BILL ANALYSIS
SB 1200
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Date of Hearing: August 4, 2010
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
SB 1200 (Leno) - As Amended: June 1, 2010
Policy Committee: Health Vote:13-5
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill requires the Department of Managed Health Care (DMHC)
and the California Department of Insurance (CDI) to update
timely access to care regulations to include care for students
during the school day. In addition, this bill specifies the
regulations require health plans and insurers (carriers) to
ensure the availability of licensed health professionals to
provide services to school children during the school day.
FISCAL EFFECT
1)Annual increased costs and pressures of more than $50 million
(33% to 50% GF) to Medi-Cal and the Healthy Families Program.
Statewide there are 10,000 schools and total premium costs and
pressures would exceed $200 million for all children's
coverage, including both privately and publicly insured
children. This estimate assumes California's largest insurers
would share contracts for nursing services at 20% of schools
statewide.
2)It is unclear the requirement to ensure adequate access to
licensed health professionals contained in this bill is
workable. The estimate above assumes health plans and insurers
contract for a portion of a school nurse at 20% of schools, so
that one full-time nurse would be shared by five carriers.
Such contracts leveraging cooperation between competitors
would be unlikely and unusual. If health plans and insurers
purchased nursing services separately, even at only a portion
of schools, costs would exceed $1 billion. Carriers indicate
this bill would require contracts with all schools, not just a
portion of campuses.
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3)One-time fee-supported (carrier fees) special fund costs of
$100,000 for DMHC and CDI, combined, to update timely access
to care regulations.
4)Unknown, potentially significant GF/98 costs and pressures to
the extent schools are subject to timely access to care
reporting requirements that providers must complete under
current law.
COMMENTS
1)Rationale . This bill increases the specificity of current law
regulations regarding timely access to care and requires
health carriers to ensure licensed professionals are available
to care for school children during the school day. According
to the author and supporters, access to care for school
children was not specifically included in recently finalized
regulations. In addition, the author indicates school children
have increased health needs due to variety of issues including
chronic diseases such as diabetes. In addition, many children
require administration of prescription drugs and other medical
care during the school day. Due to ongoing deficits, schools
have reduced health staffing. This bill shifts the focus from
schools to health plans and insurers to ensure school children
have access to care.
2)Timely Access Regulations . AB 2179 (Cohn), Chapter 797,
Statutes of 2002 required the establishment of regulations to
ensure the timely access to care. AB 2179 also required the
development of indicators related to timeliness of care. The
final timely access to care regulations went into effect in
January of 2010. They include the availability of providers to
meet specified timelines including 48 hours for urgent care
appointments, 10 business days for non-urgent care
appointments, and triage and screening by phone 24-hours a
day, seven days a week.
3)School health centers and services are located on school
campuses and provide a range of services including primary
care, screenings, immunization, physicals, and assessments.
They also play a key role in helping manage chronic diseases
such as asthma and diabetes. School health centers are funded
with a variety of public funding sources, such as the Child
Health and Disability Program (CHDP), Medi-Cal, and the
Healthy Families Program. School health services are also
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supported with local and private funding.
4)Concerns . Health plans and insurers oppose this bill due to
concerns about having to contract with 10,000 schools
statewide.
5)Related Legislation
a) AB 2454 (Tolakson), in the current session requires
school districts to employ at least one school nurse,
registered nurse, or licensed vocational nurse for every
750 pupils starting in 2020. AB 2454 was held on the
Suspense File of this committee with costs of approximately
$650 million (GF/98).
b) AB 1802 (Hall), in the current session, authorizes a
parent or guardian authorizes a parent or guardian to
designate a school employee to administer insulin to a
student during school hours. AB 1802 failed passage in the
Assembly Business & Professions Committee.
c) SB 1051 (Huff), in the current session, authorizes
school districts to authorized trained employees to provide
emergency medical assistance to students suffering from
seizure disorders. SB 1051 was held on the Suspense File of
the Senate Appropriations Committee.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081