In the 2009 Digest of Legislation section of Health, it was mentioned that the United States Congress was considering major health care reform. On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act of 2010 and on March 30, 2010, the President signed follow-up legislation – the Health Care and Education Reconciliation Act. The federal health care legislation includes numerous health-related provisions to take effect over a four-year period, including expanding Medicaid eligibility, subsidizing insurance premiums, providing incentives for businesses to provide health care benefits, prohibiting denial of coverage/claims based on preexisting conditions, and establishing health insurance exchanges and support for medical research. The costs of these provisions are to be offset by various taxes, fees, and cost-saving measures, such as new Medicare taxes on indoor tanning, improve fairness in the Medicare advantage program relative to traditional Medicare, and fees on medical devices and pharmaceutical companies. There is also a tax penalty for citizens who do not obtain health insurance unless they are exempt due to low income or other reasons. It also provides for coverage of parents’ health plans of young adults until they are 26 years old.
As noted above, under the new federal health insurance reform law, one of the provisions which is required is the establishment of an American Health Benefit Exchange and a Small Business Health Systems Program Exchange by 2014, for individuals and small employers with 50 to 100 employees; after 2017, states have the option of opening the small business exchange to employers with more than 100 employees. States can opt to provide a single exchange for individuals and small employers. Groups of states can form regional exchanges or states can form more than one in-state exchange, but the exchanges must serve a geographically distinct area. While the individual and small-group markets will not be replaced by the exchanges, the same market rules will apply inside and outside the exchanges. Premium subsidies can be used only for plans purchased through the exchanges. If the federal Department of Health and Human Services (HHS) determines in 2013 that a state will not have an exchange operational by 2014, HHS is required to establish and operate an exchange in the state. In 2017, states will have the opportunity to opt-out of the federal requirements to establish insurance exchanges through a five-year waiver; if they are able to demonstrate that they can offer all residents coverage at least as comprehensive and affordable as that required by this bill.
Federal responsibilities with respect to the exchanges include establishing certification criteria for “qualified health plans” that will be sold through the exchanges; requiring such plans to provide the essential benefits package; requiring that the licensed insurance carriers issuing plans offer at least one qualified health plan at the silver and gold levels and meet marketing requirements; ensuring a sufficient choice of providers; and ensuring that essential community providers are included in networks, are accredited on quality, implement a quality improvement strategy, use a uniform enrollment form, present plan information in a standard format, and provide data on quality measures. In addition, the HHS Secretary will develop a rating system for qualified health plans and a model template for an exchange’s Internet portal, and determine an initial and open enrollment period as well as special enrollment periods for people under varying circumstances. The HHS Secretary is also required to establish procedures under which states may allow agents or brokers to enroll individuals in qualified health plans and assist them in applying for subsidies. Such procedures may include the establishment of rate schedules for broker commissions paid by health plans offered through the exchange.
The state exchanges will be required to certify qualified health plans, operate a toll-free hotline and Web site, rate qualified health plans, present plan options in a standard format, inform individuals of the eligibility requirements for Medicaid (Medi-Cal in California) and the Children’s Health Insurance Program (Healthy Families in California), provide an electronic calculator to calculate plan costs, and grant certifications of exemption from the individual requirement to have health insurance. Exchanges will be required to be self-sustaining by 2015, and will be allowed to charge assessments or user fees to participating health insurance issuers or otherwise generate funding to support their operations. The exchanges also will award grants to “navigators” who will educate the public about qualified health plans, distribute information on enrollment and subsidies, facilitate enrollment, and provide referrals on grievances. Navigators may include trade and professional organizations, farming and commercial fishing organizations, community and consumer-focused nonprofit groups, chambers of commerce, unions, or licensed insurance agents or brokers.
Employers that are qualified to offer coverage to their employees through the Exchange may provide premium support for a level of coverage (bronze, silver, gold, platinum) and employees may choose a plan within the designated level.
The California Legislature passed, and the Governor signed into law, SB 900 (Alquist) and AB 1602 (John A. Perez) creating the California Health Benefit Exchange. This made California the first state in the nation to enact legislation creating a health benefit exchange under federal health care reform. The Exchange will be governed by a five-member board appointed by the Governor and the Legislature. Between now and the end of 2012, the Exchange staff will develop procedures and criteria to enroll Californians in the Exchange and select qualified health plans to participate. Once the Exchange opens in January 2014, California consumers will be able to use it to research their health coverage options and access federally-funded tax credits and costs-sharing subsidies.
California is to receive $1 million in federal funds to fund the costs of preliminary planning efforts related to the development of an Exchange and additional federal grants are to be expected after 2014. The Exchange will be self-supporting from fees paid by health plans and insurers participating in the Exchange.
Other California legislation enacted into law connected to the federal health care law included SB 1088 (Price) prohibiting, with specified exceptions, the limiting age for dependents covered by health plan contracts and health insurance policies from being less than 26 years of age beginning on or after September 23, 2010, and prohibiting health plan contracts and health insurance policies from being required to cover a child of a child receiving dependent coverage; SB 1163 (Leno) requiring all premiums filings be reviewed and certified by a independent actuary to ensure premium costs are accurately calculated and all proposed rate increases be posted on the department’s and insurer’s Web site, includes making costs more transparent; AB 2244 (Feuer) requiring guaranteed issue of health plan and health insurance (collectively carriers) products for children beginning in January 1, 2011, and conforming provisions related to guaranteed issue with federal law, as specified, and any rules or regulation adopted pursuant to federal law; AB 2345 (De La Torre) requiring health care service plan contracts and health insurance policies issued, amended, renewed, or delivered on or after September 23, 2010, to comply with the provisions of the federal Patient Protection and Affordable Care Act regarding coverage of and cost-sharing for, preventive services and any rules or regulations issued pursuant to those provisions to the extent required under federal law; and AB 2470 (De La Torre) prohibiting health plans and insurers from rescinding or canceling coverage, except under specified circumstances, and modifying the ability of a health plan or health insurer to cancel or not renew a contract or policy for nonpayment of premiums by requiring a 30-day grace period from the date of notification from the plan or insurer.
Other Health and Human Services legislation of importance passed and signed into law included SB 110 (Beall) strengthening the laws addressing the problem of crimes against people with disabilities; SB 270 (Alquist) extending the sunset date for the California Office of Health Insurance Portability and Accountability Act of 2001 until January 1, 2013; SB 208 (Steinberg) enacting statutory changes necessary for the Department of Health Care Services and counties to implement a new proposed comprehensive Demonstration Project Waiver in the Medi-Cal Program; SB 543 (Leno) expanding the rights of minors to receive outpatient mental health treatment or counseling services; SB 602 (Padilla) requiring a food handler to obtain a food handler card within 30 days after his/her hire date at a food facility; SB 654 (Leno) requiring Independent Living Program services be provided to former foster youth placed with non-relative legal guardians after eight years of age; SB 700 (Negrete-McLeod) strengthening the law relating to the physician pier review process; SB 769 (Alquist) ensuring appropriate allocation of federal funding for emergency response and pandemic preparedness; SB 812 (Ashburn) requiring cities and counties to include an analysis of the housing needs of the developmentally disabled in the analysis of special housing needs in their housing elements; SB 838 (Strickland) conforming California law to federal requirements for continuation of health coverage under the California Omnibus Budget Reconciliation Act statutes; SB 853 (Senate Budget and Fiscal Review Committee) enacting the Health Budget Trailer Bill; SB 882 (Corbett) making the sale or distribution of electronic cigarettes to minors illegal; SB 945 (Liu) requiring probation and parole officers to provide wards of the court formerly in foster care with notification regarding their eligibility for services and benefits available for former foster youth when the court terminates jurisdiction, or upon release of a ward from a non-foster care facility; SB 1064 (Alquist) strengthening provisions of law relating to California’s Stem Cell law; SB 1069 (Pavley) authorizing physician assistants to perform and certify physical examinations and other specified medical services; SB 1187 (Strickland) extending, to January 1, 2014, the sunset in existing law that waives informed consent requirements for medical experimental treatment provided to patients in life-threatening emergencies under specified conditions; SB 1214 (Wolk) extending the sunset of the Department of Social Services licensing provisions for crisis nurseries for voluntary placements until January 1, 2014; SB 1237 (Padilla) requiring health facilities and clinics that use imaging procedures that involve computed tomography x-ray systems (CT) for human use to record the dose of radiation on every CT study produced during a CT examination; SB 1256 (Hancock) designating January 23rd of each year as Ed Roberts Day (a long-time advocate for the disabled)–a day of special significance; SB 1353 (Wright) requiring consideration to be given to specified factors in making educational and school placement decisions for children and youth in foster care; SB 1392 (Steinberg) expediting the disbursement of various sources of mental health funds from the Department of Mental Health to counties; SB 1395 (Alquist) authorizing establishment of an Altruistic Living Donor Registry to promote and assist live kidney donations; AB 12 (Beall) enacting the California Fostering Connections to Success Act by extending transitional foster care services to eligible youth between 18 and 21 years of age and requiring California to seek federal financial participation in kinship guardianship assistance payments; AB 52 (Portantino) requesting the University of California to develop a plan to establish and administer the Umbilical Cord Blood Collection Program on or before July 1, 2011; AB 222 (Adams) allowing persons under 18 years of age to be employees of ancillary day care centers without being registered for trustline; AB 278 (Monning) allowing the California Office of Health Information Integrity to establish and administer up to four demonstration projects annually to evaluate potential solutions to facilitate health information exchanges; AB 342 (John A. Perez) enacting statutory changes necessary for the Department of Health Care Services and counties to implement a new proposed Comprehensive Demonstration Project Waiver in the Medi-Cal Program; AB 583 (Hayashi) requiring health care practitioners to provide their name, license type, and highest level of academic degree, and board certification, in a written disclosure or in their offices; AB 743 (Portantino) clarifying that social workers must place children in foster care with their siblings unless a joint placement would be contrary to the safety or well-being of one of the siblings; AB 867 (Nava) authorizing the California State University to establish a three-campus pilot program to independently award a Doctor of Nursing Practice; AB 973 (Strickland) revising the current requirements that must be met before prospective adoptive parents may take a drug-exposed newborn into temporary custody from the hospital; AB 1487 (Hill) amending existing guidelines that must be adhered to between a physician who is providing insemination, and other advanced reproductive technology services, and a female patient; AB 1503 (Lieu) requiring physicians who provide emergency medical services in hospitals to implement a discount payment policy for financially qualified patients; AB 1612 (Assembly Budget Committee) enacting the Human Services Budget Trailer Bill; AB 1629 (Assembly Budget Committee) enacting the Developmental Services Budget Trailer Bill; AB 1653 (Jones) amending the methodology for the calculation, collection, and distribution of the existing provider fee on general acute care hospitals for the 21 months spanning April 1, 2009 to December 31, 2010; AB 2129 (Bass) extending to July 1, 2014, the deadline for the Department of Social Services to develop a plan to transform the current statewide system of group homes into a system of residentially-based services; AB 1701 (Chesbro) extending the sunset date, from December 31, 2010 to December 31, 2018, of the Disease Prevention Demonstration Project, which permits cities or counties to authorize licensed pharmacists to sell or furnish 10 or fewer hypodermic needles or syringes to a person for use without a prescription; AB 1767 (Hill) requiring the Medical Board of California (MBC) to provide legal representation to a physician and surgeon who faces disciplinary action by a specialty board as a result of his/her participation in an MBC evaluation; AB 1931 (Torrico) eliminating the sunset date for the Spinal Cord Research Program (Roman Reed Program); AB 1933 (Brownley) requiring a local educational agency to allow a child in foster care to remain in his/her school of origin for the duration of the court’s jurisdiction; AB 1980 (Hayashi) changing the composition of the Veterinary Medical Board; AB 2145 (Ammiano) expanding parameters of the current pilot program authorizing opioid antagonist (Naloxone) treatment of drug overdose with limited immunity from liability; AB 2173 (Beall) providing for a $4 penalty on traffic violations to help reimburse the cost of air ambulance services; AB 2199 (Lowenthal) repealing the law requiring the Department of Mental Health to conduct research on the causes and cures of homosexuality; AB 2268 (Chesbro) authorizing physicians and surgeons in California who are registered with the United States Attorney General, pursuant to specified federal law, to provide addiction treatments that are allowed under federal law; AB 2300 (Emmerson) establishing a temporary genetic counselor license and an interim genetic counselor license; AB 2322 (Feuer) allowing CalWORKS case managers to participate on multidisciplinary personnel teams; AB 2352 (John A. Perez) requiring that a Medi-Cal beneficiary remain eligible for Medi-Cal coverage of antirejection medication for up to two years following an organ transplant; AB 2496 (Nava) enhancing the Department of Justice’s efforts to enforce existing provisions of state law related to the Master Settlement Agreement between California and major tobacco manufacturers; AB 2541 (Portantino) deleting the HIV exemption from authorized electronic reporting in order to increase federal funding provided to California for HIV and AIDS services; AB 2635 (Portantino) adding employees of law enforcement agencies whose duties include the collection of fingerprints who, when exposed to an arrestee’s bodily fluids, can have the arrestee’s blood tested for communicable diseases; AB 2650 (Buchanan) preventing medical marijuana dispensaries with a storefront from being located directly across from a school; AB 2683 (Hernandez) authorizing the practice of optometry at a health care facility or residential care facility; and AB 2699 (Bass) creating a state license exemption for out-of-state licensed health care practitioners who provide free services on a short-term, voluntary basis to uninsured persons.
Vetoed Health and Human Services legislation of significance included SB 56 (Alquist) which would have allowed specified health plans to form joint ventures to offer health coverage to individuals and groups; SB 220 (Yee) which would have required a health care service plan contract or health insurance policy to cover specified tobacco cessation treatment; SB 289 (Ducheny) which would have provided extensions to the hospital seismic mandate for general acute care hospitals that are reclassified using a regulatory option or have encountered local planning delays; SB 890 (Alquist) which would have required health plans and health insurers to categorize all individual market products into tiers, based on actuarial level, as specified; SB 961 (Wright) which would have required a health care service plan contract or health insurance policy (collectively carrier contract or policy) that provides coverage for cancer chemotherapy treatment to establish limits on enrollee out-of-pocket costs for prescribed, orally administered, nongeneric cancer medication; SB 971 (Pavley) which would have established requirements governing entities that provide blood clotting products for home use in the treatment of hemophilia and other bleeding disorders; SB 1029 (Yee) which would have allowed individuals to obtain up to 30 syringes or needles for personal use without a prescription from a pharmacy, and authorized pharmacists and physicians to distribute up to 30 needles to an individual without a prescription solely for personal use; SB 1091 (Hancock) which would have authorized counties to receive Medi-Cal reimbursement for medical and mental health services they provide to eligible individuals less than 21 years of age entering county juvenile detention facilities until adjudication; SB 1119 (Wright) which would have required temporary licensed nursing employment agencies to verify a nurse’s fitness to work, required certain reporting of unfit nurses, and specified penalties for failures; SB 1240 (Corbett) which would have established requirements for local health care district contracts with public or private entities to operate one or more of the district’s health facilities; SB 1283 (Steinberg) which would have modified consumer health coverage grievance procedures administered by the Department of Managed Health Care; SB 1322 (Liu) which would have allowed participants in the Food Stamp Employment and Training program to fulfill their work requirement through a public service placement in a public or private nonprofit agency; SB 1431 (Simitian) which would have expanded eligibility for children enrolling in the County Health Initiative Matching Fund program which uses local funds to match federal Children’s Health Insurance Program funds; AB 113 (Portantino) which would have required health care service plan contracts and health insurance policies to provide coverage for mammography for screening or diagnostic purposes upon referral of certain health care professionals, regardless of age; AB 223 (Ma) which would have established the Safe Body Art Act to provide minimum statewide standards for the regulation of practitioners engaged in the business of tattooing, body piercing, and the application of permanent cosmetics in California; AB 301 (Fuentes) which would have required applicants for a license as a water-bottling plant or as a private water source, to provide information on the volume and source of the water to the Department of Public Health; AB 542 (Feuer) which would have required the Department of Health Care Services (DHCS) to convene a technical working group to evaluate options for implementing nonpayment policies and procedures for hospital acquired conditions for fee-for-service Medi-Cal, consistent with federal laws and regulations, and to submit recommendations to DHCS; AB 1600 (Beall) which would have required health plans and health insurers to cover the diagnosis and medically necessary treatment of a mental illness, as defined, of a person of any age, including a child, and not limited to coverage for severe mental illness as in existing law; AB 1640 (Evans) which would have established additional requirements, including age requirements, in order for a client to receive services under the Every Woman Counts program; AB 1652 (Jones) which would have imposed requirements on ski resorts that operate in California (SB 880 [Yee] provided that safety helmets be worn by skiers; it was signed but cannot take effect because it was contingent on the passage of AB 1652); AB 1759 (Blumenfield) which would have required health plans and insurers to provide reports, disclosures to companies and other large group purchasers at the point of sale; AB 1825 (De La Torre) which would have required individual or group health insurance policies, to provide coverage for maternity services; AB 1858 (Blumenfield) which would have permitted the Department of Public Health (DPH) to authorize entities to provide hypodermic needle and syringe exchange programs in any location DPH determines is necessary; AB 1914 (Davis) which would have clarified existing policy for persons that are applying to the Food Stamp Program and awaiting unemployment insurance benefits; AB 2018 (Skinner) which would have established an inter-county transfer process for food stamp recipients who move from one county to another; AB 2042 (Feuer) which would have prohibited health insurance service plans and health insurers from, more than once in a calendar year, altering rates or benefit of plans and contracts; AB 2072 (Mendoza) which would have required the Department of Education to develop an unbiased pamphlet for newborns and infants identified as deaf or hard-of-hearing, to assist parents to make health decisions concerning their child; AB 2077 (Solorio) which would have permitted a hospital pharmacy to compound or repackage drugs for other hospitals and pharmacies under common ownership; AB 2093 (V. Manuel Perez) which would have required health insurance plans and insurers to reimburse physicians the entire cost of acquiring and administering vaccines; AB 2248 (Hernandez) which would have allowed an in-home supportive services recipient who receives services from an entity authorized by the Medicaid Independence Plus waiver (the 1115 waiver) to select any qualified person to provide the services; AB 2342 (Evans) which would have required the Office of the State Foster Care Ombudsperson to develop a resource guide for emancipating foster youth; AB 2770 (John A. Perez) which would have created the California Health Financing Initiative and Fund for the purpose of expanding access to healthy foods in underserved communities by leveraging non-state funding options; and AB 2786 (Assembly Health Committee) which would have required the Department of Public Health to establish a list of communicable diseases for which clinical laboratories are required to submit a specimen to a local public health laboratory.
