BILL ANALYSIS �
SB 946
Page 1
( Without Reference to File )
SENATE THIRD READING
SB 946 (Steinberg and Evans)
As Amended September 9, 2011
Majority vote
SENATE VOTE :Vote not relevant
HEALTH 13-5 APPROPRIATIONS 12-5
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|Ayes:|Monning, Ammiano, Atkins, |Ayes:|Fuentes, Blumenfield, |
| |Bonilla, Eng, Gordon, | |Bradford, Charles |
| |Hayashi, | |Calderon, Campos, Davis, |
| |Roger Hern�ndez, Bonnie | |Gatto, Hall, Hill, Lara, |
| |Lowenthal, Mitchell, Pan, | |Mitchell, Solorio |
| |V. Manuel P�rez, Williams | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Logue, Garrick, Mansoor, |Nays:|Harkey, Donnelly, |
| |Nestande, Silva | |Nielsen, Norby, Wagner |
| | | | |
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SUMMARY : Requires health plans and health insurance policies to
cover behavioral health therapy (BHT) for pervasive
developmental disorder or autism (PDD/A), requires plans and
insurers to maintain adequate networks of autism service
providers, establishes an Autism Advisory Task Force (Task
Force) in the Department of Managed Health Care (DMHC), sunsets
this bill's autism mandate provisions on July 1, 2014, and makes
other technical changes to existing law regarding HIV reporting
and mental health services payments. Specifically, this bill :
1)Requires every health plan contract that provides hospital,
medical, or surgical coverage and health insurance policy to
also provide coverage for BHT for PDD/A no later than July 1,
2012. Requires the coverage to be provided in the same manner
and to be subject to the same requirements as provided in
California's mental health parity law.
2)Provides, notwithstanding 1) above, as of the date that
proposed final rulemaking for essential health benefits (EHBs)
is issued, that this bill does not require any benefits to be
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provided that exceed the EHBs that all health plans will be
required by federal regulations to provide under the federal
Patient Protection and Affordable Care and Education
Reconciliation Act of 2010 (PPACA), as amended by the federal
Health Care and Education Reconciliation Act of 2010.
3)Requires DMHC, in consultation with the California Department
of Insurance (CDI), to convene a Task Force by February 1,
2012, to develop recommendations regarding BHT that are
medically necessary for the treatment of individuals with
autism or pervasive developmental disorder, as specified.
Requires DMHC to submit a report of the Task Force to the
Governor, President pro Tem of the Senate, the Speaker of the
Assembly, and the Senate and Assembly Committees on Health by
December 31, 2012, on which date the Task Force ceases to
exist.
4)Exempts from this bill a specialized health plan or health
insurance policy that does not deliver mental health or
behavioral health services to enrollees, or an accident only,
specified disease, hospital indemnity, or Medicare supplement
policy, a health plan contract or health insurance policy
under Medi-Cal or Healthy Families, and a health care benefit
plan or contract pursuant to the Public Employees' Retirement
System.
5)Provides that nothing in this bill be construed to limit the
obligation to provide services under California's mental
health parity law. Permits a health plan or health insurer to
utilize case management, network providers, utilization review
techniques, prior authorization, copayments, or other cost
sharing as provided in California's mental health parity law.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)One-time costs to the DMHC of in the range of $50,000 (special
fund) to conduct a stakeholder process and publish
recommendations.
2)Minor, if any, state health care costs. This bill exempts
health plans provided through Medi-Cal, Healthy Families
Program, and California Public Employees Retirement System
(CalPERS) from the coverage mandate.
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3)A California Health Benefits Review Program (CHBRP) analysis
of a similar bill, SB 166 (Steinberg, 2011) identified annual
increased premium costs in the private insurance market of
$177 million. These costs reflect increased premiums by
employers for group insurance, premiums paid in the individual
health insurance market, and premium costs borne by
individuals with group coverage. Because CHBRP's analysis of
SB 166 assumed that behavioral health services would be
delivered by licensed providers, while SB 946 stipulates that
unlicensed providers can deliver services, the costs would
likely be less than the estimate of $177 million.
4)Potentially significant one-time General Fund (GF) cost
savings. CHBRP reports in their analysis of SB 166 that $146
million in cost savings annually would accrue to current
payers of PDD/A-related services (primarily school districts
and the state Department of Developmental Services (DDS)).
Given that the mandate to cover behavioral health treatment is
only in effect for a maximum of 18 months beginning July 1,
2012, the volume of services that would transition from
current payers to health plans, and the speed of these
transitions, is unknown. Also, given data limitations, it is
difficult to estimate precisely where cost savings would
accrue. Savings would partially depend on the success of DDS
in identifying other payers.
One-time GF cost savings to DDS associated with this bill
could be in the range of tens of millions of dollars in budget
year 2012-13, assuming individuals transitioned quickly from
services provided by DDS and schools to services reimbursed by
health plan and insurers. Savings in 2013-14 would be similar
in magnitude but would only be accrued for the first six
months of the fiscal year. School districts would not
experience direct GF savings if K-12 education was funded at
the minimum amount required by Proposition 98. However, any
funds saved by school districts due to a reduction in
expenditures for PPD/A-related services could be redirected to
other activities.
5)As the bill is currently drafted, no state fiscal liability
related to the PPACA. The PPACA creates new state-run health
insurance exchanges that will likely provide coverage to
millions of Californians, and requires that health plans
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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 in 2012 that will further
define these categories. These definitions will have important
fiscal implications for the state. The PPACA 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. CHBRP indicates that EHBs
explicitly include "mental health and substance abuse disorder
services, including behavioral health treatment" as well as
"rehabilitative and habilitative services and benefits." It
is unknown whether the mandate in this bill would go beyond
what will be included in federally defined EHBs, but it is
plausible that EHBs may not mandate coverage of applied
behavior analysis (ABA).
To mitigate potential fiscal concerns, this bill does not
mandate benefits beyond those defined as EHBs. Thus, it is
unlikely that there would be an additional fiscal liability to
the state as a result of this mandate for qualified health
plans offered in the Exchange, because the state-mandated
requirement to cover ABA would be triggered off if EHBs do not
require ABA to be covered. However, if the requirement was
triggered off, children both inside and outside the Exchange
could lose coverage, raising potential policy issues related
to disruption of treatment. On the other hand, if the
operative dates of the coverage mandate were extended, the
state could incur significant fiscal liability related to the
marginal cost of this mandate for individuals in the Exchange.
COMMENTS : According to the author, the intent of this
legislation is to ensure that therapeutic decisions for the
medical treatment of Autism Spectrum Disorder (ASD) remain in
the hands of physicians and other appropriate medical
professionals. The author believes this bill closes a dangerous
loophole in the existing mental health parity law and ensures
that healthcare decisions for the treatment of ASD are provided
only by the appropriate medical professionals. This bill refers
to BHT as professional services and treatment programs,
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including ABA and other behavior intervention programs, as
specified. ABA, which is defined in state law as the design,
implementation, and evaluation of systematic instructional and
environmental modifications to promote positive social behaviors
and reduce or ameliorate behaviors which interfere with learning
and social interaction, seems to be at the center of coverage
disputes, settlements and litigation. The main question is
whether or not ABA is a health care service covered under
California's mental health parity law. A secondary question is
whether behavior analysts who provide ABA should be licensed by
the state.
This bill is sponsored by the Alliance of California Autism
Organizations; Autism Speaks; Special Needs Network; The Help
Group. The Association of Regional Center Agencies supports
this bill for many reasons including that it will save the state
millions of dollars through offsetting regional center funds
towards funding autism health-related treatment and services,
which could be used to support other segments of the regional
center population. The California Association of Health Plans
writes in opposition that this bill will increase health
premiums by hundreds of million, promises autism benefits that
could prove false if the benefits are not included in EHBs,
timing is wrong and other mandates were wisely held, government
purchasers are exempt, early childhood screening, diagnosis and
medical services are already covered by health plans and
shifting the responsibility for educational services increases
premiums and sets a costly new precedent. Consumer Watchdog,
which is involved in class action litigation against Blue Cross
and Kaiser, as well as individual suits seeking damages for
personal injuries, related to wrongful denials, requests
amendments. Consumer Watchdog believes provisions in this bill:
allow bureaucrats and health insurers to make medical decisions;
permit future "proposed" federal regulations to pre-empt state
law and open the door for insurers to inappropriately refuse to
cover ABA on the grounds that it is educational; undermines
access by requiring autism specialists to "employ" providers;
and, gives insurers an inappropriate shield against several
pending civil lawsuits and an enforcement action brought by CDI.
Kaiser Permanente indicates that this bill fails to provide
clarity around statutory service provision, excludes millions of
children from coverage, and creates increased cost pressures on
families and businesses that purchase health coverage, and for
these reasons oppose this bill unless it is amended to address
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their concerns.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
FN: 0002863