BILL ANALYSIS �
SB 1410
Page 1
SENATE THIRD READING
SB 1410 (Ed Hernandez)
As Amended August 20, 2012
Majority vote
SENATE VOTE :25-13
HEALTH 19-0 APPROPRIATIONS 17-0
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|Ayes:|Monning, Logue, Ammiano, |Ayes:|Gatto, Harkey, |
| |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, |
| |Garrick, Gordon, Hayashi, | |Charles Calderon, Campos, |
| |Roger Hern�ndez, | |Davis, Donnelly, Fuentes, |
| |Bonnie Lowenthal, | |Hall, Hill, Cedillo, |
| |Mansoor, Mitchell, | |Mitchell, Nielsen, Norby, |
| |Nestande, Pan, | |Solorio, Wagner |
| |V. Manuel P�rez, Silva, | | |
| |Smyth, Williams | | |
| | | | |
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SUMMARY : Modifies the external Independent Medical Review (IMR)
process established for individuals enrolled in health plan
products licensed by the Department of Managed Health Care
(DMHC) and insureds of health insurance policies licensed by the
California Department of Insurance (CDI) by enhancing
requirements of clinical reviewers, and requesting additional
patient demographic information. Specifically, this bill :
1)Makes the existing IMR framework inoperative on July 1, 2015,
and as of January 1, 2016, is repealed, unless a later enacted
statute deletes or extends it, and establishes a new framework
revised as follows on July 1, 2015:
a) Requires the notification from each department to the
enrollee or insured regarding the disposition of the
enrollee's or insured's grievance to include a section
designed to collect information on the enrollee's
ethnicity, race, and primary language spoken that includes
both of the following:
i) A statement of intent indicating that the
information is used for statistics only, in order to
ensure that all enrollees get the best care possible;
SB 1410
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and,
ii) A statement indicating that providing this
information is optional and will not affect the IMR
process in any way.
b) Modifies minimum requirements of medical professionals
selected to review medical treatment decisions to require a
clinician expert in the treatment of the enrollee's medical
condition and knowledgeable about the proposed treatment
through recent or current actual clinical experience
treating patients with the same or similar medical
conditions as the enrollee.
c) Specifies requirements for the database and that the
database be accompanied by:
i) The annual rate of IMR among the total enrolled or
insured population;
ii) The annual rate of IMR review cases by health plan
or health insurer;
iii) The number, type, and resolution of IMR cases by
health plan or health insurer; and,
iv) The number, type, and resolution of IMR cases by
ethnicity, race, and primary language spoken.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)One-time costs of about $125,000 for DMHC to revise its
existing database (Managed Care Fund).
2)Ongoing costs of about $100,000 per year for DMHC to input and
manage additional data, and $200,000 per year for DMHC to
provide medical consultants with increased clinical expertise
(Managed Care Fund).
3)One-time costs of about $580,000 for CDI to revise its
existing database (Insurance Fund). CDI's system is a legacy
system and more costly to upgrade.
SB 1410
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4)Ongoing costs of about $100,000 per year for CDI to input and
manage additional data, and $200,000 per year for CDI to
provide medical consultants with increased clinical expertise
(Insurance Fund).
COMMENTS : According to the author this bill is based upon
issues raised in a recent report and briefing on IMR that was
sponsored by the California HealthCare Foundation which
evaluated over 10 years of IMR cases in California. The author
states that this bill strengthens the standard for IMR case
reviewers, and by doing so, ensures that cases are reviewed by
medical professionals with appropriate specialized knowledge and
experience.
Proponents of this bill agree that increasing standards of the
IMR process by requiring expert reviewers knowledgeable about
the proposed treatment through actual and recent experience and
expanding transparency of information will enhance the quality
of medical care for Californians in managed care. The
California Podiatric Medical Association supports this bill but
requests that Doctors of Podiatric Medicine be specifically
included in this bill. The California Psychiatric Association
supports this bill but suggestions further clarification that an
expert reviewer should be board certified or qualified to be
board eligible in the medical specialty which is the predominant
field of treatment (e.g., a psychiatrist as opposed to an
internal medicine specialist for treatment of a psychiatric
disorder).
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
FN: 0005047