believe it will be
impossible to ensure timely access to school-based health
care without requiring health plans to contract with every
school in California.
CTW:mw 6/1/10 Senate Floor Analyses
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SUPPORT/OPPOSITION: SEE ABOVE
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