BILL ANALYSIS �
AB 652
Page 1
Date of Hearing: May 18, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 652 (Mitchell) - As Amended: May 10, 2011
Policy Committee: HealthVote:14-4
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires health insurers and health plans to cover
initial health assessments of children in out-of-home placements
and forensic medical evaluations when requested by child welfare
agencies. Specifically, this bill:
1)Requires that the costs of initial health assessments of
children in out-of-home placements (primarily foster children)
and forensic medical evaluations to be reimbursed by
individual and group health plans, including plans
participating in the Medi-Cal and Healthy Families (HFP)
Programs.
2)Requires coverage whether or not providers of these services
are in the contracted provider network.
3)Prohibits plans from requiring prior authorization for these
services.
4)Defines terms relevant to this mandate, including initial
health assessment and forensic medical evaluations.
5)Establishes minimum reimbursement amounts of $250 for the
initial assessment and $750 for the forensic medical
evaluation.
FISCAL EFFECT
1)According to the California Health Benefits Review Program
(CHBRP), additional state costs of up to $3.0 million ($1.6
million GF) to provide coverage through Medi-Cal managed care
plans, the Healthy Families Program, and CalPERS HMOs plans.
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2)Increased employer-funded premium costs in the private
insurance market of up to $2.5 million.
3)Increased employee and individual premium costs of up to $1.3
million.
4)Cost savings to counties of up to $5.9 million due to
increased reimbursement by other payers associated with
forensic examinations.
5)Costs reported by CHBRP and cited in this analysis are the
upper bound of potential costs, due to the adoption of two
recent amendments to the bill since CHBRP's analysis: (a) the
removal of the requirement for coverage when an examinations
is requested by law enforcement and (b) the ability of
counties to excuse carriers from payment for these services if
sufficient alternative arrangements are made to provide these
services. It is unknown what proportion of examinations is
requested by law enforcement versus child welfare agencies,
but it is likely that the majority are requested by child
welfare agencies. In addition, it is unknown whether and to
what extent counties would excuse carriers from covering these
services on a county-by-county basis.
6)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. At this time, it is unclear whether there may be
additional future state costs associated with this bill.
COMMENTS
1)Rationale . The sponsor of this bill, L.A. County, states that
children entering the child welfare system often have
undetected health and mental health problems. The sponsor
notes that state regulations require an initial medical
examination for all children newly placed in out-of-home care,
and authorize counties or local law enforcement agencies to
refer a child for a forensic medical evaluation to determine
if the child is a victim of physical or sexual abuse or
neglect. According to the sponsor, counties are only
reimbursed for these services when they are provided to
children with FFS Medi-Cal. This bill would relieve cost
pressure on counties by requiring all plans in the state to
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reimburse counties for these services.
2)Current Coverage . CHBRP found that initial medical
examinations are covered by Medi-Cal for the vast majority of
children in out-of-home placement. However, CHBRP found that
coverage for forensic medical evaluations by health plans and
policies is quite limited, and that services are typically
paid for by a combination of child welfare services and law
enforcement funds at the county level. Most children who are
removed by the local child welfare agency and placed in
out-of-home care are automatically eligible for
fee-for-service (FFS) Medi-Cal; however, the child must first
be disenrolled from prior coverage, if any. DHCS indicates
that this is done on an expedited basis, but county experience
indicates that many children are not enrolled in FFS Medi-Cal
in time for counties to claim reimbursement. If children are
enrolled in other health care plans that do not cover
services, counties cannot claim reimbursement from those
plans.
3)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 federal 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.
Since the EHB package will be based on what is covered in a
typical employer plan, and most employers currently do not
cover the services mandated by this bill, it is likely that
the mandate in this bill will exceed the federally defined
EHBs. Therefore, it seems likely that there will be future
state costs associated with this mandate.
4)Other Mandates in the Current Session . There are 14 health
mandates proposed this year, including AB 652. Other mandates
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in the current session include:
a) AB 72 (Eng): Acupuncture
b) AB 137 (Portantino): Mammography
c) AB 154 (Beall): Mental Health Services
d) AB 171 (Beall): Autism
e) AB 185 (Hernandez): Maternity Services
f) AB 310 (Ma): Prescription Drugs
g) AB 369 (Huffman): Pain Prescriptions
h) AB 428 (Portantino): Fertility Preservation
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