CDCAN REPORT #165-2011: State Senate passes autism health insurance mandate bill; heads to governor

STATE SENATE PASSES AUTISM PRIVATE HEALTH INSURANCE MANDATE BILL - ADVOCATES SAY PASSAGE OF LANDMARK BILL A MAJOR VICTORY FOR THOUSANDS OF FAMILIES WITH AUTISM
Bill Passes 25 to 4 - Would Require Private Health Insurance Plans To Provide Behavioral Health Treatment As Covered Benefit; Bill Heads Next To Governor to Veto or Sign - Governor's Position on Legislation Not Certain - Has Until October 9th To Sign or Veto Bills

SACRAMENTO, CALIF (CDCAN)  [Last updated 09/09/2011 11:41 PM] - In what is viewed by advocates as a landmark bill and a major legislative victory for thousands of families with children with autism spectrum and other disorders, the State Senate late Thursday evening passed by a vote of 25 to 4, SB 946, authored by Senate President Pro Tem Darrell Steinberg (Democrat - Sacramento), that would require effective July 1, 2012,  private health insurance plans to cover, as a benefit, certain behavioral intervention therapies for persons with autism spectrum and other related disorders.  [CDCAN Note:  a "mock-up" copy of the 43 page bill as amended and passed by the Assembly and State Senate is attached to this CDCAN Report, as a word document, titled "2011-09-08 - SB 946 - Mockup of Bill with 09-08-2011 Amendments.doc". The document was saved as a document and not an image, which persons who are blind or sight impaired should be able to read using a screen reading device.]

Steinberg said there was no dispute that behavioral therapy works as a treatment for thousands of children with autism spectrum disorder - but there was a dispute between families and health plans on whether that treatment should be a covered benefit.

Sen. Sam Blakeslee (Republican - San Luis Obispo) spoke out strongly against the bill because he felt the "gut and amend" approach taken to bring the bill for a vote was an "abuse" of the legislative process.

"It is time to pass this over-due measure for these parents with children with autism" said Sen. Rubio (Democrat - Bakersfield).

Sen. Bob Huff (Republican - Diamond Bar) urged a no vote, saying the measure was simply cost shifting at a time the State's economy cannot afford it.

Democratic Senators Lou Correa and Elaine Alquist both rose to urge the State Senate to support the bill.

The bill passed out of Senate Appropriations Committee after a brief hearing that was held at 10:25 PM Thursday evening. The vote on the Senate floor came about an hour or so after that.

The Assembly earlier today approved the measure referred to as the "autism health insurance mandate" bill by a vote of 51 to 10 with amendments that were made to the bill in the Assembly Appropriations Committee yesterday.

The legislation now heads to Governor Brown for approval, whose position on the bill is not certain. The Governor has until October 9th to sign or veto the bill.

Both the Assembly and State Senate are meeting in late night sessions because Friday (September 9th) is the final day of the 2011 regular Legislative session.  Barring a special session called by the Governor, the Legislature will not reconvene at the State Capitol until January for the start of the 2012 Legislative Session .  Bills not acted on this year, theoritically, are still alive, at least for the month of January.

Advocates Say Bill Will Have Sweeping and Dramatic Impact for Thousands of Children With Autism

Advocates and supporters of the legislation say the bill will have sweeping and dramatic impact for thousands of children with autism spectrum and other related disorders and their families including the ongoing impact of making available critical behavioral ttreatments that previously was delayed or denied by health plans, and major savings in State general fund spending for those interventions and treatments that health plans would instead be required to provide as a covered benefit.

Opponents - including health plans - however disagree and said that the bill will result in higher premiums for all persons covered in private health plans..  Opponents also argued that SB 946 was seriously flawed because it excluded persons who are enrolled in government funded health programs, including Medi-Cal and Healthy Families from the bill's requirements.

Similar Bill SB 770 Held In Assembly Appropriations Committee

• As previously reported, a similar bill by Steinberg, SB 770, was held in Assembly Appropriations Committee in late August after strong opposition from health insurance plans who claimed that bill would also result in an increase health insurance premiums and that the required behavioral treatments in that bill is more appropriately the responsibility of the schools or other entities.
• Disability advocates, including regional centers and thousands of families with children with autism spectrum disorders and other developmental disabilities, strongly urged passage of SB 770 - and now SB 946, saying that health insurance plans had a responsibility to provide this critically important coverage that is costing the State hundreds of millions of dollars in State general fund spending.
• Asssemblymember Jim Beall Jr. (Democrat - San Jose) authored earlier this year a far more comprehensive bill, AB 171, on the same issue, but that bill was held in the Senate Health Committee for action in the 2012 legislative year.
• However Sen. Steinberg, followed a series of informational hearings on the issue - most recently in July, decided to push this year for passage. of an autism health insurance mandate focusing on behavioiral intervention therapies.   Beall, along with Senators Evans, and Alquist, is a principal co-author of the bill.

Next Steps

• Governor Brown has until October 9th (Sunday evening 11:59 PM) to sign or veto bills sent to him by the Legislature in the final weeks of the legislative session.
• The Governor's position on the legislation - strongly opposed by many health insurance plans - is not clear, though some disability advocates fear that he could be considering a veto. [CDCAN will be issuing a more detailed report and action alert on this bill following the final action by the State Senate later today]
• The bill, if it is approved by Governor Brown, would technically becomes effective January 1, 2012, the actual provisions go into effect for health care service plans and health insurance policies after July 1, 2012 (see CDCAN Summary below of the bill for more details).

CDCAN SUMMARY OF SB 946

SB 946 - HEALTH CARE COVERAGE: MENTAL ILLNESS - PERVASIVE DEVELOPMENTAL DISORDER OR AUTISM
AUTHOR: Sen. Darrell Steinberg (Democrat - Sacramento)
CDCAN SUMMARY (As amended 09/09/2011):

• Would require every health care service plan contract that provides hospital, medical or surgical coverage shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. The coverage shall be provided in the same manner and shall be subject to the same requirements as provided in the Health and Safety Code, Section 1374.72.
• Notwithstanding the effective date provision in the bill (paragraph 1), as of the date that proposed final rulemaking for essential health benefits is issued, this section does not require any benefits to be provided that exceed the essential health benefits that all health plans will be required by federal regulations to provide under Section 1302(b) of the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152).
• Provisions of this bill shall not affect services for which an individual is eligible pursuant to Division 4.5 (commencing with Section 4500) of the Welfare and Institutions Code or Title 14 (commencing with Section 95000) of the Government Code.
• Provisions of this bill shall not affect or reduce any obligation to provide services under an individualized education program, as defined in Section 56032 of the Education Code, or an individualized service plan, as described in Section 5600.4 of the Welfare and Institutions Code, or under the Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400, et seq.) and its implementing regulations.
• Would require that every health care service plan subject to this section shall maintain an adequate network that includes qualified autism service providers who supervise and employ qualified autism service professionals or paraprofessionals who provide and administer behavioral health treatment. Nothing shall prevent a health care service plan from selectively contracting with providers within these requirements.

PREVIOUS ACTION 09/08/2011:  Passed with amendments out of the Assembly Appropriations Committee by vote of 12 to 5 ("Do pass as amended").
LATEST ACTION 09/09/2011:  Amended In Assembly. PASSED Assembly by vote of 51 to 10.  PASSED as amended by State Senate.25 to 4.
NEXT STEPS: Heads next to Governor (who has until October 9th Sunday evening 11:59 PM to sign or veto this and other bills sent to him by the Legislature)
LATEST AVAILABLE 09/06/2011 VERSION OF THE BILL -HTML:  http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0901-0950/sb_946_bill_20110906_amended_asm_v96.html  [new version of bill should be available Saturday 09/10/2011]  
LATEST AVAILABLE 09/06/2011 VERSION OF THE BILL - PDF:  http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0901-0950/sb_946_bill_20110906_amended_asm_v96.pdf  [new version of bill should be available Saturday 09/10/2011]
COPY OF LATEST AMENDMENTS TO BILL:  Attached is word document of a "mock-up" of SB 946 with the 09/08/2011 amendments included (mock-up is a document that is used on the floor for members to review a bill with new amendments when there isn't time (due to deadlines) to wait for a new official version that usually takes one or more days to produce).  The "mock-up" attached is titled "2011-09-08 - SB 946 - Mockup of Bill with 09-08-2011 Amendments.doc"  The actual official amendment date of the bill is 09/09/2011 - because the full Assembly (called "second reading") has to approve amendments even when made in committee, which they did this afternoon.   
CDCAN PRIORITY: VERY HIGH
CDCAN COMMENT:  This bill replaces an earlier similar version (SB 770 also by Steinberg) that was held in Assembly Appropriations Committee in late August.

[[Webmaster Note: I have created a PDF version of the document initially contained in this CDCAN REPORT for those that wish to provide a PDF instead of an editable document.  Both versions are available below this report.]]

File Attachments: 

2011-09-08 - SB 946 - Mockup of Bill with 09-08-2011 Amendments.doc (169.5 KB)

2011-09-08 - SB 946 - Mockup of Bill with 09-08-2011 Amendments.pdf (646.19 KB)