CDCAN REPORT #177-2011: Governor signs autism health insurance mandate bill, SB 946

GOVERNOR SAYS IN SIGNING MESSAGE THAT "MUCH WORK TO BE DONE" ON ISSUES RAISED BY SB 946 - AUTISM HEALTH INSURANCE MANDATE REFORM BILL

Said Remaining Questions About Duration, Effectiveness, and Cost of Covered Behavioral Health Treatments for People With Autism Spectrum and Related Disorders "Must Be Sorted Out" Still  - Senate President Pro Tem Steinberg Praises Governor's Signing of Bill

SACRAMENTO, CA (CDCAN)  [Last updated 10/09/2011 01:05 PM] - Governor Jerry Brown released a signing message following his approval of SB 946, the autism health insurance mandate reform bill that clearly showed concerns and even some reluctance in the legislation he approved saying "there is still much work to be done" including resolving questions regarding effectiveness, duration and the cost of covered treatments under the bill.   The leislation will require private health insurers and health plans to provide as a covered benefit, beginning July 1, 2012, behavioral health treatments for persons with autism spectrum and related disorders - though the bill's provisions will sunset (end) July 1, 2014.

The legislation, hailed by supporters as a major step in disability rights and authored by Senate President Pro Tem Darrell Steinberg (Democrat - Sacramento, 6th State Senate District) was signed  into law today  by the Governor in an announcement released just after 1:00 PM. (see CDCAN Report #176-2011 for details of that signing):

The provisions in the bill could expire sooner depending on how "essential health benefits" are defined in the coming months by the federal government as the federal health care reform law begins its next major steps in implementation across the nation - though disability advocates are hopeful that behavioral health treatments for people with autism spectrum and related disorders will be included as an "essential health benefit".

The fact that the bill's provisions cannot exceed those "essential health benefits" that will be defined soon by the federal government - and the bill's sunset (ending or repeal) date of  July 1, 2014 and the task force to be established to help review outcomes and come up with a more permanent solution, probably saved it from a veto from the Governor.

Steinberg Praises Governor's Approval of Bill - And Applauds Families and Advocates

Steinberg though had nothing but praise for the Governor's approval of his bill, commending him for "...acknowledging that every child in this state matters, by signing a measure that will literally benefit thousands of kids for generations to come," and that the enactment of SB 946 "...is a critical victory for thousands of California children and families. For many of them, having this therapy covered by their insurance is the difference between despair and hope."

The Senate President Pro Tem - who will soon be engaged with the Governor and other legislative leaders in yet another long battle to resolve a still enormous on-going State budget shortfall that could mean more sweeping cuts, was still hopeful saying that "...as our state’s fiscal health improves, I will keep working to ensure that when it comes to autism treatment, every child, every young adult, and every family in California has affordable access to this therapy," and noted the struggle of thousands of families adding that "I would also like to applaud the countless families and advocates who have been working tirelessly on this issue for many years."

Bill Drew Strong Support and Opposition

Supporters - including thousands of families with children with autism spectrum and other related developmental disorders, and also a wide range of statewide and local disability rights advocacy groups said that the bill was needed because that thousands of children were being denied treatment for services they had a right to have under their private health insurance or service plans. Supporters also claimed the issue was a major disability rights issue.

Two rallies in support of the bill were held on September 26 at the State Capitol and on September 30th at the Ed Roberts Campus in Berkeley.  Those rallies, attended by Senate President Pro Tem Steinberg and others can be viewed at:

September 26th Rally in Support of SB 946:  http://www.youtube.com/watch?v=x21OaMQvXCw
September 30th Rally in Support of SB 946:  http://www.youtube.com/watch?v=c5TtXj_jrCA

Opponents - including health insurance plans, said that the bill required behavioral treatments that are not medical and should be provided by the school districts or through community-based services  for persons with developmental disabilities funded through the 21 non-profit regional centers.  Some individuals and groups opposed the bill because it exempted those covered under the Medi-cal (Medicaid), Healthy Families programs and also those under the California Public Employees Retirement System (CALPERS).

COMPLETE TEXT OF GOVERNOR BROWN'S SIGNING STATEMENT

Here is the complete text of Governor Brown's statement after signing SB 946  [CDCAN Note: the official 1 page copy is attached to this CDCAN Report titled  "2011-10-09 - Jerry Brown - Signing message on SB 946.pdf".  It was sent out as a pdf document by the Governor's office as a pdf image file - meaning it cannot be viewed by people who are blind or sight impaired using a screen reading device.  To help them and others know what the wrote, I typed out the complete text below - Marty Omoto]

CDCAN SUMMARY OF BILL

SB 946 - AUTISM HEALTH INSURANCE MANDATE REFORM

AUTHOR: Senate President Pro Tem Darrell Steinberg (Democrat - Sacramento, 6th State Senate District)
CDCAN SUMMARY:

• Would require private health care service plans and health insurers to provide coverage for behavioral health treatment for pervasive developmental disorder or autism (PDD/A) from July 1, 2012, through July 1, 2014, with implementation that is consistent with existing state mental health parity law.
• Would provide that as of the date that proposed final rulemaking for essential health benefits is issued under the federal Patient Protection and Affordable Care Act (PPACA), the provisions in this bill would not require any benefits to be provided that exceed the essential health benefits, which all health plans and insurers would be required  to offer. If the federal rules are defined prior to July 1, 2014, then the provisions in this bill would sunset (end or be repealed) prior to that date. Additionally, these provisions in this bill may effectively sunset  earlier than July 1, 2014, since the Patient Protection Affordable Care Act essential health  benefits law would go into effect January 1, 2014.
• Would define "behavioral health treatment" as  professional services and treatment programs, including applied behavior analysis and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism and that are provided by licensed, unlicensed, or uncertified providers, as specified in the bill
• Would require the Department of Managed Health Care (DMHC) to establish the Autism Advisory Task Force and to submit a report to the Governor and the Legislature by December 31, 2012.
• Provisions of this bill would not apply to specialized health care service plans or insurance policies that do not deliver mental or behavioral health services and health plans or insurers that contract with the state's Medi-Cal (Medicaid) Program (Medi-Cal), Healthy Families Program (Healthy Families), and the California Public Employees' Retirement System (CalPERS).

PREVIOUS ACTION 09/16/2011: Sent to Governor.
LATEST ACTION 10/09/2011: SIGNED by Governor.
COPY OF BILL (AS SENT TO GOVERNOR) - HTML:  http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0901-0950/sb_946_bill_20110914_enrolled.html
COPY OF 32 PAGE BILL (AS SENT TO GOVERNOR) - PDF: http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0901-0950/sb_946_bill_20110914_enrolled.pdf
COPY OF GOVERNOR'S SIGNING MESSAGE: http://gov.ca.gov/docs/SB_946_Signing_Message.pdf
TEXT OF GOVERNOR'S SIGNING MESSAGE:

October 9, 2011

To the Members of the California State Senate:

I am signing Senate Bill 946.  It requires health plans and insurers to provide behavioral health treatments for individuals with autism and pervasive developmental disorder.  The new law is effective as of July 1, 2012, and expire July 1, 2014.

While this bill provides relief for families of autistic children and some clarity for health plans, insurers and providers, there are remaining questions about effectiveness, duration and the cost of the covered treatments that must be sorted out.

Under national health care reform, the federal government will establish "essential health benefits."  If the coverage established by this bill is not included as an essential benefit, the mandate of Senate Bill 946 will automatically expire.

The Institute of Medicine said in its recent report that the top priority in defining the essential health benefits is finding the right balance between making coverage available for people to get the care they need and doing so at a cost we can all afford.  The report also emphasized the need to distinguish services and treatments that are medical from those that are not.

There is still much work to be done.

Sincerely,
(signed)
Edmund G. Brown, Jr.

ASSEMBLY & STATE SENATE FINAL VOTE:
State Senate - Final Passage Vote 09/09/2011 by vote of 25 to 4..
Assembly - Final Passage Vote 09/09/2011 by vote of 52 to 21.
WHY THIS BILL SHOULD BE IMPORTANT TO YOU:  Impacts thousands of families with children with autism spectrum and related disorders who need access to behavioral intervention treatments for their children.  Also impacts State general fund spending for those services in the budgets of the Department of Developmental Services (through the 21 non-profit regional centers) and also school districts.   
CDCAN COMMENT:

• The bill was strongly supported by nearly every major statewide and national autism advocacy organizations, families and a wide range of disability advocacy groups (including CDCAN) who argued that behavioral intervention treatments are medical or health services that should be covered by health plans and health insurance as other treatments and services are and that denying such coverage harms their children at a crucial stage of lives - and is outright discrimination due to their disability.
• It was strongly opposed by private health insurance groups who argued that the bill would raise premiums for everyone in their plans - and also that behaviorial treatments should remain the responsibility of schools and the State funded programs for people with developmental disabilities coordinated through the 21 non-profit regional centers.   Some opposed the bill because it exempted persons who are covered under the Medi-Cal, Healthy Families programs and also those under the state retirement programs (California Public Employees Retirement System or CALPERS).
• However none of those persons covered under those programs would lose any existing services or nullify any settlemetns reached under those programs since the bill expressly states that its provisions does not cover those persons in those programs.

PRIORITY: VERY HIGH

File Attachments: 

2011-10-09 - Jerry Brown - Signing message on SB 946.pdf (277.36 KB)