BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
SB 690 (Hernandez)
Hearing Date: 5/23/2011 Amended: 5/10/2011
Consultant: Katie Johnson Policy Vote: Health 9-0
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BILL SUMMARY: SB 690 would, beginning January 1, 2014, prohibit
health care service plans and health insurers from
discriminating against a provider who is acting within the scope
of that provider's license or certification.
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Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
DMHC regulations $85 minor and
absorbable ongoing Special*
and filings
DMHC Help Center unknown, potentially
significant,Special*
and enforcement commencing January 1, 2014
Potential increase in unknown, potentially
significant,General/**
utilization of services due to commencing January 1,
2014Federal/
increased provider access
Special/
Other
*Managed Care Fund
** Medi-Cal costs shared 50 percent General Fund or 50 percent
local funds, 50 percent federal funds; CalPERS costs shared 55
percent General Fund, 45 percent special and other funds;
Healthy Families costs shared 35 percent General Fund, 65
percent federal funds.
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STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
This bill would, commencing January 1, 2014, conform and be
implemented pursuant to the provider nondiscrimination
provisions established in Section 2706 of the federal Public
SB 690 (Hernandez)
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Health Service Act (U.S.C. Sec. 300gg-5) and any federal rules
or regulations issued under that section. This bill would
prohibit health care service plans and health insurers from
discriminating against a health care provider who is acting
within the scope of that provider's license or certification
with respect to participation or coverage under a contract or
policy.
This bill would provide that these provisions would not be
construed to 1) require that a health plan or insurer contract
with any health care provider willing to abide by the terms and
conditions for participation established by the plan or insurer,
and 2) prevent a health plan or insurer from establishing
varying reimbursement rates based on quality or performance
measures.
Existing federal law, the section 1001 of the Patient Protection
and Affordable Care Act (Pub. L. 111-148), as amended by the
federal Health Care and Education Reconciliation Act of 2010
(Public Law 111-152), (ACA) established the requirements
described above. This bill mirrors federal law. Federal guidance
on these provisions is expected sometime in 2012; depending on
the regulations, the costs of this bill could increase or
decrease, since this bill is required to be implemented pursuant
to the ACA and any related rules or regulations.
Costs to the California Department of Insurance would be minor
and absorbable. Costs to the Department of Managed Health Care
(DMHC) for filings and regulations would be approximately
$85,000 in FY 2011-2012 and minor and absorbable ongoing.
Additionally, there could be unknown, but potentially
significant costs related to the DMHC Help Center and
enforcement of complaints.
In the event that this bill would increase access to health care
services, including to those paid for by the state by Medi-Cal,
the Healthy Families Program, and the California Public
Employees Retirement System (CalPERS), there would be unknown,
potentially significant costs to the General Fund, federal
funds, special funds, and other funds commencing January 1,
2014.
SB 690 (Hernandez)
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