BILL ANALYSIS �
AB 137
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Date of Hearing: May 11, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 137 (Portantino) - As Introduced: January 12, 2011
Policy Committee: HealthVote:18-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill requires health insurance plans to cover mammography
upon a provider's referral. It also requires both health care
service plans and health insurance plans to notify subscribers
and policyholders regarding recommended timelines for an
individual to undergo tests for the screening or diagnosis of
breast cancer.
FISCAL EFFECT
1)The California Health Benefits Review Program (CHBRP)
indicates that, based on their review, all plans in California
affected by this bill are already compliant with both the
coverage and notification requirements. Thus, they estimate
no impact on coverage for mammograms and no associated cost.
2)Federal regulations implementing the federal health reform
law, the Patient Protection and Affordable Care Act (ACA)
(PL-111-148), may impact the costs of this bill in future
years. However, as mammography is widely covered and
considered a standard preventative service, it is unlikely
that there would be additional future state costs associated
with this bill.
COMMENTS
1)Rationale . According to the author, this bill updates the
statute governing insurance coverage of mammography to remove
obsolete age-based screening guidelines and instead require
coverage based on the referral of a medical provider. In
addition, the author states that given the recent confusion
created by the release of new guidelines on when a woman
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should begin to be screened, the information required to be
disclosed by this bill on when women should begin screening is
vital to the health of women in California.
2)Mandates and the Affordable Care Act (ACA) . The ACA creates
new state-run health insurance exchanges that will likely
provide coverage to millions of Californians beginning in
2014, and requires that health plans offered through an
exchange cover certain categories of benefits, called
Essential Health Benefits (EHBs). The Secretary of Health and
Human Services (HSS) is expected to publish guidance later in
2011 and 2012 that will further define these categories. These
definitions will have important fiscal implications for the
state.
The ACA specifies that if states require plans in the exchange
to offer additional benefits that go beyond the defined EHBs,
then states must pay the additional cost related to those
mandates. At this time, there are a number of outstanding
questions related to how federally defined EHBs will interact
with state-level benefit mandates.
According to federal law, EHBs are to resemble what is
typically included in an employer health plan. CHBRP
indicates that it is likely that all employer-based plans
already comply with the requirements of this bill. Therefore
it is unlikely that this bill would result in increased future
state costs.
3)Related Legislation . AB 113 (Portantino) of 2010 was identical
to this bill. Governor Schwarzenegger vetoed AB 113, stating,
in part, that it was unnecessary and had no practical impact
on the current state of health coverage in California.
AB 56 (Portantino) of 2009 was similar to this bill. AB 56 was
vetoed due to affordability concerns with regard to health
coverage and the premium pressures created by this and other
health mandates.
AB 2234 (Portantino) of 2008 would have required health plans
and health insurers to provide coverage for tests necessary
for screening or diagnoses of breast conditions, in accordance
with national guidelines, upon referral of a specified health
care provider and required health plans and health insurers to
notify female enrollees or policyholders in writing of their
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eligibility for testing. AB 2234 was held on the Suspense
file of this committee.
4)Other Mandates in the Current Session . There are 14 health
mandates proposed this year, including AB 137. Other mandates
in the current session include:
a) AB 72 (Eng): Acupuncture
b) AB 154 (Beall): Mental Health Services
c) AB 171 (Beall): Autism
d) AB 185 (Hernandez): Maternity Services
e) AB 310 (Ma): Prescription Drugs
f) AB 369 (Huffman): Pain Prescriptions
g) AB 428 (Portantino): Fertility Preservation
h) AB 652 (Mitchell): Child Health Assessments
i) AB 1000 (Perea): Cancer Treatment
j) SB 136 (Yee): Tobacco Cessation
aa) SB 155 (Evans): Maternity Services
bb) SB 173 (Simitian): Mammograms
cc) SB 255 (Pavley): Breast Cancer
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081