Bill Text: CA AB1764 | 2015-2016 | Regular Session | Amended
Bill Title: California Health Benefit Review Program: financial impacts.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2016-11-30 - From committee without further action. [AB1764 Detail]
Download: California-2015-AB1764-Amended.html
BILL NUMBER: AB 1764 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 3, 2016
AMENDED IN ASSEMBLY APRIL 27, 2016
AMENDED IN ASSEMBLY APRIL 6, 2016
AMENDED IN ASSEMBLY MARCH 18, 2016
INTRODUCED BY Assembly Member Waldron
FEBRUARY 3, 2016
An act to amend Section 127660 of the Health and Safety Code,
relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 1764, as amended, Waldron. California Health Benefit Review
Program: financial impacts.
Existing law, until July 1, 2017, requests the University of
California to establish the California Health Benefit Review Program
to assess, among other things, legislation that proposes to mandate
or repeal a mandated benefit or service, as defined. Existing law
requests the University of California to prepare a written analysis
with relevant data on public health, medical, financial, and other
impacts of that legislation, as specified.
Existing law requests the University of California to provide the
analysis to the appropriate policy and fiscal committees of the
Legislature, as specified, and to submit a report to the Governor and
the Legislature regarding the implementation of these provisions by
January 1, 2017. Existing law establishes the Health Care Benefits
Fund in the State Treasury to effectively support the University of
California and its work in implementing these provisions.
The California Health Benefit Review Program has been reauthorized
since its predecessor was established in 2002.
This bill would additionally request the University of
California, commencing July 1, 2017, California
to include in its analysis, as part of the financial impacts of the
above legislation, relevant data on the impact of coverage or repeal
of coverage of the benefit or service on anticipated costs or savings
estimated upon implementation for the 2 subsequent state fiscal
years and, if applicable, for the 5 subsequent state fiscal years, as
specified.
This bill would make its provisions operative on July 1, 2017, and
only if the California Health Benefit Review Program is
reauthorized, as specified.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 127660 of the Health and Safety Code is amended
to read:
127660. (a) The Legislature hereby requests the University of
California to establish the California Health Benefit Review Program
to assess legislation proposing to mandate a benefit or service, as
defined in subdivision (d), and legislation proposing to repeal a
mandated benefit or service, as defined in subdivision (e), and to
prepare a written analysis with relevant data on the following:
(1) Public health impacts, including, but not limited to, all of
the following:
(A) The impact on the health of the community, including the
reduction of communicable disease and the benefits of prevention such
as those provided by childhood immunizations and prenatal care.
(B) The impact on the health of the community, including diseases
and conditions where disparities in outcomes associated with the
social determinants of health as well as gender, race, sexual
orientation, or gender identity are established in peer-reviewed
scientific and medical literature.
(C) The extent to which the benefit or service reduces premature
death and the economic loss associated with disease.
(2) Medical impacts, including, but not limited to, all of the
following:
(A) The extent to which the benefit or service is generally
recognized by the medical community as being effective in the
screening, diagnosis, or treatment of a condition or disease, as
demonstrated by a review of scientific and peer-reviewed medical
literature.
(B) The extent to which the benefit or service is generally
available and utilized by treating physicians.
(C) The contribution of the benefit or service to the health
status of the population, including the results of any research
demonstrating the efficacy of the benefit or service compared to
alternatives, including not providing the benefit or service.
(D) The extent to which mandating or repealing the benefits or
services would not diminish or eliminate access to currently
available health care benefits or services.
(3) Financial impacts, including, but not limited to, all of the
following:
(A) The extent to which the coverage or repeal of coverage will
increase or decrease the benefit or cost of the benefit or service.
(B) The extent to which the coverage or repeal of coverage will
increase the utilization of the benefit or service, or will be a
substitute for, or affect the cost of, alternative benefits or
services.
(C) The extent to which the coverage or repeal of coverage will
increase or decrease the administrative expenses of health care
service plans and health insurers and the premium and expenses of
subscribers, enrollees, and policyholders.
(D) The impact of this coverage or repeal of coverage on the total
cost of health care.
(E) Commencing July 1, 2017, the The
impact of this coverage or repeal of coverage on anticipated costs
or savings estimated upon implementation for the following periods:
(i) The two subsequent state fiscal years.
(ii) If applicable, the five subsequent state fiscal years through
a longer-range estimate.
(F) The potential cost or savings to the private sector, including
the impact on small employers as defined in paragraph (1) of
subdivision (l) of Section 1357, the Public Employees' Retirement
System, other retirement systems funded by the state or by a local
government, individuals purchasing individual health insurance, and
publicly funded state health insurance programs, including the
Medi-Cal program and the Healthy Families Program.
(G) The extent to which costs resulting from lack of coverage or
repeal of coverage are or would be shifted to other payers, including
both public and private entities.
(H) The extent to which mandating or repealing the proposed
benefit or service would not diminish or eliminate access to
currently available health care benefits or services.
(I) The extent to which the benefit or service is generally
utilized by a significant portion of the population.
(J) The extent to which health care coverage for the benefit or
service is already generally available.
(K) The level of public demand for health care coverage for the
benefit or service, including the level of interest of collective
bargaining agents in negotiating privately for inclusion of this
coverage in group contracts, and the extent to which the mandated
benefit or service is covered by self-funded employer groups.
(L) In assessing and preparing a written analysis of the financial
impact of legislation proposing to mandate a benefit or service and
legislation proposing to repeal a mandated benefit or service
pursuant to this paragraph, the Legislature requests the University
of California to use a certified actuary or other person with
relevant knowledge and expertise to determine the financial impact.
(4) The impact on essential health benefits, as defined in Section
1367.005 of this code and Section 10112.27 of the Insurance Code,
and the impact on the California Health Benefit Exchange.
(b) The Legislature further requests that the California Health
Benefit Review Program assess legislation that impacts health
insurance benefit design, cost sharing, premiums, and other health
insurance topics.
(c) The Legislature requests that the University of California
provide every analysis to the appropriate policy and fiscal
committees of the Legislature not later than 60 days, or in a manner
and pursuant to a timeline agreed to by the Legislature and the
California Health Benefit Review Program, after receiving a request
made pursuant to Section 127661. In addition, the Legislature
requests that the university post every analysis on the Internet and
make every analysis available to the public upon request.
(d) As used in this section, "legislation proposing to mandate a
benefit or service" means a proposed statute that requires a health
care service plan or a health insurer, or both, to do any of the
following:
(1) Permit a person insured or covered under the policy or
contract to obtain health care treatment or services from a
particular type of health care provider.
(2) Offer or provide coverage for the screening, diagnosis, or
treatment of a particular disease or condition.
(3) Offer or provide coverage of a particular type of health care
treatment or service, or of medical equipment, medical supplies, or
drugs used in connection with a health care treatment or service.
(e) As used in this section, "legislation proposing to repeal a
mandated benefit or service" means a proposed statute that, if
enacted, would become operative on or after January 1, 2008, and
would repeal an existing requirement that a health care service plan
or a health insurer, or both, do any of the following:
(1) Permit a person insured or covered under the policy or
contract to obtain health care treatment or services from a
particular type of health care provider.
(2) Offer or provide coverage for the screening, diagnosis, or
treatment of a particular disease or condition.
(3) Offer or provide coverage of a particular type of health care
treatment or service, or of medical equipment, medical supplies, or
drugs used in connection with a health care treatment or service.
SEC. 2. This act shall become operative on July 1,
2017, and shall become operative only if the dates on which Chapter
7 (commencing with Section 127660) of Part 2 of Division 107 of the
Health and Safety Code becomes inoperative and is repealed are
deleted or extended.
