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ITUP’s 2010 Healthcare Legislation Recap

In addition to passing AB 1602 (Perez) & SB 900 (Alquist/Steinberg), California’s monumental Health Benefit Exchange bills, the state Legislature also passed a series of important healthcare bills this year, many of which directly implement or are closely related to implementation of federal health reform.

Each of the bills below has successfully moved out of the legislature and is on the Governor’s desk awaiting his signature or veto on or before September 30th.

Health Reform Implementation Bills

SB 890 (Alquist) would implement several insurance market reforms contained in the Patient Protection and Affordable Care Act (PPCAC), including a prohibition that would prevent health insurance issuers from establishing lifetime limits or unreasonable annual limits on the dollar value of benefits for any participant or beneficiary. In addition, the bill would allow enrollees to switch health plans on their annual renewal day (the previous requirement was for the enrollee to stay on the plan for at least 18 months before switching plans). The bill would also require health plans to categorize their plans into 5 tiers according to actuarial value.

SB 1088 (Price) would implement the provision of federal health reform that extends dependent coverage to young adults, allowing children to stay on their parents’ coverage until they are 26.

SB 1163 (Leno) would require health plans and insurers to file health insurance rate information with the state and would enable California to be in line for federal grant funding to conduct rate reviews. It would also require certain health care service plans and insurers to give reasons in writing when denying coverage or enrollment and would require insurers to notify patients of any change in premium rates 60 days before implementing that change.

AB 1503 (Lieu) would prevent emergency room doctor overcharges for patients whose incomes fall under 350% of poverty by allowing these patients access to discount payment policies.

AB 1825 (De La Torre) would ensure that maternity care coverage is available as a basic benefit in health plan packages, including individual insurance plans. This bill enacts the related requirement in the PPACA beginning January 1, 2011 until the federal requirement takes over on January 1, 2014. This bill also allows some individual plans to include a 12-month exclusionary period as long as the consumer is notified of this exclusionary period.

AB 2244 (Feuer) would prohibit denial or limitation of coverage because of pre-existing conditions for children and would limit differential premiums for children with pre-existing conditions.

AB 2345 (De La Torre) would implement a provision of PPACA to expand preventative care coverage and services with no cost-sharing requirements (copayments or coinsurance) to consumers.

Other Healthcare Bills

SB 56 (Alquist) would allow local initiatives and county organized health systems to form joint ventures in order to expand affordable coverage regionally.

AB 542 (Feuer) would prevent Medi-Cal payments for hospital-acquired conditions known as “Never Event” medical errors.

AB 1600 (Beall) would expand coverage requirements so that certain plans contain coverage for the diagnosis and treatment of mental illnesses including substance abuse (excluding nicotine dependence).

AB 2042 (Feuer) would limit individual health plans and insurers to just one rate hike and plan change per year.

AB 2274 (Beall) would allow a person who receives services as part of an entity authorized by the 1115 waiver to select any qualified person to provide care. This bill extends the freedom to choose a provider to those enrolled in 1115 waiver programs.

AB 2345 (De La Torre) would require insurers to eliminate cost sharing for some preventive services such as pap smears, mammograms, and other cancer screenings, and immunizations.

AB 2470 (De La Torre) would eliminate the practice of rescinding health insurance while a consumer is enrolled in a health plan. The rescission prohibition would be in affect for two years after the insurance is first issued. The bill would also ban post-claims underwriting for that two-year period as well.

AB 2540 (De La Torre) would impose a fine for rescinding, canceling, or limiting a policy due to the insurer’s failure to complete medical underwriting before issuing the policy or after a claim has been filed.